bring back the basics of birthing
Just as we were leaving the clinic for the day, Jeba’s mother called to inform us that her daughter’s pain was "beshi beshi" and they were coming into the clinic. As usual it did not take long for Jeba to begin pushing. At that point things usually get a bit wild and crazy in the delivery room which results in the staff kicking everybody out. No men at all, unless they are doctors, are allowed in the birthing scene here anyway, even at home births. Jeba’s eyes were searching around the room. My guess is that she was looking for family. I insisted to the nurse that her family must be allowed to come in. The nurse brought Jeba’s sister in. The difference was amazing. It was still very intense and loud, but she was not alone. This was Jeba’s first baby and she was doing everything she could not to push. I could tell by the high pitched sounds and her trying to do anything to prevent more pressure. I was doing my best to be calm, gentle and reassuring. The nurse was doing the opposite: hitting, yelling and well just being mean.
I had one of those out of body moments. I could see the whole scene and I just felt useless. I so wanted Jeba to know that she deserved to be treated with respect and that she could say no or stop. It seems so out of control. Back to reality, I kept taking the nurses hands off of Jeba and I kept my voice calm. Her little boy arrived safely. Once the head was born, this tiny little baby slid into my hands. At that moment I love him. He was so tiny but so pink and lively.
Going to the home visit the next day, I was very anxious to check on this little bird baby. I was very happy to find that he was eating well and had not lost much weight. We visited about nutrition and I tried to persuade the grandmas to allow Jeba to drink something other than hot water. The subject of the bad man came up. (A little side note about Bengali… There are no gender specific pronouns. She, he and man can and are used for male and female). My Bengali is coming along but I could not quite make out who the “bad man” was. I asked them to speak slowly, and with my fellow midwife, Aporna’s, help it was discovered that the nurse was the bad man. I wish there were no “bad men” here. Yet, I was so happy to know that they saw how different it could be as they expressed how appreciative they were with how kind I was and that I was able to stop the “bad man.”
I hope that in the future that Jeba will remember that she is to be treated with respect and can ask for it.
Smoke is choking everyone in the room but we would all rather be with a fire than without. One midwife is holding a blanket over the fire to heat it for the baby that will soon receive the shock of being welcomed by a cold mountain morning. Before the morning dawned, I awoke to a man's voice yelling from below. I woke one of the midwives and we went downstairs. Stars were still shining brightly across the sky, they had traveled over one hour to reach the health post (they being a husband, wife and mother in law), the wife not being far off from delivering her baby. She is taken into the birth room where the bed made of wooden boards is so high that she walks up a ladder to get on to it. While we do an initial examination the others are outside preparing a fire to be brought into the room. She is completely dilated; so we wait until she feels the urge to push. The fire is brought into the room on a metal plate. Down off the bed she comes and sits by the fire to get warm. Then she leaves to go to the toilet, the space outside between the main clinic and the birth room. I almost followed thinking if her water breaks, the baby is is coming right after. I didn't follow but when she came back in, the next contraction her water broke, almost putting out the fire. The tiny woman climbed back up the ladder and immediately went into a squatting position. One midwife is hurrying to put on gloves and the other is heating a blanket by the fire. Concerned that the baby might come out in one push, I use the petticoat the mom is wearing to prevent the baby from falling into the placenta bowl. The little one arrives and is greeted by a chilly morning, smoke and a very happy mother.
In the days leading up to the birth of her baby, Helana frequented the clinic and dear Aporna was busier than usual. Helana was pregnant for the 4th time and had given birth three times. However, she had only seen one daughter alive. Here in Bangladesh, when taking a history of the previous pregnancies, more often than not the mother has lost at least one child. Due to this, Helana was greatly concerned, as any mother would be, about the little one she was carrying. Gratefully we were always able to reassure her that her baby sounded well and that all was going as it should.
We discussed this patient with Dr. K and due to the stillbirths she had had and her borderline low hemoglobin levels she needed to come to the clinic to deliver. Thank goodness she did.
The morning finally arrived and Helana made it into the clinic. What a joy that the day was finally here. Her blood pressure was through the roof and it took a bit to calm her down. Like many women here, she is one tough little lady and once she got settled she handled labor very well. As the clinic staff isn't used to monitoring fetal heart rates and such, we, the Proshanti staff, stay close by and make sure everything is alright. When it came to pushing it was lovely to be able to let Helana hear her baby's heart beat between contractions so she would know that her baby was fine. Out came a lovely little girl and as pink and perfect as ever.
All was well and the grandmas were very attentive to the lovely little lady. As we went back to attending to the mother, it was clear her uterus had had enough and wanted to be done for the evening. Her hemorrhage was quickly managed and taken under control. However, two hours later it picked up and again with the proper medication stopped rather quickly.
I really can't imagine what on earth would have happened if they hadn't come into the clinic. Well I can actually, and it happens all too often here. Where they were just stories or birth statistics before to me, they certainly are not now. I have seen the motherless babies and heard the tragic stories from families that are now incomplete. It seems unreal that a place like this exists.
With all of the problems and all of people here, it seems overwhelming to try to make a difference. The moments of proud mothers coming and showing off their babies to us in the months and years following their time with Proshanti makes resolving the world’s problems seem possible.
I tried not to give to many birthy details. Even my family has told me not to talk about work at the dinner table as not everyone is as fond of placentas as I am.