La primera semana/The first week

¡Buenas tardes! Good afternoon! I just finished my first week of orientation at the birth center and feel saturated with so much amazing information. In this week, I have learned the condensed version of what students learn in their first three weeks of orientation at Maternidad. I will describe a bit of what I learned and experienced each day along with some pictures I took of the school, birth center, and a local mercado (marketplace) we went to today.

On Monday, the Assistant Academic Director provided us with the history of MLL and midwifery in Texas. The vision of MLL has always been to be accessible and affordable to both students and clients and it is the only school in the country that has a birth center a house away for students to do their clinical training. We also got a tour of the clinic and learned about infection control and the different clinical items in each of the rooms. Judith gave us our clinical schedules and shifts (when we will be in the clinic) and told us we would be allowed to conduct citas (prenatal appointments), initial appointments (getting a woman's medical history when she first comes to MLL), and attend births as documenters, go-fers, and shadowers (I will explain what those mean in a bit - we learned that on Wednesday). Judith also gave us prenatal and postpartum books in English and Spanish that were made at MLL and we will use during citas to provide recommendations and informational support.

On Tuesday, we were with one of the staff midwives for the entire day. She taught us how to conduct a prenatal cita, including how to take vital signs and make recommendations depending on what a woman is experiencing. We learned how to check blood pressure, pulse, respirations, a urine sample for glucose and protein, weight, height temperature, and the belly for position, size, and gestational age. We spent a long time practicing these skills on one another and going to the clinic to try then out on all of the patient midwives and students! We were back and forth a lot between the school and birth center this week and MLL places a huge importance on making learning truly hands-on, which is crucial with the sort of skills we are learning. At the end of the day, we practiced citas in English and Spanish together and learned all about assessing a baby's position and size and how to listen to fetal heart tones. The midwife who taught us Tuesday is currently pregnant and graciously allowed us to practice on her belly. I am a bit nervous about conducting my first cita next week because there is so much to remember and taking blood pressure is really tough, but the staff midwives fortunately check all students' assessments once they are finished.

We spent Wednesday learning all about birth at MLL and the roles that we will be playing at births. We spent the day with two students who have been at Maternidad for 9 months. I felt so fortunate to meet many of the women with whom I will be working during my 24 hour shifts this week. It is an amazingly patient, gentle, calm, open, kind, and passionate group of women and they provide incredible care. It is evident that they are truly present for all of the citas, births, and all that happens in between. While at MLL, the other short-term students and I will be documenters, go-fers, or shadowers at births. The documenter documents everything that happens from the pushing stage until the baby is born. The go-fer is available to run around the birth center and get anything that the student or licensed midwife may need during the birth. As shadow primary or shadow assist, we are able to either shadow and help the primary (responsible for the mother's care) or the assist (responsible for the baby's care). If a woman desires a doula for labor support, we are also able to play that role for her. We are essentially observers at the births and our level of involvement depends on which role we are rotated through. Today felt a lot like my doula training and was my favorite day of the week. We spent the afternoon with another student who is from Canada and reviewed the stages of labor, labor support positions, and different items within one of the birthing rooms again. All of this reinforcement is so helpful!

On Thursday, I did a twelve-hour shift in the clinic from 8am-8pm. This is only half of what my days will be like and I was so exhausted! I saw my first natural, non-medicated birth and it was incredible. The familial support was sensational and I felt very fortunate to witness my fourth birth. I knew that it would be a special experience witnessing birth in such a different setting and it was both emotional and empowering. I was shadow primary, which means I spent the entire active stage of labor, pushing, and postpartum with the student midwife who served as primary. Once the woman was pushing and the student midwife was set to catch the baby, I became the documenter, documenting the birth time, calling out when to take the 1 and 5 minute Apgar scores, the birth of the placenta, and other important information. I was able to see the entire process through, get to know the family, see and learn about the placenta, see how often the woman and baby are checked on throughout the day, the newborn screening, and the pile of paperwork involved with a birth (and just in general). This was my main role the entire day, so I did not see any citas. I was thankful to be a part of this birth, though, and it was a good first day bringing together all of the skills we have been absorbing.

Today, we focused on learning how to conduct an initial cita. It is a lot longer than a prenatal cita and requires a lot more time from both the student/midwife and client. It can last anywhere between 2-4 hours and allows the midwife/student and client to discuss her entire medical history. We practiced calculating estimated delivery dates and learned how to check for hemoglobin. We were pricking and practicing on one another all over again! In the afternoon, we headed over to Mercado Mayapan, which is a market run entirely by women, many of whom are former maquiladora (factory) workers. Every month, a different state within Mexico is represented and this month it is San Luis Potosí. I ate tostadas con pollo (chicken) and had a licuado (smoothie) con plátanos, fresas y leche (with bananas, strawberries, and milk). The focus of this afternoon was to learn more about the clients at MLL and the issues that they face living on and negotiating their identities along the border. One of the midwifery students who considers herself Mexican and Chicana and has lived in El Paso her entire life discussed the Mexican value of family, but also said we would be meeting a diverse array of clients from many states within Mexico. She emphasized how strong the women are that come to MLL and told us to not feel sorry or hopeless about the challenges they face living in Juárez.

She told us how the clients negotiate their identities (Mexican, American, Chican@, Hispanic, Spanish), languages, traditions, superstitions, and the ambiguity of living on la frontera (the border). Speaking from her own perspective, she reminded me of the course I took last semester on Chican@ and Native American literature and how fortunate I am to be able to listen to and interact with many women in the El Paso-Juárez area. I bought a blanket and camisa (top) from Mexico and am excited to return to this fantastic market alone and with my Dad when he comes later in the summer.

This weekend, I have A LOT of catching up to do writing my fieldnotes, practicing citas in Spanish, doing laundry, and confirming my interview intentions with the Assistant Academic Director. I am meeting up with a woman tomorrow from Juárez who spoke at UNC last semester and will go to a potluck at one of the midwives' houses on Sunday. It can be lonely at times, but I am feeling better getting into the routine of life here and getting to know the city, too. We are supposed to reach triple digits temperatures this weekend though! I will be back in the birth center on Tuesday for my first 24-hour shift so check back for details about that next week!