On Monday, June 21, I enjoyed spending the morning eating and chatting with Molly before heading to my second class at MLL, Normal First Stage of Labor. The class took place during a big four hour block, but I really enjoyed the material and it truly augmented what I had learned in my doula training and read in some supplemental books. I also found it nice to think back to the birth I had just attended on Saturday, June 19 and relate it to the themes that came up in class and with the student who had been the primary.
Tuesday, June 22
My fifth shift at MLL was steadily busy all day long, but I would soon realize that in comparison to the shift I would have on Saturday, today was relatively calm. It's all relative! My morning began a bit differently than usual because there were no women waiting for citas during the 8:00 hour and I had been assigned as shadow primary for a woman in labor in the purple room. Because there was only one woman waiting for a prenatal cita and one of the students was interested in the woman being her on-call client (the students have to have so many on-call clients for continuity of care), she took the cita and told me I could labor sit with the woman in labor. The woman had great support from her mother, who had given birth naturally seven times, and this birth was interesting (especially in comparison to the one I had attended on Saturday, June 19) because I couldn't really tell whether my presence was desired. Every labor and birth is individual and this woman (she was a fourth timer) seemed extremely uncomfortable and in a lot of pain. I had a hard time knowing what kind of support to provide because she labored in bed for most of the time and groaned/screamed through her contractions in labor and while pushing. This birth really reminded me that every woman experiences labor and birth differently and that midwives (and other labor support people) really have to mold to the woman's needs rather than their own vision of labor and birth. I remained with her and her mother until about 10:47am when her daughter was born and left shortly thereafter because the clinic was getting crowded with citas. It was also interesting to transition so quickly from a birth back to fast-paced citas; I had only been to one another day birth and time definitely feels more pressed balancing births and citas.
There are positives and negatives to
working the same days each week, but one aspect that I love about it is seeing the same clients over and over again. I was happy to find a prenatal client who I had done a cita with the week prior waiting in the sala with her family. She was concerned because she was a few days past her estimated delivery date, but I reassured her this was normal, especially for a first-time mother. We also discussed it when la titulada (the licensed midwife) came in to check the cita, but she still seemed a bit worried. It's difficult to provide consolation and comfort in such instances and I tried my best to reassure her, but she definitely seemed a bit nervous and concerned.I spent the rest of the afternoon doing two initials and missed Birth Talks, which is the class that takes place each Tuesday from 1-4pm during which students provide input and feedback on births and the way the clinic and school runs. I didn't mind missing Birth Talks, however, because I felt it was important to see the initial through and be completely present for the young woman and her mother. They had traveled nine hours to get to MLL from Coahuila, which is the state that borders Chihuahua (directly below El Paso) on the right. Tuesdays are a hard day for initials because all of the students are at Birth Talks from 1-4pm and I always feel that women come in during this time period for their first encounter with us. Because the initial generally takes up to three hours, I am always cognizant of how much time the women and their families are waiting and must travel afterwards.
I spent the rest of the afternoon, from about noon until 6:30pm, doing the initials, with lunch thrown in there around 4pm. What I love about initials is that you learn a woman's story, at least in terms of where she is from, what she does, if and where she has given birth and what those experiences were like, what preferences she has for this birth, and who will support her in the birth and postpartum. There are some aspects of initials that I find especially challenging, namely the personal questions and the nutritional counseling. The personal questions include inquiries about whether a woman has experienced emotional problems, physical domestic violence, if she feels safe in her home, and about her mother and (if she has any) sister(s)' medical histories. The young woman who I worked with in the first initial was my age and had experienced repeated instances of emotional abuse from her partner and did not want his name to appear on the birth certificate (we ask this question during the initial, as well). While I have taken numerous classes on being an ally to those who have experienced abuse or assault, all of that seems to fade away in the moment and I just try to be as validating and empathetic as possible. It is important to understand a woman's history of trauma and abuse because it can and does affect her experience in labor and birth, but it's hard to find a sensitive way of asking these questions to a woman you have only just met. Because this young woman was the first to tell me about the emotional abuse she experienced, I wonder how many other women who come to the clinic have experienced this and do not feel ready or able to say anything about it.
The other challenging aspect of initials (and my work at MLL thus far) is the nutritional counseling we are required to provide and the homework sheet we give to the women in which they fill in triangles with the portions of each food group (grains, vegetables, fruits, calcium, sweets) they have eaten each day. I believe that due to a combination of factors, such as my inexperience with nutritional teaching, issues of access and cuisine, and age, I feel uncomfortable telling a woman who may not be able to afford pan integral (whole wheat breads) or who is 36 years old what she should eat. This comes up in a lot of my citas and I noticed it yet again today, especially when I was with my second initial who was 35 and pregnant with her third child. While I believe a balanced diet is important throughout a person's entire lifespan, I struggle reconciling the aforementioned issues of access, cuisine, and differences in my and clients' ages in relation to diet and nutrition and will continue to ponder this during the July Intensive.
The evening brought a delicious hamb
urger (I have never craved meat like I do at MLL and in Texas!), chocolate pudding, open conversation with the students (I learned one went to the same university as Sam's best friend in Canada!) and a birth at 11:31 pm. A wonderful aspect of MLL is the wide range of births you experience and are a part of while you are there. This birth was calm, peaceful, and beautiful. I was up to be shadow assist (which means I would help check fetal heart tones after each contraction in the second stage of pushing, help determine the 1 and 5 minute Apgar scores, and help with replacing towels and hats once the baby is born), but did not get as involved in my role as I usually do. The student up to be assist offered for me to check the heart tones, but the woman was so in tune with herself inwardly and engaging with the baby as his head descended, that I didn't want to interrupt that probing around her belly for heart tones. This is yet another aspect of MLL that can be challenging because as a student, you should be learning and taking opportunities to do so, but during a birth, it feels so intrusive to take heart tones after every contraction with the doppler (part of protocols), especially if you're not seasoned at it. Something in me said to just sit back and so I did. The young woman held the assist's hand through the contractions and decided to stand up in the last few seconds of her second stage to give birth to her son. Her mother had wanted to catch, but he came so quickly it wasn't possible (this happens a lot)! She immediately returned to the bed and continued interacting with her son as she had done touching his hair as he was descending, moving him into a position to breastfeed within minutes. I left shortly thereafter after placing a new hat on his head and giving her a new towel, taking some laundry to be treated and then getting ready for a couple hours of sleep until it was time to clean the room at about 6:30 in the morning and finish up our shift. 
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