The De-Mystification of Pushin' One Out
Hola amigas y familia. This is your trusty ol' Claire Campbell. I am in Cusco, Peru from Jan. 9 thru Feb 18, 2009. I am living in a house with 25 people, all studying to be midwives or doulas. This blog chronicles my time here. As I am studying and participtaing in childbirth, my time has been very emotional, beautiful, vivid and at times grotesque. The details are revealed here in writing and pictures, so you have been thusly warned. It is a very long, strange dream.
Thursday, February 5, 2009
I went on shift at the hospital yesterday at 8pm. Only one woman in labor, Marina, and many students present so Adrienne and I sat on an empty bed and played a really good game of Scrabble during which I spelled such words as "wonton" "squaw" and "helix". I got all the big money letters and both blanks.
Another woman came in and within an hour she was ready to push and the OB asked Adrienne ot deliver the baby and asked me to stay behind and watch over Marina.
Everyone left the room, so I turned off the lights and let Marina labor in peace. She told me her side was hurting so I applied pressure during contractions. I gave her some water and a piece of candy.
At some point a few students came back in along with a new laboring woman, Gloria. She was 17 and had given birth by cesarean 2 years ago. She was clearly in active labor and was moaning and crying and gripping the metal bedframe. She kept passing out and the technica would wave a cotton ball covered in alcohol under her nose. That really works, by the way.
Gloria also progresses very quickly. At some point the OB, Antonietta, asked if I would like to ATTEND Gloria´s birth. My Spanish is muy mal, so I thought she was asking if I would like to WATCH the birth. I said, "Sure, okay." Then I went back to supporting Marina. They were walking Gloria to the delivery room as I was walking Marina to the bathroom. I was getting Marina back into bed when a nurse poked her head into the door and said, "Clara, rapido!!!" I told Marina I´d be back in a minute and went to watch Goria´s birth.
Antonitta is one of the relatively patient obstetricas. She performs less episiotomies and will allow a few minutes longer before the cord gets cut. And she doesn´t physically pull on the placenta to come out.
So, I walked into the deliveria and everyone was bustling around like crazy. Antonitta pointed to a green doctors surgical gown. I said, "Para ti¨", I thought she needed help putting it on since she was already gloved. She said, "No, para TI!" My brain said "Hmmm." I put the gown on. Then she tossed a pkg of sterile gloves on the table and motioned for me to put them on. And then my brain said, "Wait just a minute..." And then I realized I was about to deliver a baby.
I put on the gloves and everybody kept having to remind me to clasp my hands together so I wouldn´t touch anything unsterile. I was standing between Gloria's legs. She was on the table already in stirrups. She was in between contractions, and the silence felt kinda akward, so I thought I´d introduce myself. SO, I did. She said, "Mucho gusto" and had a really hard contraction with pushing.
A few more contractions and when I reached a finger into her vagina I could feel the head. Antonietta, was explaining things ot the students. I was mentally psyching myself up and breathing very consciously. At some point I farted and everyone giggled and then went on listening to Antonietta.
Gloria had a few more contractions and I could see the top of the baby's head. Antonietta handed me a huge piece of gauze and put it and my hand up to Gloria's perinium. I held pressure there and on the next contraction the baby's head totally crowned and began coming out. Antonitta reached around me and pulled Gloria's vagina around the head, which is a peculiar thing that they do here to speed the delivery of the head. Then all of a sudden the baby slid out into my hands all covered in blood and dark bluish purple. I held the baby up and said "Gloria, es tu bebe!!! Es perfecto." The baby made a bit of a coughing sound. Antonietta asked me to lay the baby on the tiny table covered in green cloth. EVeryone got quiet, listening, and then the baby coughed and began wiggling and crying! Yea! In my excitement I had forgotten to see if the baby was a boy or girl. Antonietta held the baby up with its genitals facing Gloria and said "Es una mujer!!!" Which means "It is a girl". Then she laid her back on the table. I clamped and cut the cord and the baby was whisked away to be weighed and checked.
Very shortly thereafter, I saw the umbilical cord elongate out of Gloria's vagina. The placenta was detaching. At one point I felt it in her vagina and Antonietta asked me to gently pull on the cord to get it out (this is safe if the placenta is already detached). Out is came, steaming. I held it in my hands and twirled it around as some membrane was still inside the vagina. There was one long string of membrane that had not yet come out of the uterus but was still attached ot the placenta. While one of the nurses massaged Gloria´s uterus I gently kept twirling and lowering the placenta and final the string of membrane slipped out. We examined the placenta to make sure all the membranes and cotyledons were intact and present (the uterus can become infected or leak blood if any prt of the placenta is not birthed/removed). Everything looked great and Gloria donated the placenta ot our class for examination. I put it in a tupperware salad container.
Next, Antonitta asked me if I knew how to suture. I said yes, a little. She said that was okay and gave me new gloves. Antonietta sutured internally, horizontal tissue, then vertical, then right under the skin, and then let me do the last to sutures of the actual skin. By this time the lidocaine had worn off and Gloria was moaning and her legs were shaking and my hands were shaking like crazy. Antonietta was very helpful and I got finished as fast as I could and said "pardon" alot.
They brought ina gurney and we all helped Gloria onto it. Then she was wheeled into the next room. I took her blood pressure and the brought in her baby. I handed out candy to everybody and couldn´t stop smiling. Then Adrienne and I packed up and went home. In bed at 3 AM.
Today in class I told this story and everybody gloved up and examined Gloria's placenta.
Cutting Egyptian Mythology class right now to write this. Yea!
Tuesday, February 3, 2009
I spent my 32nd birthday mostly on the toilet, or in bed thinking about being on the toilet, or thinking about the hamburger that started it all.
Liz Stein (a fellow Athens, Georgian) and I went to downtown Cusco to trapse around and shop and eat. We found an Irish pub with WiFi. It has THE cleanest bathrooms I have EVER seen in Peru and now I canÕt remember its name. But, I know it is near the infamous 12-sided stone.
Anyhow, at teh pub I got te` negra (black tea) and I called Page on Skype. She regaled me with info about our band and also about her love interest who I will be torturously grilling and inspecting when I return stateside... be warned! Then we went around the corner to a restaurant that serves typical Andean food, except I really wanted the hamburguesa royal. It tasted kinda sweet for some reason. Then we went to a dance-off at the Teatro Cultural. Lots of youth dance teams dressed in crazy, superhero-like outfits performing to loud souped-up Andean disco music. I have a video I'll post so you can see what I mean.
Then we slept at Liz's hostel in San Blas.
In the morning I woke up and nearly puked on her. Happy Birthday. Then we took a cab to the casa for class. But....
I spent the next two days in bed, eating and drinking mostly nothing, yet stuff continued to leave my body. At one point it left my body from both ends at the same time. Has this ever happened to you? It feels like you are dying. I was certain I was going to die. In two days my lips got awfully chapped, my eyes and cheeks sunk in a bit, everything hurt, I couldn't walk 10 ft without having to sit down and catch my breath. Ew. Brooke brought me a coke and saltines. Liz brought me a giant chocolate bonbon. Adrienne came and sang "Happy Barf-day to you". Finally I sent Liz out to buy Cepro.
On the 3rd day things had, shall we say, dried up a bit. But I still took one Cepro and have the rest of the pack handy just in case.
CEPRO is one of the strongest antibiotics you can buy. I am a proponent of self-medicating via research, but in Peru you can really take it to a whole new level. You can get mostly anything you want without a prescription here. You just tell the farmacia what you want (antibiotics, muscle relaxers, lidocane, sleeping pills, etc) and they give it to you no questions asked. Anyhow, I wanted Cepro. It is the strongest. It kills everything from anthrax to the clap. Seriously. It is good to have around, but NOT good to take unless you really need it as it is hell on the kidneys and liver. I theorized that I am naturally a scrawny lass, thus I cannot afford to really go more than two days without food and drink, and I warranted that if by the morning of Day 3 I was not completely well, I would pop a Cepro. So I did. We'll see how it goes. I am aware that you are supposed to take the entire recommended doses, but Cepro scares me a bit, so I have only taken one. If I get sick again then I'll take the whole schedule of doses. I promise. Or maybe I'll go to a clinic and actually get diagnosed.
I am sitting outside Liz's hostel room right now. It is beautiful except for the three brokedown mattresses on top of the roof. There is a b&w cat on the roof, too. She is staring at me trying to decide if I am good company.
Saturday, January 31, 2009
I arrived on shift at 5 pm.
The nurse said, " Clara! Im so glad you are here. We have been so busy. Please check her tones." And she pointed to a young laboring mother in one of the four beds. There were two other women laboring as well.
I introduced myself to the mother and asked if I could listen to her baby's heartbeat. Her name was Placida. She said this was her first baby. We waited through a contraction, during which she stood on the floor and leaned over the bed, breathing while I rubbed her lower back.
Placida laid back down and I put the doppler on her belly. I moved it around for about 3 minutes. I tried all the places I knew a heartbeat could hide, but nothing.
I crossed my fingers that I was doing something incorrectly, or that the machine was malfunctioning. I said to the nurse, "Amiga, no escucho los tonas." The nurse sighed and left her paperwork. She tried for several minutes, but likewise could not hear a heartbeat. I apologized to Placida for so much interference with her labor, as it is difficult to concentrate thru contractions when people are pressing on your belly.
The obstetrica came in, could not find a heartbeat, and asked for another machine. The nurse wheeled over another machine, and still no heartbeat. At this point all of us became very concerned, especially Placida. Her eyes kept getting wider and she was trying hard to listen to the nurses through her contractions. The OB asked her if she could feel her baby moving and she said "Si". Not knowing what else to do, and I guess not wanting to call the doctor, the OB put a metal bedpan underneath her, inserted a long thin tool into her vagina, and ruptured Placida's membranes (i.e. broke her water). I could not stop myself from gasping. I know I am supposed to keep a poker face, or at least be optimistic, but what flowed out of this mother was dark, greenish-black, thick meconium laced amniotic fluid.
A baby's first feces are called "meconium". When babies are in distress they will often defecate while still in utero. Depending on the amount of meconium, the amniotic fluid can become a very thick, greenish substance. It can be very harmful if aspirated into a baby's lungs.
This was the first time I'd seen such a bad case of meconium. And I think I must have gasped or else someone gasped, and I heard the OB sort of give a quick knowing moan. Immediately the mother knew something was wrong and began crying and shaking. The OB kept trying to check for the baby's heartbeat, and at one point landed on 125 bpms for about 3 seconds, but then it faded away.
Soon after, the doctor came in and led the woman to the ectografia room, which is where ultrasounds are performed. I followed, as did one of the nurses. The doctor sat her on an examination table and moved the wand across her belly. The room was very quiet except for Placida's breathing through contractions. The doctor began to talk and say something about malformation and it turned out the umbilical cord had been wrapped around the baby's neck 3 times. He told her that her baby was dead.
I have never, ever, ever, ever seen someone scream the way Placida screamed. She sat up on the table and screamed and cried and moaned and berated the doctor and the nurses. The doctor told her to calm down and breath (which made me want to punch him in the face). One of the nurses tried to embrace her and hold her still. I just stood there and watched. I had just met this woman 30 minutes ago and now here I am suddenly witness to the most awful moment of her entire life. I knew she did not want to be held or comforted. I knew she wanted to tear the place to pieces. Finally the doctor and nurses let her be, and she just sat there screaming and crying. She was holding on to one of the leg stirrups and violently rocking it back and forth. I hoped she would break it. At some point her husband came in. He did not go to Placida. He stood across form the doctor and demanded to know why this had happened. His fists were clenched at his sides.
Everyday for the past 3 days, he and Placida had come in to the hospital because she had felt something strange. They had been told it was just nervousness and had not been given an ultrasound. They were told "Everything is fine. Go home." And on this 3rd day she had finally dilated enough to be admitted. At some point during her labor the obstetric unit became very busy with deliveries and they stopped checking Placida's vitals, and so they missed the fact that her baby was in distress.
Literally, the doctors excuse was that they were "too busy" That's it.
For some reason, we all went back to the dilation room where the other two women were still laboring. Placida's entire family came in, as did all the nurses, obstetricas and several doctors. They yelled and argued. The doctor started shuffling thru paperwork to find out when the baby's heartbeat was last on record, to find out who to blame. Basically, no one had checked her for about 6 hours. They saw that she was having contractions and assumed all was well. They doctor basically forced Placida's husband into signing a waiver and then, instead of letting her deliver naturally, he sent her for a cesarean.
I followed as they wheeled Placida's gurney across the hospital yard, down the winding sidewalks towards surgeria. Her family surrounded te gurney and her cousin peppered her with questions while videotaping the whole thing. The staff did not allow any of her family to attend surgery. In fact, they had to bar the door as her family kept trying to barge in with the camera. The doctor who took her ultrasound would be performing the surgery. I asked him if I could observe. He shook his finger at me and said no. I turned around so he could get dressed in green scrubs. He walked past me into the hallway and stopped. His head was down. I put my hand on his shoulder and said, "Doctor?" He looked at me very sadly, took a deep breath and went to deliver Placidas baby.
I went out into the hallway and sat next to some of her family. I did not know what to say. They made phone calls and texted family members. I walked outside and cried and made my way across the grounds back to obstetrics.
I worked for a few more hours and went home.
I was on shift the next day and saw Placida sleeping in the maternidad. I wanted to tell her how much I was thinking of her, but then I thought, she probably has no idea who I am. She only knew me for about an hour. I just happened to be the person who couldn´t find her baby´s heartbeat. Would my face even register? I don´t know.
I did not wake her. I think about her everyday.´
Thursday, January 29, 2009
Thanks to everyone for being so patient. I've been trying to process through my time here thus far, trying to decide what to write about, what you might want to know.
Below are some words, pictures and a few slide shows.
Here I go. Whew.
It is my 20th day in Cusco, Peru. I live in a large house called CASA DEL CONDOR. I am participtaing in a program from the Matrona School (based in Asheville, NC). My main instructor is Whappio Diane Pilgrim, a lay midwife with a head of spiked grey hair and arm tattoos. She practices a very holistic, hands-off approach to midwifery, but she also makes us study the hell out of all the clinical and anatomical aspects of childbirth. We are also instructed by two local midwives, Sunday & Christine.
We live at the top of a very busy street. There is the constant sound and smell of diesel trucks, construction, and taxi traffic. At the bottom of the hill, in the middle of the street, is a giant column atop which sits the statue of a condor, one of the icons of Peru. Across from our house the sidewalk is lined with car washers. They stand there all day with their buckets waiting for taxis to stop and get washed. It is very easy to tell a taxi driver how to find my house, I just say "Donde llavan los taxis", or "Where they wash the taxis".
Living with 25 people is very wild. In a short time, because of the intense work we are doing, we have become a very tight group. I have held an amiga while she collapsed and sobbed in the yard after an 18 hour hospital shift during which the woman she`d been attending was suddenly carted away for an "emergency" cesarean. She could do nothing to prevent it, was unallowed to attend, and had to listen to the woman crying out for her all the way down the hall. I have taken care of housemates while they were extremely sick with altitude, and likewise had folks take care of me last week when I was very ill with some kind of strange upper respiratory bug. We all share clothes, and I think I have seen just about everybody naked.
About thirty minutes ago I left "counsel" or "circle", which is when the entire house is called to meet on a specific matter. This was a long one. We sat in circle for almost 4 hours. There had been a giant indiscretion. One woman had slept with the husband of another woman last week. The husband and wife are local Peruvians, and the wife attends our classes. She was not present today. There was so much gossip and tension that Whappio cancelled class and called a circle. There were a lot of tears and questions and discussion of character, integrity, self-discipline, etc. It is difficult to explain, but basically it is like family. Each persons actions can have repercussions for the entire family, can create inner tensions, and can affect the family's reputation in the community. So, this is what we met to discuss.
Now back to the basics. Our house has beautiful adobe handiwork, lots of plants, lots of different paint colors, many windows, decorations, altars, and no closets or storage space. We do our laundry in buckets outside. We have one small kitchen in our house. We drink only distilled water so as not to get parasites from the tap. We do not have an oven, only a tiny gas stove with two burners. Once a day, Abbey or Llana (fellow students) cook a meal for the entire house. There is a tiny, old Peruvian woman who comes and cleans the house Mon-Fri. This takes her about 4 hours as there are 7 bathrooms, as many bedrooms, and 3 common areas. I live in a room with 4 other women. We each have an uncomfortable lumpy mattress pallet on the floor.
The only hot water in the house comes from bath showers. And there are only two showers in the house with working hot water heaters. Ours is one of them, so we have a lot of wet foot traffic. In Peru, most houses do NOT have hot water. And if you do have it, the water is heated at the moment it passes thru an electric shower head. In order to get the water hot, you must keep the pressure very, very low so that the water has enough time to be heated as it passes thru. So, basically, I am showering in a warm trickle. And if I try to change the temp or pressure, when I touch the handle I complete the circuit and endure a low, consistent shock of electricity. Ugh.
Everyday we have class in the two common spaces. Classes are from 9am - 12pm, one hour for lunch, and then more class from 1-4pm. And sometimes there is class in the evening as well. The class subjects are: Quantum Midwifery, Clinical Skills (suturing, vaginal exams, palpation, etc), Medical Astrology, Egyptian Alchemy & Herbology, Qigong Technique for DMT Release, Fertility Awareness (family planning, ovulens, etc), Holistic Sexuality (cosmic orgasm, tantra, etc), Woundology, Rank, Power & Priviledge, and Mayan Massage. I realize this sounds like a bunch of metaphysical, hippie shit, but I promise all of it is based in biology, chemistry, ancient history, anatomy, quantum physics, the medical sciences and is corroborated by the empirical evidence of my teachers and classmates. And, yeah, we get "deep" and talk about our feelings, god, the universe, energy and the many other things that cannot be measured so easily by scientists.
AND... once a week it is mandatory that we attend a Birth Circle. I am very glad for these, as what we learn in class and what we are seeing and experiencing in public, Peruvian hospitals... well, these are very different things. On the one hand we are studying birth as a holy rite of passage, and then we go on a 12 hour hospital shift to see women rushed through their labors with pitocin, paid no attention by the staff, told to lay down and be quiet, routinely given episiotomies for no reason, stitched up for 2 hours with no pain medicine by obstetric students who have never sutured anything EVER, given cesareans because some doctor put his fist to her vagina and decided her pelvis was too small, cathaterized by a tube that touched the doctors clothing, the bedsheets, and even the floor before it was inserted roughly by an untrained hand, and a dead baby put in a bed pan and stuck on a shelf in the maintenance closet until someone could deal with it.
If you ever get really sick in Peru, I would suggest spending your life savings to get airlifted back to the states. Otherwise, there is a HIGH chance you will leave the hospital sicker than you arrived. In the maternity ward, all the women are given water to drink out of the same cup. This means, if the woman next to you has Hepatitis, it's your lucky day! There is only one technica (orderly) on staff at any time, and so this one woman must maintain the cleanliness of the entire obstetric ward, which is physically impossible. So, there are random open trashcans full of used gloves and masks floating in a pool of placentas, urine, feces and amniotic fluid. Sterility is virtually non-existent. Yes, the doctor will put on a sterile glove before a vaginal exam, but how many things will he/she then touch before the actual vagina? Lots. The technica does NOT wear gloves when she handles bodily fluids. Bedsheets are rarely changed, even if they are bloody. Many of the sinks have posters describing the importance of soap and hot water, but most of the sinks have neither soap or hot water.
BIRTH AT A PERUVIAN HOSPITAL
Here, as in the states, birth is not a natural rite of passage, it is an emergency. Laboring women are put on a timeline. After 4 centimeters, they are expected to dilate one centimeter every hour. If they do not, then they are given pitocin (a synthesized version of oxytocin), which produces faster, larger, and much more painful contractions... but does not necessarily dilate the cervix. If this does not work, her amniotic sac is forcibly broken. If this does not work her labor will be augmented with more pitocin, sometimes combined with a narcotic to help her relax. It would seem quite obvious to me that relaxing through a pitcocin induced contraction would be impossible, since your entire being lays in fear of how painful the next one will be.
Anyhow, so more narcotics, more pitocin, more narcotics, more pitocin. All during this, there are doctors and obstetrical students talking, laughing, listening to the radio, dancing, throwing things, watching TV, paying no attention to the laboring woman, yet in every way distracting her from concentrating on her labor. People lay their purses and charts on her bed. If she cries out or sobs she is told to calm down and breathe. Once in awhile she will receive a long, painful palpation or vaginal check from the doctor.
When she has reached 10cm, they consider her "complete". She is then moved to the delivery room, put on her back in stirrups and encouraged to push whether or not she actually has the urge. The doctor will generally have her gloved fingers inside the mother, moving all around the vagina. And generally someone is bearing down on the mothers stomach with their elbow. And the doctor and obstetric students are paying no attention to the mothers cries and whimpers and are laughing and gossipping with each other. Once the baby's head is in the vaginal canal, the mother's perinium is usually cut with sissors, and she pushes the baby out. Immediately, and while the umbilical cord is still pulsing with blood, the cord is clamped and cut, and about 20 seconds after she delivers her baby, the mother watches as the baby is taken away, oftentimes without even knowing if the baby was born a boy or girl, dead or alive.
After this, she will lie almost completely naked in stirrups in a room with no heat and several different obstetric students will take their turn sewing up her unnecessay episiotomy, taking out the stitches, and resewing it. They will start this suturing by administering lidocaine, but this will wear off about 30 minutes later. So, she will spend the next 90 minutes enduring what amounts to torture. At some point the doctor will take over and actually stitch her up for good. She will then be moved to the recovery room where there is a tiny old heater with on working coil. At some point she will be given her baby and can try to breast feed for awhile. Then she will be moved to the maternity ward to sleep.
If she did not deliver within 24 hours of her water being broken, she will be given a cesarean.
I realize there are some burning questions which haven't been answered yet. I promise to attend to the following in my next post:
1) If the hospital sucks so bad, why are you there?!?!?!?
2) What is it exactly that you do at the hospital?
3) What weird stuff have you seen during births?
4) Have you taken San Pedro or Ayhuasca?
5) How are Peruvian men on the dancefloor?
In the meantime, here are some pictures of my travels in the Sacred Valley and in Cusco...