La séptima semana/The seventh week Part III

Friday, July 16

Friday was a busy, but productive and fun day. After taking a shower at the casita and returning to the birth center to meet up with two of the students from the previous shift, we went to Casa de Nacimiento, another birth center in El Paso just a mile from MLL. We spent about an hour at Casa getting a tour of the birth center and the house next door where all of the interns stay. Casa has a bigger space than MLL and feels more like a clinic, too. It is set up a bit differently with short-term students, as well, because they are mainly responsible for catching babies and do not do prenatal or postpartum citas. The staff was extremely welcoming and gracious to us and spent about an hour showing us all around and answering any questions we had. I was grateful to have the opportunity to see Casa and couldn’t believe so many students had never been because it’s so closeby to MLL. Just shows how busy and tired they are!

The student with whom I had done couch the night before and I then went to the Percolator (a local coffee shop with great eats, too) and spent a bit of time together just chatting and enjoying one another’s company. I was hungry (what’s new?) and had a croissant with eggs, avocado, and tomatoes before I took the student back to MLL and she was off to see another friend. Since my interview was at 3pm, I had some time to see some sights around El Paso and was trying to decide between going to the El Paso Museum of Art or the Chamizal National Memorial which straddles the Texas-Mexico border. I decided I was in the mood for the art museum and spent an hour and a half or so there taking in a variety of pieces created by Native Americans, Mexicans, and Mexican-Americans over the past two centuries. The art museum was comprehensive and included pieces ranging from Mexican retablos (painted on tin, generally of Christ, Mary, and Joseph) to expansive pieces chronicling the Southwest. The tension on the U.S.-Mexico border was palpable as I took in an exhibit called “Dreamland/Tierra de Sueños: The Way Out of Juárez/Una Salida Lejos de Juárez,” which aimed to document the violence in Juárez, but also link it to similar violent uprisings and occurrences around the world. Other pieces explored the historical and present relationship between the U.S. and Mexico. I must say (and another short-term student said this after visiting, as well) that I wish there had been more inclusion of pieces by women and about women, but this is a common historical theme and past I cannot change.

I was a bit late getting to the staff midwife’s house for an interview because I spent awhile in the gift shop buying some beautiful plates and salt shakers hecho en México (made in Mexico) and got confused on some streets trying to find her. It had rained a bit when I left the museum and I was beginning to notice how ominous the skies get in the rainy season of July. My interview with the staff midwife (she had been doing staff-in-training for six months and just became a staff midwife) was incredibly open and candid and lasted for about an hour and a half. Among many things, she discussed the challenges of balancing her role as a midwife (who has the final say-so) and teacher to students with various personalities, backgrounds, and beliefs. I was surprised when she told me that she feels pretty disconnected from the clients because she is juggling so much and as a protective mechanism. Fascinating how much perspectives can vary depending on how long you’ve worked in a place and what exactly your job is. I was grateful for her time and her delicious cole slaw and mint water – how refreshing!

Saturday, July 17

While I had set my alarm for 7:00am so that I could start the day off early getting in recordings and blog postings, I stayed in bed until about 7:30am until I heard a knock on my front door. It was the Assistant Academic Director and midwife who I live behind and she asked me if I could come in today instead of Sunday for my 24-hour shift. One of the students was sick and needed the coverage and weekends are generally pretty busy at the clinic. I took a few minutes to decide, and would have to reschedule my planned interview with one of the students, but felt good going in after having slept on my last shift. I was also excited to work with students with whom I had not worked in a long time or ever before.

The Assistant Academic Director told me to take my time getting ready and made sure I had food to bring in for the shift. Luckily, I had just been to the grocery store the night before! I arrived at the clinic at 9am and had a pretty busy morning, barely fitting in time to eat some delicious tortellinis (the housekeeper I interviewed had never tried one before and had a spinach one; she really liked it) as it neared 2pm (we are supposed to be cerrada – closed – between 12 and 2 pm, but we continue taking citas if it’s busy). How I wished I had a gordita to nibble on throughout the morning but the woman who sells them luckily takes time off on the weekends. What I noticed during this shift is how rusty I was not getting enough time in between to rest and recuperate. As I measured fundal heights, checked positions, and listened for heart tones, I found I was having a harder time today than usual and attributed it to the fact that I was doing a back-to-back shift (when you only have one day in between instead of two).

My first cita was with a young woman who was having her first child. She seemed a bit shy, but her aunt did plenty of talking for her (what seemed loving and doting to me may have felt extremely awkward to the niece, though). This was my first cita during which the woman did not seem to be eating enough. I had to ask one of the students how to encourage her to eat more without acting as if I didn’t appreciate where she might be coming from in terms of access and eating habits and the student told me to remind her that she had a baby growing inside of her and that newborns eat every 2-3 hours and need the same nourishment in the womb, as well. The client asked some questions, but it was mostly her aunt (who I embarrassingly addressed as the grandmother by asking, “¿Está emocionada sobre la llegada de su nieto?/Are you excited about the arrival of your grandson?” (Nice move) who was asking about what kind of positions were best in labor, whether her niece could tener relaciones (have sex) during pregnancy, and whether her niece needed to do anything to prepare for breastfeeding now. I asked the aunt to help me check her belly (after asking the client if this was alright) and we palpated together. The cita felt inclusive, but I also noted a sense of awkwardness with the client, as if she didn’t want to discuss all of these things as openly as her aunt. Her aunt said that her niece had verguenza (embarrassment) and that was why she was asking all of the questions. It’s so interesting to observe family dynamics, as coming to MLL is often a family event, and note the tensions and comical moments that arise among family members during citas.

The next woman I saw came with her sister and they were having a grand time together. They were smiling and giggling and seemed so happy to be in one another’s presence. The client was having her second child with us and was about 33 weeks along. I’m always amazed how much I learn about a person in a cita whom I may never see again. As the client went to do her prueba de orina, her sister and I spoke for a few minutes about her birth at a local birth center and her husband, who she said treats her badly. What sparked the conversation was the fact that all of the women in the family had had boys and I asked the sister if she ever wanted to try for a girl. She told me más adelante (later, in the future) due to how badly her husband treated her. I felt at a loss for words as she revealed something so personal to me and found myself in yet another situation where I wanted to counsel, but wasn’t sure if anything I said would be any consolation or comfort to her. She also told me about one of her birth experiences at a local birth center in which they had given her tequila (not exactly sure why); she didn’t seem to pleased about this! Both women were extremely outgoing and chipper. The sister bobbed her head back and forth (as if rocking out to some tunes) as the baby’s heartbeats clicked on the doppler; I couldn’t figure out why the client was laughing as I counted heart tones for a minute and only had to look back at the sister to realize why. The client really didn’t want her pap smear done, though. When I asked if she would like me to leave, she said that both the student and I needed to be there or else she would leave. She didn’t audibly complain during the pap smear and I saw no visual signs of discomfort; the student and I decided she was just very open telling us how she felt about the procedure, in general!

I took another cita before breaking for lunch (it was pretty busy) and realized when I put my initials next to her name on the sign-in sheet that I recognized her name from the past. It was a woman whose initial I had done in June and I was excited to see her and her mother again. I could tell I was getting tired and hungry during this cita because I was having trouble explaining what the plasma glucose test looks for (I said it was to check for pre-eclampsia, but the student in the mama cita room told me it was actually for gestational diabetes) and felt a bit disorganized. Yet again, I noticed my gaps in knowledge and that I so often have to explain tests which I knew very little about (and have had little time to learn about both in orientation and throughout the summer as I have had to keep up with the research side of my work, too). She and her mother were extremely patient with me as we went over other aspects of her cita and I appreciated how gracious they were as I felt a bit sloppy.

I quickly boiled some water for tortellinis and ate them fast before getting into another cita after lunch. I felt guilty taking a break to eat as there were many women waiting in the sala, but also realized that we needed to take breaks if we were going to do a good job. As I inhaled my lunch, I confessed to both the staff midwives that I felt I was doing a bad job getting positions and fundal heights right and they reassured me I was doing great for someone with so little training. I also told them I couldn’t believe I only had two weeks left and the Assistant Academic Director told me she sensed I would be back to MLL at some point. She said I would be an asset to the center and that I fit in so well. I appreciated her kindness and feedback, especially because I felt really rusty today.

As I got fuller, one of the students told me she’d take the initial waiting if I took the woman she was originally going to take. I had noticed this woman sitting with her husband and two children; they had been in the sala for awhile. The woman had thin, long bangs with her hair pulled back into a ponytail and a thick black headband on. She had a warm, inviting face and a calm demeanor. I noticed her belly seemed small for being 38 weeks and that her baby had only been measuring about 5 pounds over the last two citas. While I also got a small fundal height and weight, the midwife who checked got larger numbers, which again made me wonder what on earth I was doing wrong. The client told me she had been feeling colicitos (little cramps) in her lower abdomen and I told her that her body was preparing for the arrival of her daughter (she already had a daughter and son who were out in the sala with their dad, who was entertaining all of the kids at the table of Legos and blocks). We did the 40-week protocol together and I, again, felt like I was in new territory because I had not yet done one of these with a client. Even though I’ve done dozens of prenatal citas now, there is still so much learning to be done. While some things remain the same, like giving UTI prevention recommendations, other aspects are so different and I feel like I stumble each time I try a new one, but am confident that at least it will be better (hopefully) the next time.

After this cita, the clinic became a lot calmer and it was nearing 4:00pm. I sat down at the table with the two staff midwives who were trying to figure out how to schedule the student who had been and was still feeling sick. She had a throat infection and had received a shot of Penicillin that would make her non-contagious in about two days (so Monday). They asked if I’d be able to come in for another day shift Sunday and said I’d work until citas calmed down. I was perfectly fine with this plan and liked the opportunity to work just during the day and get rest at night. I was disappointed that I would not be attending births and sort of felt like my presence at births wasn’t nearly as important as in citas (which it may not be at this point), but still appreciated the shift in schedule. I left soon after around 4:30pm and spent the rest of the day catching up with family and friends on the phone and on my five birth reports and reviews so that I could prepare for the next two weeks of births. I didn’t feel like I had really had a break when I returned to the clinic at 8am the next morning, which has become a theme in my last two weeks here with so much to do and so little time to do it. I almost feel as if I am in last stretch of school at the end of the semester when you’re tired and unmotivated, yet have to push forward. I am so happy with what I’m doing, but am finding that I really need time at night to decompress and release by watching a movie. Sunday, 7/18 will be part of the week 8 update!