The Awkward Doula

I was given the very great honor of naming a baby this weekend. There are some littles out there with my name but this baby was a boy and I figured if this kiddo didn't want to be teased the rest of his childhood, I had better choose something a little more manly. So, I gave him my father's name and then told the mama that my daddy loved the Lord very much and that I hoped her son would grow to love the Lord as well. It was a very sweet conversation.  

This was an excellent end to a day that was just terribly confusing from the very start. I misread every single sign thrown at me by every single mama. Every. Single. One.

"So this woman isn't fully dilated??"

"Oh. So...she's only at four centimeters, huh?"

"Hmm. Well, that would explain why I've been waiting 2 hours for her to start to push."

....followed by much laughter and teasing from the midwife....

I had completely missed what she was telling me after the exam. In my defense, she was speaking a foreign language that I have not yet mastered.

-or-

"She's throwing up and hiccuping and holding her breath at the top of her contractions so I just know she's in transition!"

"What?! She's at 6 centimeters? That's all? Oh poor mama..." 

It's alright. I laughed at myself. In fact, I'm laughing right now. It's all pretty ridiculous. 

Something unusual happened though. Something that even the midwives couldn't have predicted. One mama delivered after a very difficult labor and then before she could deliver the placenta, her cervix just closed right back up. Just like that. They gave her a ton of oxytocin and brought the baby over to nurse, both to no avail. In the end she was taken to the OR where it was removed surgically. The bummer was that if they had any difficulty, they were going to do a full hysterectomy. I left before she returned so I don't know what the outcome was. 

Retained placentas are scary here. The women don't get the speedy emergency surgery that women in the States have access to. 

One mama waited hours for her operation (as is very common) and by the time they came for her, she was so weak and hypotensive that she could hardly speak. They made her stand and climb up onto the gurney that took her to the operating room. I wanted to stand right next to her in case she fell but I couldn't get around the bed to be close to her. So instead I did this half-help, half-awkward jerk over the bed to steady her wobbling body, all the while being very much in the way of the OR staff who'd come for her. Did I mention that I hit the OR nurse in the face with the IV tubing as I was trying to keep the mama from getting tangled? 

Oh well. What can I say? It was just an off day. 


On the bright side, this mama came through surgery and was awake enough to nurse when I carried her chunky (yes, sausage-legged) newborn to her!

O, For the Joy of It!

Culture stress is real. I'd heard about it before I came over here, to the far side of the world, but I didn't really consider how it would feel. I didn't count on it being so hard.

I was given some language and culture lessons upon my arrival but then was left to figure out a lot on my own. People have always been available to answer questions but there are days, even still, where I feel like I'm stumbling in the dark and offending, or in the very least, confusing everyone I come in contact with. For this girl, that is very distressing and it makes me want to stay indoors and browse facebook and look at pictures of the "comfortable" times. 

This however, is not constructive and will never lead me to learn anything or ever become confident in my new surroundings.

I'm ashamed to admit it but on my especially culturally-stressful days, I feel distrustful and self-protective. It's ugliness and I know it. I know it even as it's spilling forth from my heart.

Enter, the haus sik.

Talk about a place that breeds culture stress. Little to nothing is like the health facilities at home. From the lack of medical supplies and adequate staffing to the archaic methods and the practices dictated by centuries-old spiritual beliefs, it's a lot to take in, let alone process effectively. 

The ministry at the haus sik came along during a time when I was really wrestling with yet another change. I had just left a very, very busy job in an emergency room where I knew my job and I did it well. Above all, I Ioved the patient care and in the ER, I had a LOT of it. 

When I came to this little mission base, my work load diminished a great deal and patient care became a thing of the past and I grieved it - deeply. But, this was all a part of God's perfect plan to develop my trust and prune me; to make me more like His Son.

In my grieving I heard about the ministry at the haus sik and the opportunity to train as a doula. And if you've been following, you know the rest.

But this is what strikes me and leads me to stand in awe before the Lord...

I am at home in the haus sik. I walk into that ward and I feel this unbelievable sense of belonging. This doesn't make any logical sense which can mean only one thing - that it is a gracious gift from the Lord. He didn't owe it to me - in fact, He owes me nothing, but He gave from His love for me. 

In addition, something beautiful happens when I'm at the haus sik. I see these vulnerable women simply for who they are; mothers, sisters, wives. I don't know their pasts, how they behave around others or if they're honest and upstanding citizens. Suddenly, all of those things no longer matter. All I know is that they are in labor, in pain and need the comfort and emotional support of another. This just disintegrates all of that scary culture stress and leaves me marveling at the One who will glorify Himself regardless of anything I do or say and yet, He lets me be a part of what He's already doing among those mamas. It makes me want to jump up and down! It makes me want to sing at the top of my lungs for the joy of it! 

Those tender moments of comforting a woman or the sweet ones when presenting a newborn to the waiting family cause me to draw closer to the Creator who makes those things possible. How can I put into words His goodness?!    

I know that I have so much (SO MUCH) left to learn about my surroundings and the people that I live in community with and I wish I could say that I have embraced it all and loved everyone without question, but I can't. However, I can say with confidence that my Mighty God, my Gentle Shepherd, continues to lead me and loves me so deeply that He won't leave me where I am. And that is a great source of comfort.

  

Spit Out Your Gum and Don't be a Creeper!

A little nugget of wisdom... Don't chew gum and work with a mama at the same time. Unless you are extremely sanguine and relaxed. I popped a piece in one day and unbeknownst to me, I was chewing that stuff within an inch of its life. I'm surprised it didn't just disintegrate in my mouth! With each contraction, I chomped harder and faster until hours later, my jaw was crying for mercy. There are other means of obtaining minty-fresh breath. Just saying.

On another note, my doula friend is leaving me for another region. I'm sad. Don't get me wrong. I'm so excited for her and her family and where the Lord is leading them but my selfish side is just sad. She has been a tremendous encouragement to me as I've stepped out into the unknown and very unusual realm of labor and delivery. She has taught me so many valuable doula skills and opened the door for experience that I would never have gotten anywhere else and some really special relationships with the national staff at the hospital. But above all, she's taught me this tangible love of another and has demonstrated such grace and gentleness. 

Last week we were bent over in tears, laughing so hard at our awkwardness the last time we were in the ward together. A mama in transition was demonstrating none (and I mean NONE) of the usual signs of this very physically-taxing change in labor. She was up, walking, sipping on water and smiling like she'd just been told she'd scored the prize-winning hog. It was confusing for my friend and I who had been checking on her and monitoring her dilation all the way up to 10 cm. She had been quiet through the entire process and we praised her composure but now... Don't you wanna push mama? 

There were no other laboring women in the ward at the time and in our eagerness to see this thing through to the sweet end, we hovered. Yes. We were helicopter doulas and if this lady made the slightest sound or movement, we were there, offering water, a little massage or a word of encouragement. It was all well and good until she got up to go to the bathroom and we followed her. All you listening out there - if a woman is stable on her feet, shows no signs of pushing and for crying out loud, is smiling (!), let her have a minute alone to pee! 

My friend and I visited while we waited for her but little did we realize, we had followed her right up to the bathroom door and were blocking the poor lady's exit from the bathroom. When she opened the door, we had to move so she could get around us! But, as before, she was smiling and acting like delivering a baby was her usual Saturday activity. Bless her heart.

After that awkwardness, we backed off. I can't imagine that it makes a mama feel at ease when the doulas are acting like groupies. 

In the end, we needed to leave and she still hadn't delivered but I am confident that she did just fine without us. In fact, she was probably glad to have a little breathing room.

  
  

Baby by Vacuum?

Two words: Vacuum Extractor. Sound scary? Well it is. At least I think so. 

I had heard about this contraption and had even seen it sitting on its shiny metal cart, tucked away against the wall just waiting for its next victim. But I had never seen it in use...until this weekend.

Just the word "extract" sounds unnatural and painful - like what happens at the dentist when you have to get a tooth pulled. Or the machine in the Princess Bride that sucks the life out of people.

Well it is unnatural and it's the method by which the doctor "extracts" a baby who is stuck (for lack of a better word). I had visions of horrific events that precipitated the vacuum extractor's use and my overly active imagination was checked because I got to witness this first-hand just the other day and it wasn't the torture I had anticipated.

The mama in question had fully dilated but didn't have the urge to push. The baby's heart rate was climbing and it was in distress. The one doctor who was currently in the hospital and qualified to perform the extraction was finishing a C-section and wasn't available right away. 

Welp, that leaves one, very uncomfortable and increasingly more fearful mama and myself, the new doula, trying to keep mama at peace and somewhat comfortable while attempting to track what's happening as hospital staff communicate at warp speed in a foreign language.

Eventually the doctor arrived clad in rubber rain boots and a giant rubber apron. He opened a sterile tray and pulled out a metal cup-shaped device, about 3 inches across, with a little chain attached. Honestly, my first thought was, "Oh that looks like the thing that expresso grounds are packed into when you make those fancy lattes!" Leave it to me to be thinking about coffee at a time like that.

The doc put some cream into the metal cup, I assume to create a vacuum, and then put it up inside the mama and right onto the the baby's vertex. Then they plugged the contraption in, turned the suction on and told mama to push with her next contraction, whether she felt the urge or not. 

What was interesting (and hurt just to watch) was when the doctor put a pair of hemostats through the chain and pulled! *insert shudder*  Between the vacuum suction, the doctor pulling and the mama's contractions, out came a huge baby girl! 

This was a 41-week, first baby, born to a petite woman via vacuum extractor so she tore horribly and it took the nurse over an hour to get her stitched up. 

On the bright side, the baby was healthy and the mama was trying to hobble out to see family shortly thereafter. Have I mentioned how resilient these women are? 

So, thus ends my first experience with The Extractor. However unusual and painful it was, it turned out to be far less dramatic than my imagination had made it out to be. 

So glad. So very glad.

8 Pounds of Good News!

Imagine my surprise when I peeked through the curtain and saw a mama in the waiting area, legs splayed, puddle of water on the floor and the family rushing around her in excited concern.

I couldn't get out to her right away and neither could the midwives so her family took her into the closest room, the place where the midwives do paper work and drink tea. When I got there, the mama was squatting down pushing and her mother was right there preparing to catch her grandbaby! 

Unsure of what to do and not wanting to ask them to move, I just talked excitedly about the coming baby and for more details about what was going on.

Just when I was running out of things to ask, the midwife came in and rather abruptly told the mama to follow her to a bed. The mother's hands we wet with amniotic fluid so I showed her to a sink and while she washed, we visited.

She told me that this was her daughter's second child. Her first had been born at the hospital on a busy day when there wasn't enough staff and it had died. Oh how my heart went out for this mama! How she must be reliving that horrible day right at that moment! Her mother clutched my arm, looked into my eyes and pleaded with me to take care of her daughter.  

Oh sweet lady. Let me tell you about my Lord who already knows your daughter and loves her deeply. I wish I would've said these words out loud.

After showing the mother back out to the waiting area, I went over and stood with her daughter. Within a few moments, a big baby boy came splashing out into the cold room. It didn't seem to register for this mama that her child was here, alive and healthy. It wasn't until she put her hands on her baby that her face softened. I think it was then that she really saw him.

As my friend and I were leaving the ward, we passed the family, all anxiously awaiting any news of their daughter and sister. The mother jumped up and rushed over to me. "Has she had the baby? Is it alright? Is she alright?" The questions came in a hurry and I barely caught each one as my brain translated. I answered.

"She has delivered!"

"What is it??!"

"It's a boy!"

Then came all the hugs, the kisses, laughter and perhaps a little dancing! Any bystander may have thought we were apart of their family if my friend and I weren't so white!

We left laughing and praising God. 

The Miracle of Life!

I'd like to start with a shout out for the abdominal lift-pelvic tuck! A mama I worked with wasn't progressing very well and was getting really frustrated and vocal. The out-of-control kind of vocal. She was up and down off the bed which was wonderful so the next time she stood, I explained what I wanted her to do and tried to show her. She was so miserable and my explanation wasn't helping her understand. She also wasn't too keen on me pausing in the back rubbing to explain anything so the next time she contracted, I stood beside her, lifted her belly with my right arm and rubbed her back with my left. Because of my lifting, she naturally tilted her pelvis forward. It was great! We did this through two contractions. I can't imagine how awkward we looked. The pictures in books and online, show this gentle, supportive maneuver that generally doesn't involve any struggle or grunting from the doula. Oh well. I'm pretty convinced the abdominal lift is what kicked this mama's labor forward. She delivered an hour and a half later. Woop woop! 

I have never cried at a birth...until now. I've been wide-eyed or worried and of course, ALWAYS happy when each mama delivers and it truly is beautiful. Those who mock (generally guys) and mimic in a silly high voice about birth being "the miracle of life" have clearly missed something in their experiences with it, or have just missed out all together. It IS a miracle!

The other day, I was vigorously rubbing a mama's back and providing lots of counter-pressure. I was also giving LOTS of hip squeezes per her request. I'm telling you all of this to point out that I was pooped. My arms and back were protesting, along with my bladder. With promises to come back as fast as I could, I dashed away to the bathroom.

When I returned, I found her husband had sneaked in through the curtain on the side of the bed where he wouldn't be observed by any nurses or midwives and he was rubbing her back!! I gave him two thumbs up and promised not to give him away! 

Some minutes later, mama called for me. Maybe all those years of farm labor (don't laugh mom) have paid off because she wanted my firm massage. Her husband whispered very sweetly, "Good luck!" and sneaked back the way he came.

Some minutes after that, mama wanted to stand but was feeling dizzy so she put both arms around my neck, laid her head on my chest and hung with me supporting her. It is such a privilege to have a mama put her trust in me to hold her so closely during a time that she will never forget, like the birth of her child. Which is why it was so beautiful when she asked me to get her husband to come hold her in the same way. Again, I told no one and he held his wife while she moved into transition.

When it came time for her to push, he was kicked out and I took to her side again. When their daughter was born and bellowed out that lusty cry of a healthy baby, I peeked through the curtain and there was that great big man, sitting on a bench a few yards away, just crying like a fool. 

Mama let me carry their daughter out for him to see. I laid her in his arms and he just stared and sniffed and wiped the tears away and in a low voice whispered, "We were praying for a girl."

This is when I walked away and started crying. It was absolutely beautiful. I haven't seen anything quite like that here. The culture dictates that women who come to the haus sik labor almost alone and most husbands don't seem to take a tender interest in their wives. This was the exception and I was so pleased to step aside and let the husband comfort the wife. It was as it should be. 

Later on I headed over to check on mama and new baby and got more of their story. This was their first child. Due to medical issues, they weren't sure she would be able to carry to term. When they found out she was pregnant, they began praying for a girl (also counter-cultural) and so when she delivered a healthy baby and a girl nonetheless, they were over the moon. 

The couple insisted I take their phone number (oh alright, twist my arm) and I am excited to call them for a visit soon! Oh I love this work.    

   

Beginnings!

Where to begin... I’m new to this - new to it in every sense of the word. Until a month ago, I had never provided labor support to any human (cats and goats certainly don’t count) and being unmarried with no children, I have never experienced labor in all its particulars. As you can imagine, witnessing delivery for the first time was amazing…and eye opening. But I’ll get into that later.

I live in a third world country far from the comforts of sleep number beds and Starbucks or consistent water and power for that matter. My training and background work is medical but not in the realm of labor and delivery. Over two months ago, a dear friend of mine opened my eyes to the difficulty women here have when delivering their babies. Infant mortality rates are through the roof and mother mortality rates aren't pretty either. The records for this country don't take into account the deaths happening in the bush so I'll just tell you the broader picture. Every day worldwide, 32 thousand children under the age of five die. Every day, 800 women die from pregnancy and childbirth. Here, hospital care is meager and cleanliness standards are appalling. In our labor and delivery ward, there is one toilet for all the women. A couple of buckets are used between them all for pre-delivery “bathing” and the ward sports a whopping two (count them – two!) pillows that get moved around between the seven beds.

Not only is the environment rough, these ladies labor almost entirely alone! Family members aren't allowed to come into the ward with them. They are checked in by a nurse or midwife, given a bed and then left to themselves. A nurse or midwife is suppose to come around every 4 hours to check their progress but if the ward is busy or they are short staffed, that can drag out much longer. Only when a mama is ready to push (and I mean seriously you-can-see-the-baby’s-head push) does a nurse or midwife stay with them to catch the baby.

To be in excruciating pain, afraid and exhausted, without the support of a husband or mother or sister must be so incredibly lonely.

This is where my friend comes in. She has been providing doula support to these ladies for some months now but there are more than she can care for alone so she has trained me and one other to accompany her! I'm not paid for this special job but I've gotten to witness God's faithfulness again and again and that is abundant compensation for all the hard work.

I look forward to using this space to tell of my adventures, the heartache and the Father’s provision as I support and love on these special mamas.