Traditional Midwifery Education Classes

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Monday
Nov152010

Twins Born at Haiti Clinic, 11/2010

I was up early and went downstairs to have some tea and was laying in the hammock when Sherline came down and said there was a laboring woman at the Dome. Marie Antoinette was up at the clinic helping the woman get settled in and told Sherline to send for me. So although Melinda was going to be considered "first-on" that day I figured I was up so instead of waking her to do a labor assessment I thought I would go up there to check in. I knew Sabine had had a multip birth in the night so I went up to check on everyone. 

When I arrived I could see that the mom was in a good active labor (G4P2) - close contractions and vomiting - so I set up and settled in with Marie Antoinette and Sherline. It was about 6:15 a.m. at this point and the mom said that she had been in labor since 5 a.m. - so really not long at all.

Marie said she would like to catch the baby so I got her a pair of scrubs and put her in receiving position at the foot of the bed. I asked what she needed and Marie replied, "just to have you by my side." 

The birthing mom's Godmother was there and I could see that she had a knowledge of midwifery, an inherent skill and sense of the mom and baby and the process - she had that energy and wisdom of a wise woman about her. I found out that she had attended births as a midwife over the years. I liked her very much.

The birthing mom said that she had felt the baby move but not really that morning and I thought I would check for heart tones just for reference but I was having difficulty finding where to hear them best so I am gently palpating her belly in between a couple of contractions and it's was a bit confusing - feeling for sure there's a back here but there also seems to be a lot of "fullness" on the other side as well but doesn't seem posterior (you know, that train of midwifery thoughts and "hmmmmms..." that go through one's mind). 

I catch a bit of heart tone and it sounds good and labor is progressing really well so I just set back, get everything prepped and ready. I support the Mamma and Marie. Marie suggested to the mother to get off of her back and possibly walk or change position but the mother reported that she was shaking too much and couldn't do it. She had told Marie when she first arrived that this labor felt "strange", different from her other labors.

Sabine, who came up to check on her post partum mother, came in to help us out when she heard that the mother was pushing.

The mom starts pushing around 7:15 a.m. and it 's obvious progress but the baby isn't flying out, in fact, it's coming slow enough that I just consider the possibility of big shoulders (as the mom's belly was quite big) and then watch and observe. So slowly and beautifully a head emerges and after a couple of contractions and it rotates to an posterior position and comes out the rest of the way.....hmmmmm, I'm thinking, that sure is a small baby for a term gestation - a little baggy and wrinkly - possible IUGR - but it is a vigorous little baby and we put her on Mom's belly. It has a pretty short cord. She rests a moment and touches her babe when she seems to push again, or really, scrunch up her face as if she's getting an approaching contraction. Marie says, the placenta is coming and I think, "Gee, that's an awfully strong contraction for a placenta, and so soon after the baby!" 

So I look down and I see a bulging BOW and a head behind and I say, "that's not a placenta, that's another baby!"

Marie was really surprised and jumped back a little reporting later that she didn't know what was coming - at first she thought, placenta but then thought something "worse" but she looked into her heart and told herself she would not be afraid, she would not run away, she would stay and do her job. So as the baby emerged out gently, completely in the caul, I received that babe and laid it on the bed and then removed the membranes. This child was the most peaceful looking babe in the caul - you could see her perfectly and you could tell she was doing great. The baby was small enough that it did not break the amniotic sac at all on the way out and the baby was completely encased in the sac. It was like getting a peak into the womb. The placenta came with the baby. She barely bled at all, uterus was great, I had given her some Yunnan soon after the first babe came out just to be sure we didn't get an extra bleeding but her body was really doing all the right things.
Second baby was smaller but actually "pinked" up more quickly than the first although both babies were really quite vigorous! We got them to breast pretty quickly and it was bit of a juggle but it was also all so smooth. One couldn't have asked for a smoother twins birth. Both baby girls, fused placenta, two amniotic sacs, both head down, baby #1 5lbs and baby #2 just over 4 lbs, and both babies and mom were so strong!

Looking back at her chart I saw that her last baby died because it came prematurely....she said that she already had 2 boys at home and her family told her not to come home with anymore boys so she was pretty happy that she balanced everything out with 2 girls! She got an extra spirit to come back to her after the loss of one - it was all just really beautiful. Sherline reports that the mother told her after the babies were born that she had had a dream earlier the morning of the labor of two girls, her girls, playing outside of her home.

I asked the Godmother if she knew there were two babies because I could just see that wisdom in her being and she said that yes, she could tell but that she never said anything to the birthing mom because, as is tradition to Haitian culture, you don't tell a woman because you don't want her to be afraid.

I looked back at her prenatal chart and no one had ever suspected twins and she had been measuring appropriately and she went to term.

Anyway, there was never any hitches and after several hours everyone was ready to go home. We talked about keeping the babies warm, nursing them plenty, and having them sleep together. They were the most vigorous little babes I've seen who were that small. I never once doubted their strength, or moms, it was all flowing smoothly.

The babies are now 9 days post partum and came in for their first visit since the birth. Both babies have gained weight and are over their birth weights by about 300 grams. The mother has no complaints and her body feels good. She says she isn't too tired and finds that nursing two babies is not too difficult. Everyone who was at the birth reports feeling blessed and thankful to have been a part of this beautiful experience. One couldn't have asked for a more perfect birth to welcome the first set of twins to Mother Health International, Haiti!

Emily Baker, volunteer midwife



Thursday
Jul172008

Live from Haiti

Story by Clare Loprinzi

Haitian women move with strength and grace as they continue to work hard for dignity and empowerment. Last Friday we had a full day of prenatals here at the Jacmel, Haiti clinic. Ludnabert, a strong young woman came to the clinic in early labor. She walked and rested outside the yurt close to the outdoor prenatal area during the day with her beautiful mother staying close to her side. While I worked with woman after woman checking their babies and giving them the vitamins, I would go over and give her water and smile and check in with her. She was graceful in her movements and breathe. I was to find out later that she was a professional soccer player for Haiti. Toward the late afternoon we finished with all the women we were seeing, we being Marzia (a Sicilian midwife), Emily (CPM from Idaho), Melinda (CPM and full on volunteer midwife) and myself. Marzia and I decided to stay up to help Ludnabert birth.

As the night progressed I showed Ludnabert how to hang on the metal bars that support the dome. She and I would go into a full squat position and move back and forth. We moved together throughout the night, dancing and sitting back to back moving and breathing. The clinic uses a lot of dance movement as one of the Haitian assistant midwives, Marie Antoniette loves to dance (so do I ) with birth. Marie has created some lovely dance movements that we use.  In the center of the dome we have a nice counter that surrounds the supply area and we have made it a place where they can lean on to help with their dance movements. The night moved forward with lovely movement and smiles. Around ten pm. Ludnabert decided to lay down, contractions slowed down just a little but were strong. She was in control and moving her baby through her body. I checked how far she was progressing by palpating and massaging the muscles that connect to the uterine wall on the side. Feeling the baby’s shoulders and head ever so low down I knew she was close to full dilation. This is often a lovely time that the mom and baby rest between contractions before the baby births.  I decided to go and lay down on one of the beds to stretch my back and adjust my hips. Little did I know that within minutes I would fall asleep. Marzia was sitting by her side. I awoke to Marzia calling,” Clara, Clara” and realized that I had fallen asleep. I jumped up and went to Ludnabert but I could see that she was still resting between longer spaced contractions. I then went to the next birthing area and saw Marzia sitting there with another older woman. Marzia told me that she had just come, I must of fallen asleep for about 20 minutes (twenty rejuvenating minutes).

Eloufene, a 50 yr olf woman guesses her age from what was happening in history comes from a long line of Haitians. Eloufene was born at home in Jacmel, had all her babies at home, this birth was her 11th baby, some of her births she had done by herself. I could tell from the worried look on her face that she had some real concerns and hard life. I knew that we needed to know what was on her mind so with my creole being basic I asked an translator to come in. She told us that she was scared because of loosing three of her babies and that she was also concerned that this baby was a month early. I told her that I understood that she must be scarred but that this was her baby’s birthday. I put my hand on her belly and talked to the baby who responded to me. I then looked at her and with my eyes and then words told her that her baby had chosen to have this day as her birthday. I told her that her baby felt big and strong enough. I told her that my second child was a month early and was born at home and now he is a big strong doctor. I told her that although I could not promise her anything that I felt with all my heart that her baby was all good. She smiled a little at me and I asked her if we could all, her daughter, Marzia, her and I breathe some good breaths into this room full of love and if she would open up her legs and let her baby come. I talked to the baby and said the same and told her that when she was born that we would bring her right up to nurse from her mom and that she was safe with us.  Eloufeine said yes with a nod. We all breathed love into this area and she let this sweet baby girl be born in the sac of waters into the world. The baby was small and strong and went right up to her moms’ breast where she started after a few minutes to vigorously suck. Marzia stayed with Elofeine checked her hard uterus and smiled with her. I went back to be with Ludabert. I opened the sheet between the two of them and Ludnabert could see Eloufeine nursing her baby. They both smiled at each other.

Within a few hours Ludabert’s baby was ready to come into the world. Eloufeine and her sweet baby girl were nursing and resting. The baby had not yet made any noise other than the ferocious nursing she was doing. Ludabert was moaning and the baby was coming. As her sweet baby’s head came out we heard Eloufeine/’s baby make two sounds; veeni,veeni, so close to the ceole word come come. We all were filled with the amazing power of birth and love as Ludnabert’s baby girl entered the world.

As the early morning was coming and Marzia and I had finished cleaning up the clinic and were ready to come down to the house to sleep a little, we peeked in at the two moms with babies at breasts and smiled. We went back a few hours later to check on the women. Both were doing well. It was asked of Eloufeine, “Why did you travel two hours to come here to birth She said that she had heard of this clinic from other women in the country side. She said that it was told to her that we give good care to the women. She was so happy with her care. She said that we love the women here and we treat them with respect. She smiled. That late morning her family came to help her home. She walked proud out of the grounds of MHI. Two weeks later, she came back to a postnatal. You can the see the photos of the two women and their baby girls living side by side. She handed me a bag, it had two papayas and a jackfruit that she had carried the long distance. My heart was again filled with love. for this work that I am honored to do and for the resilience and strength of the Haitian women.

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