La cuarta semana/The fourth week Part II

I spent Thursday and Friday doing interviews with one of the now 2nd quarter students and with the Assistant Academic Director. I have been able to do about two interviews per week so far and I have only done them with students or staff who have personally told me after hearing about my research that they are interested. The interviews are lasting about 50-60 minutes on average and feel really comfortable. I am so grateful to have had the experience interviewing last semester and feel that the interviews have a pretty informal feel, as if they are conversations taking place between friends. I was also able to go for another hike in the Franklin Mountains with one of the short-term students and it reminded me how appreciative I am to have those mountains as a natural haven in a pretty urban area. Before I knew it, it was time for my Saturday shift. I had done a bit of packing, but would be rushing around the casita and to the airport after my busiest shift ever!

Saturday, June 26
Let me just start by saying WOW! This was the busiest day I have ever seen during my time at MLL so far and it coincided with the full moon and lunar eclipse! Today, I did seven citas, two of which were initials, and attended a labor and birth that lasted into the early hours of the morning. I began the day with an initial that I was only able to get about halfway through because the woman told me she was still bleeding a bit in the beginning of her second trimester. I asked one of the licensed midwives about this once the client told me and she referred her to see the obstetrician with whom MLL has a longstanding relationship. It was a shame that she had to leave before the initial was over with the concern of the well-being of her child and whether she would be able to receive care at MLL. She had previously given birth to her three children here and we are always so excited to have repeat clients. She asked me during the initial whether she would be able to see the same person throughout her period of care at MLL (the continuity of care/on-call I have mentioned before) and I told her that while I could likely do her citas in July, I would be leaving in early August. I was grateful that she had asked me this, though, and wish I could have an on-call client while I am here because your relationship has the potential to become even closer seeing the same woman throughout her pregnancy.

The clinic was hopping after this and I began taking cita after cita. Women were coming in for labor checks like crazy! And all of the birth rooms were filled up! One was in labor in the purple room, one was in her postpartum in the rose room, another was in labor in the peach room, and another was in labor in a divided part of the sala. Not only was the sala divided in half, it was also divided into quarters on the back side to accommodate the woman in labor and citas! Women were waiting for citas for 1-2 hours and the porch and hallways were filled with overflow from the tiny part of the sala available. One of the main things I learned today was how to work with everyone amidst tight quarters and with so few students available to do citas. The licensed midwives, who are generally checking citas, and keeping up with phone calls and chart reviews at the midwives' table were having to also incorporate citas because it was just so busy. I worked with a range of women today, a few of whom were getting closer to or had passed their estimated delivery dates, and others who were 6 or 7 months into their pregnancies. I did another initial in the afternoon with a client who had also given birth at MLL one time before - it was great to see another repeat client and I also noticed how much my Spanish improved (especially conjugating the past tense, which is most difficult for me!) with the intensity and demands of the day. While the afternoon began tapering off a bit, I was busy with citas until about 8 pm and then it was time to clean the clinic and make some dinner. I squeezed this in quickly before getting more into my role as shadow primary with a student with whom I have worked before.

The student and I were in for a long night and morning of rounds together. The young woman was a first-timer and had been reaching all of our limits for dilation (dilating 1 cm every 4 hours). She had been walking around outside a lot all day with her husband, had aromatic candles burning in the purple room, had drank a smoothie to hasten labor, and had taken hierbas (herbs). She had a very quiet demeanor and never verbally said anything or complained during contractions (at least when the student and I were there to check on her and fetal heart tones every thirty minutes). I really learned about dealing with family dynamics during this birth because her mother was pretty protective and did not seem to trust or appreciate what we were doing. This made for a bit of an awkward dynamic, especially mixed in with being absolutely exhausted after a crazy day in the clinic. The comic relief came with the student was fixing her hair and her clip made a line straight for the toilet. We were laughing so hard! At least we have a lot of bleach around!

At about 3:30am, the client began feeling ganas de empujar (desire to push). After a two-hour process during which the client had to receive oxygen due to low fetal heart tones, the licensed midwife had to do many different techniques, such as bone stretching (the midwife has to stretch the vaginal area so that the baby can be born), Ritgen's maneuver (the midwife has to reach inside and pull the baby's chin downward), the woman valiantly gave birth to her son (screaming with strong lungs) at 5:45 am. He had to be suctioned about twenty minutes later because he had some fluid remaining in his lungs that could not be resolved by lying him face down across his mother's belly, which contributed to the intensity and difficulty of this birth. I was documenting the 2nd stage for those two hours and was nodding out every few seconds. It was strange feeling so tired and seeing what looked like an extremely painful and traumatizing experience for the client. This was the most difficult birth I have attended and it made me question whether I could deal with such situations as a midwife. It seemed to push everyone involved and left me feeling uncertain and saddened at the experience for the woman who was now exhausted and swollen.

After the longest circle ever (18 minutes of explaining the previous day's events), I said goodbye to the short-term student who would be leaving in a few days and scrambled home to get ready for my trip back to the east coast. The flights back were painless and I felt so tired that I actually napped while on the airplane I think. This shift was quite an experience to end the month of June on and I am still processing what happened during that birth and accepting that natural childbirth can be extremely painful and difficult for the woman, her family, and the midwives present.