La tercera semana/The third week Part II

Saturday, June 19
I entered Saturday with the feeling that there would be two to three births during my shift. I shared this with one of the other students who felt this, as well. Not only were there two births and a woman in labor, but also lots of citas! We filled up almost an entire page of prenatal, postpartum, and initial citas, which made for a busy day indeed. I did two prenatal citas and my first initial ever. I had been avoiding initials because I was scared of speaking Spanish for two to three hours straight and giving a bad impression of Maternidad to a newcomer. One of the students encouraged me to take the initial, though, and told me that I would have to get over my fears at some point. Fortunately, the couple spoke both Spanish and English and said we could speak in English. I was so thankful! An initial is full of questions about family medical history, pregnancy history, use of birth control, and other personal information and my main fear was not understanding information that is important for Maternidad to know. The initial took a pretty long time - 3 hours or so - after also doing the woman's first prenatal cita and drawing her blood (I have to get a student to do this) and I was pretty drained afterward. I took another prenatal cita after the initial and was thankful that one of the students was looking out for me and told me she would take the next prenatal after that so that I could take a break. I was so grateful and appreciated the level of awareness students have of one another. I learned how to write up lab work and spin the blood to separate the blood and plasma while I was back at the midwives' table and finished looking through the women's charts. Overall, I was getting more and more accurate readings of blood pressure and fetal heart tones that matched up with the midwife checking the citas. I was still having some trouble with fundal height (measurement from the pelvic bone to the highest point of la matriz - uterus), though, and find that palpating and measuring the belly takes a great deal of practice and experience.

During the afternoon and early evening, I helped translate at a postpartum cita and clean up the clinic before it was time to make dinner and have some down time. There was some nice calm before the storm in the evening and all of the students and I sat in the sala talking about relationships and the transformation journey of being a student at MLL. One of the students said that time here was 50% midwifery studies and 50% inner journey. This mirrored many of my sentiments. A woman came in at 9:30pm for a labor check and would return two hours later to labor and give birth. I was up to be shadow primary with one of the students and had only been lying down for thirty minutes when it was time for me to meet the woman and begin labor sitting. Little did I know I was about to provide and experience a level of labor support I never had before. This was to be the woman's eighth child, but she told me this (el trabajo de parto) was her least favorite part of having children. One of her daughters was with us the entire time sleeping on the bed in the rose room. The woman was active throughout the process and wanted to stand up, sit in the rocking chair, lie in a semi-sitting position on the bed, and walk around a lot. Her husband did not arrive until two hours later and I served as her main source of labor support. At first, I applied counterpressure to her lower back, along with a hot compress, but as the active stage of her labor progressed and we became more comfortable with one another, the level of support heightened. As I stood behind her, she rested her head on my shoulder and we were cheek to cheek. We swayed through the contractions together as she held my left hand and I wrapped my right arm around the front of her shoulders. As she moved into a position on the bed, she rested her feet on the other student's knees and I sat next to her holding her hand. She kept rubbing my hand in a downwards motion on her belly and silently told me she wanted me to massage her belly through the contractions. With the lights low and Mexican music playing, the level of intimacy and trust was palpable. When her husband arrived, he joined the support team and we left them for a few minutes to have some time together. It wasn't long after we returned that she gave birth (she knew exactly when to switch from the rocking chair back to her semi-sitting position on the bed) extremely fast. Once my right leg was baptized (more MLL lingo for when water breaks on you), the head began emerging and I barely had time to call birth team and get the licensed midwife before the baby was born at 3:32am. The woman was relieved and happy and her daughter woke up immediately to meet her new sister. Can't say she enjoyed seeing the placenta, though! Because it's so crucial for the woman to eat after giving birth and before she gets up to use the bathroom (so she doesn't faint from the blood loss), her husband offered to buy everyone Whataburger (Texas hamburger chain that's open 24 hours). I had been craving a hamburger and was pumped! It's strange the kinds of cravings you get being up for 24 hours. Once vitals were checked and we removed some of the new laundry to be done, we began filling out some paperwork before checking in on her again.

Her husband returned pretty fast with the Whataburger and I was salivating. Another woman was in labor in the purple room and soon after I had placed the delicious smelling hamburgers and fries (and huge Cokes) on the midwives' table, another woman was outside doubled over on the stairs looking like she was about to give birth right then and there. I immediately got the midwife again and she and another student brought her into the front cita area as quickly as possible. I prepared the peach room with the student who had been at the birth with me and when we returned in just a few minutes, she had already given birth. The baby looked a bit blue and had to be resuscitated, but he ended up being just fine. This woman was a sixth timer and had five girls before having this boy. By this point, the laundry was piling up and I needed to treat some of it outside. All I wanted was my Whataburger and I was surprised how unaffected I was cleaning off blood and poop stains and then eating inside. It was about 5:30am now and my stomach wasn't too pleased with all the greasy food I had put on it. I continued checking in on the woman who's birth I had attended with the other student and we went through paperwork, making the patitas (footprints), and the newborn screening (I held the baby as her foot was pricked for blood samples that are sent off to check for 26 diseases/infections). Everyone was sleeping but the woman, but she looked pretty exhausted. We were in and out for the rest of the shift and I did not leave the center until 9:30am. I had never been up for the entire night on a shift and was definitely feeling tired and emotional.

Sunday, June 20
No matter how many shifts I do, it's always hard to transition from the birth center to the casita again. Especially during a shift full of so many experiences, insights, and emotions, it's hard (at least for me) to come back to the casita and not have someone outside of the experience with whom I can process the day. I was, therefore, extremely happy when my friend arrived and we were able to enjoy the day and following morning together. We went to Mercado Mayapan for licuados, burritos, and tostadas, looked around at the exhibits on the history of the Chicana/o movement in El Paso and the maquiladoras (factories), the birth center and school (she understood what I meant about the energy there), downtown El Paso, and the scenic overlook where I took the pictures you have seen on this page. We enjoyed a beer together outside the casita, which was the perfect preparation for an early bedtime. We spent a leisurely morning enjoying fried eggs, toast, and fruit before heading to Kinley's Coffee Shop (local place) for a little while. I had to leave for my First Stage of Labor class at 1pm but was thankful for her presence and realized how much better I do living with another person. While living alone has impelled me to do so much more for myself and learn how to balance that with work, I have realized that I enjoy living in partnership more and that this allows me to respond to the communicative, sharing part of myself. The next time I write I'll be back in Charlotte for the week in between the June and July sessions. Thank you all again for your continued support through cards, emails, packages, and phone calls. I am so grateful and couldn't do it without you!

La tercera semana/The third week Part I

Sorry I am so delayed in both composing and sending out my third week post! I spent Sunday showing my friend from UNC, Molly, around El Paso and the birth center/school. It was so wonderful to have someone to process my Saturday shift with because it was both busy and incredible on a lot of different levels. We had a fulfilling time chatting and seeing some sights around El Paso together. With class and grocery shopping Monday and my fifth shift this Tuesday, there hasn't been much time to write! It is strange to write last week's post right now since I have already seen and learned so much this week. Every shift brings a new skill, insight, or discovery, yet time blurs and becomes so fluid that it becomes difficult to distinguish the shifts, citas, and births. I began feeling far more integrated into life in El Paso and at the birth center last week, though, and various realizations and experiences that I will always treasure and cherish. I also conducted my first two interviews, which was very exciting! I've included some pictures of the peach room of the birth center (the smallest, but with the most natural light and connected to the bathroom with the tub for water births), my dog neighbors (Kaiser - the big one and Babushka, the Pomeranian), my student midwife ID card (I love that it says student midwife), the kitchen at MLL (we spend lots of time there making delicious meals and getting water for citas), Mesilla, NM, and from the scenic overlook near the casita where you can see la frontera and into Mexico for miles. ¡Que disfruten!/Enjoy!

Tuesday, June 15

I was finally able to get a good night's sleep before my third shift at MLL on Tuesday. Probably due to nerves and the newness of my schedule, I hadn't slept great for the first two shifts and was grateful to rest well before this one. It was a busy morning all the way up until Birth Talks began at 1pm. It wasn't extremely crowded at first, but around 10 or 10:30, the sala was hopping. It had to be divided so that we could take more and more citas. Despite the high volume, I noticed how I was becoming more comfortable with finding heart tones, taking blood pressure, providing recommendations (I had memorized the recommendations for the prevention of urinary tract infections because I had repeated them so much), and reading the woman's energy. This was one of my most valuable lessons of the day because I realized how important it is as a midwife (and in daily interactions with family, friends, and acquaintances) to be aware of a person's energy and consider what they need out of an interaction. As a midwife, you're constantly interacting with a woman, her family, her friends, her children (whoever is at the cita or birth) and each has a different personality, background, and story. While I had always thought about the importance of being attuned to and understanding of another person's energy, I didn't quite get what that felt like and meant until today. I was thankful to realize this through my three citas and that I had the time to absorb and consider this insight.

During Birth Talks, we discussed three births that had been challenging or surprising for the students who served as primaries. The various topics addressed included how to simultaneously address a baby born with an anomaly and manage the delivery of the placenta (extremely crucial due to risk of hemorrhaging and because MLL is required by Texas Midwifery Laws to transport women to the hospital if they haven't delivered their placenta an hour postpartum); how to handle a situation in which the woman and baby have elevated temperatures and the student must decide whether or not to transport; and how to discuss a woman's lacking support system with differences in the age of the student and client and accompanying awkwardness from varying levels of experience. One of the students had just been to a conference in Chiapas, Mexico, "Saber Nacer," and shared some ideas for being less obtrusive immediately after the baby is born. She said it was inspiring to be around 450 midwives, 50 of whom were indigenous.

I shadowed a postpartum cita once I returned from Birth Talks (I will learn how to do those for the July session) and had some time to sit in the sala, work on some birth documentation (I am very behind and after attending nine births the details begin to blur and get a bit hazy), and chat with a woman's husband who had just given birth the day before (I had done one of her prenatal citas the week prior). A woman who had come to MLL earlier in the day for a labor check returned again between 6 and 7 looking like she was in the pains of el trabajo de parto (labor). The student who had just been to the conference was up to catch (sounds like baseball, doesn't it?) and desired to incorporate some of the themes she had gleaned from the midwives in Mexico. This meant allowing the baby to lie over the woman's chest face down (this drains 60% of the fluids inside the baby) until she was ready to emerge out of the transition of giving birth into introducing herself to her newborn. We stayed quiet and low (sitting on stools) throughout the pushing process and immediately after the birth. The silence was beautiful and gave me goosebumps. While I am not sure how she felt during this time because I was documenting and helping clean the room, it was incredible to see this different process unfold.

I was able to get about 4 hours of sleep after retiring upstairs at 1am and more insights began flooding into my mind. They were about appreciating the time I had here; that I was supposed to be at this center, school, and place. That it was okay to miss the comforts of home, but that I didn't need to spend time pining for those things if I wanted to be truly present here. I fell asleep pretty quickly after this and when I woke up, had a nice conversation with one of the students. I truly value those calm moments when we have time to just talk and relax. It was a nice way to wake up. The rest of the morning entailed cleaning the purple room where the woman had given birth and changing out and folding laundry until the next shift came in at 8am. There is always laundry to do, but treating it, washing it, and folding it (along with all of the cleaning and restocking we do in the rooms) makes me feel like I am a small part of the foundations of the center. That level of involvement and dedication is truly inspiring. I left my shift feeling happy and grateful and was excited for my day trip to Mesilla, New Mexico.

Wednesday, June 16 and Thursday, June 17
One of the other short-term students and I headed to Mesilla, New Mexico on Wednesday per recommendations from the midwives and students at MLL. It is about 50 miles away and we took back roads that passed by dozens of farms, mainly with pecan trees. I never knew there would be so many in western Texas and southern New Mexico. And that there would be lush green grass! The mountains in New Mexico are a lot larger than those in El Paso and it was spectacular to see them all along the way. Mesilla is a quaint town with a few shops and restaurants. We had been told it was like a smaller version of Santa Fe, NM and it is just a few miles from Las Cruces, NM. We enjoyed some delicious enchilada's at Felix's (pretty spicy, at least for me!) and looking at the Native American inspired pottery, jewelry (so much turquoise), and dinnerware. Despite the small size of the town square, the stores have a lot in them and I plan to return in July to take a longer look. It's a great place to shop for family and friends :)

On Thursday, I had scheduled my first interview with one of the fourth quarter students (meaning she's been here for nine months) for the morning and it went wonderfully. It lasted an hour and a half! I then returned to the school for my first class ever at MLL, Introduction to Labor, which was a lot to absorb, but extremely enjoyable. We learned all about the signs and symptoms of labor (both conjecture and research-based), the stages of labor, and the mechanisms of labor (what the baby does to wriggle its way out). MLL is very hands on and we practiced these mechanisms with a cloth pelvis and baby. We also carved the landmarks on a baby's head into grapefruits and put them inside of socks to practice feeling for them when the head is emerging. I was pleasantly surprised that class ended early and I was able to conduct forty-five minutes of another interview with one of the second quarter students (here for four months so far). The day had come together so nicely and I was grateful for the small class size, hands-on practicum, and to attend my first of many classes.

June Community-Based Research Reflection

¡Buenos días/Good morning! I hope you all are doing wonderfully on this lovely Friday morning. A lot has happened this week in terms of insights and interviews, but since I have one more shift tomorrow, I will update the blog Sunday for a more holistic view of the week. This post will be devoted to reflection on my research and fellowship thus far in response to questions that APPLES, which administers the CBR (community-based research) portion of the grant I have received, has sent to the seven CBR-SURF fellows. The questions are below, along with my reflections, and some pictures from Mesilla, New Mexico and outside the back of the birth center. More to come on Sunday, though!

Please share surprises or challenges you've encountered with your fellowship project thus far.

While I have noticed a distinct shift in my internal happiness and comfort being here this week, one of the biggest challenges of the beginning stages of my fellowship was getting used to living alone and coming to a new place and part of the country I have never been to before. Even though El Paso is in the U.S., it doesn't exactly feel like you are in the U.S. Since I have never been to Mexico, I am not sure if it feels quite like that either, but the culture, food, and people certainly appears more Mexican. One of the professors I will have next semester who is a native El Pasoan told me before I left that El Paso feels neither like the U.S. nor Mexico. This ambiguity was strange and unsettling at first, but as I became more used to it, I realized that it's full of opportunities for blending and sharing in a very unique way. I read so much about the border and Southwest in my English class last semester, but to truly understand and absorb the way a border town feels, you have to live in it yourself.

Mixed with this uncertainty was the extreme loneliness I was experiencing becoming used to living alone for the first time. While I had been planning for months to live alone in the casita, yet again, it did not truly become real until I arrived and Sam left. Coping with those first two weeks was extremely painful and different. Doing most of your errands, eating, and reflecting alone (at least for a person who likes to process and be in the company of others) in a place that already feels a bit ambiguous is/was challenging. It was not until my shift on Tuesday that I finally clicked in and felt completely present at the birth center and in El Paso. I'm not sure what changed, but as I was lying upstairs after documenting a special birth (I will write more about that Sunday, but it was the first one I have ever been to in which we remained completely silent as the baby was born, allowing the woman and her family to experience this transition and introduce themselves to their new family member without interference checking heart tones or blood pressure), all of these thoughts began flowing into my mind. I listened intently. Some of the lessons I had learned that day about reading people's energy and meeting them halfway in interactions flooded into my mind, reiterating the importance of being completely present. Of course I miss my family and friends, but I realized that pining away for or thinking about what I was missing at home did no good. I was in this place, these challenges, these joys for a reason and I needed to immerse myself in them to get the most out of the experience. I felt like I was finally awake and aware in a way I hadn't been before. I have noticed I feel more like myself again and am trying my best to hold onto that significant lesson and incorporate it into my daily life. Living alone is hard and lonely at times, but allows you to live in a heightened sense of awareness of yourself and all that's around you if you let it.

In terms of the research itself, I never anticipated how difficult it would be to keep up with detailed fieldnotes and how my focus would shift from client's experiences to those of the staff and students. Even though I keep a small notebook with me at all times on shifts and write notes in it frequently, my desire to transfer these onto my computer and embellish them was pretty minimal. I believe this was due to two factors. I didn't want to feel even more lonely by writing in the quiet for hours on end and I wanted a way to feel separated from the intensity of my experiences from the center to have time for self-care and reflection. Communicating with Karen (my research adviser) and my family has really helped me understand the discipline it takes to do research and that it must be balanced with time for fun and relaxation. While I am feeling better about working through these notes now, I am not sure if writing them will be my favorite part of the experience. The birth center is a truly transformative place and I like to let what I learn and feel just be for awhile before writing about it. The insights about the scope of my project and interviews leads nicely into the next question.

Talk about the scope of your project. Has it changed? Become more focused?

While my research proposal had a distinct focus on the experiences of clients and reasons they were crossing the border to access care and give birth at MLL, I have realized the various limitations on their time. They spend so much time waiting at the border and birth center and have families and their life to get back to once they're finished with their cita or parto (birth). I respect what they go through to get and stay here (once a woman is "in dates" at 36 weeks, she will often stay here with a family member or friend until she gives birth to ensure she can make it to the center in time) and feel that adding one more thing to their trip here could be both stressful and disrespectful. There is also an interesting dynamic in my role as a care provider and researcher. I feel like I am walking a thin line with these two roles and that my desire to interview clients could seem confusing or odd to them. I have observed and accepted the challenges of doing interviews with clients and will only do them if it feels right. Therefore, my project has become more focused on interviewing students and staff, but especially the students. Being here has also helped me see how crucial the relationship between the center and school is and how important it is to understand the dynamic between those two places. There are many power dynamics at play, as well, among the students/staff and clients in terms of race, class, and educational opportunities and the students/staff are very cognizant of those. While my research is always evolving, I would say my interview focus has shifted more to students and staff. Some important themes that have emerged in my fieldnotes (Karen really emphasized these for me) include the apparent divide between the emotional and clinical aspects of being a midwife and the challenge of blending those into one's practice, the many forms of "family" at the birth center, and the concept of time and how staff, students, and clients are experiencing that in similar and dissimilar ways.

Well, it's time to write up and think about my fieldnotes from Tuesday and go to the laundromat to do some laundry. I have my fourth shift at the clinic tomorrow and am excited that a fellow Women's Studies friend from UNC will be visiting me on Sunday on her way out to Arizona. I will be sending out this week's update on Sunday. ¡Cuidense/Take care!