Before I knew it, it was time to come back to MLL for Birth Talks from 1-4pm. The student who had been caring for the baby during the PP period and I had planned to get pancakes and finish her interview that we had started in June, but she needed some time to rest at home. I enjoyed the reprieve, as well, and it felt nice to come to Birth Talks on a day when I was not also in the clinic so that I could really focus and absorb student’s experiences and concerns. As two students presented about births from earlier in June, I realized how many births I had witnessed in such a short period of time and realized that I was where I needed to be at the births. It’s sometimes hard to remember I have been in El Paso for seven weeks, six weeks of which have been in the clinic. Hearing these students process helped me remember just how much I had seen and been a part of in such a short period of time and was a perfect antidote for my disappointment in the morning. I was excited to share a doughnut with one of the students (she’s the one who made the hamburgers the night before) and she gave me some constructive criticism (which I am still learning how to take without taking it personally – I think I will be doing that for awhile) about improving my documentation skills. So many feedback and styles to consider and work with!
I spent Wednesday recording my fieldnotes from the Friday prior and Monday (I’m enjoying the recording as a nice change from writing!), completing readings on posterior presentation and water birth, and doing an interview with one of the housekeepers at MLL at Mercado Mayapan. I was grateful to hear her perspective and wanted to capture her experience doing “un poco de todo” (a little of everything) From being in charge of the majority of the cleaning in the birth center and school and filling up the ice cube boxes with water to helping incoming students with new words and phrases (I’ve learned techo for ceiling and pasillo for hallway recently) and painting doorway frames, she is a vital part of the birth center and I am grateful for all of the constant work she does. It couldn’t function without her and she brings a strong, warm presence to the community at MLL.
Thursday, July 15
I promise it won’t take as long to go through Thursday as it did Monday! With no labor checks or births Thursday night/early Friday morning (so weird when this happens and we actually sleep), I spent the majority of my time doing five citas, attending a small portion of the water birth class (I was bummed to miss out, but happy to help with a PP cita for another client whose birth I had attended on July 9), and enjoying some pork tenderloin marinated in Asian sesame dressing for dinner. We eat meat and well!
The morning was steadily busy and I did thre
e citas before going to only an hour of our water birth class. My first cita was with a woman about 34 weeks along. While at first she seemed more interested in getting through the general questions and vitals of the cita, she later showed me a picture of her two-year old son on the phone and really warmed up. She had to have a pap smear done (this is recommended, but not required once women enter the third trimester at MLL) and since I have not learned how to do this, I always ask the woman if she’d prefer me to leave the room once another student has entered to do it. She said it was completely fine for me to stay and while she did not audibly complain, her face looked extremely uncomfortable. The staff-in-training midwife (this is a six-month program that students choose if they’d like to become a staff midwife at MLL after the one-year program) had done the pap smear and then began explaining and demonstrating how to do a breast exam. The midwife brought out a fake breast that felt like it had jello inside so that the client could search for lesions and abnormalities. For some reason, I really enjoyed this part of the cita and it reminded me what an important practice breast exams are in guarding against potential problems or complications.It was then time for an initial (I am realizing I haven’t done an initial since this one) with a woman who had been waiting in the sala ever since I took my first cita. She had birthed at MLL four times before and was extremely familiar with everything. She was pregnant with her seventh child and told me how she was a vieja (old woman) when I asked whether she had signed the handout about the potential risks or complications giving birth past 35 years of age. I reassured her plenty of women give birth past this age with no problems or complications and that I trusted she would be perfectly fine. This seventh child was not expected, yet not unwelcomed, and she was very candid trying to remember all of her other children’s past birth histories. She had given birth to two of her children in the hospital and when I asked her about what she had and had not liked about her past birth experiences, she said that they had not treated her well in the hospitals in Mexico and that she had much been happier giving birth here. Her special request was that her husband be with her during labor. What struck me most during this cita was her family’s personal history and I felt at a loss for what to say or do. When I asked how many times her mother had been pregnant (we ask about the client’s mother and sister(s) pregnancy and birth histories), she at first said eleven, but then realized it was ten. I am always worried when I ask whether any of the children are no longer living and, sadly, this client told me four of her brothers and sisters had either passed right at birth, from cancer, or had been killed. While I have heard the phrase, “Midwives aren’t psychologists,” it’s still hard when faced with situations such as these to know what to say and do for the person when they have just revealed an extremely painful part of their past to a virtual stranger. I certainly don’t have the answers; just another aspect of being a midwife that’s hard.
I was already a bit late for class when I finished the initial, but the staff midwife asked if I could do a PP cita since a lot of women were waiting. I was so happy to find that the woman who had given birth Friday, 7/9 in the purple room was there with her family and that I would be able to do her five day PP cita. I really appreciate opportunities for continuity of care and it is one aspect of being in a clinic and working different shifts that is extremely difficult to satisfy. Right when I saw the woman, I could tell she was exhausted and discouraged. She spoke to me in a low tone in both the sala and the baby cita room, telling me that she had been having a lot of trouble breastfeeding due to the pain and that she had taken a rest yesterday, feeding her daughter with a biberón (bottle). She seemed like she felt down not only because it had been a hard process, but also because she felt guilty taking a day off to give hers
elf a rest. I reassured her she was doing everything right and that it was an extremely difficult process at first. Again, however, I felt my lack of personal and general knowledge about breastfeeding affected my ability to comfort her and I find so often in PP citas that I am saying, “Podemos discutir con la titulada” (We can discuss with the midwife) instead of giving her solid advice or recommendations. The midwife encouraged her and told her that she could try a cream called Triple Nipple and the client eagerly wrote it down. While the woman did not seem annoyed or concerned about my relatively small knowledge about breastfeeding (she seemed happier to have someone listen to and validate her exasperation), I still noticed how those gaps of knowledge continually resurface when you’re learning new skills and practices.It was already about 2:30pm by this point and there was only an hour and a half of class left. I was happy to get a break and head over to class, but had already missed the majority of it. I had barely eaten all day (I had just been taking bites of my gordita con papas – fried tortilla with potatoes and salsa inside) and decided to finish off my gordita. Luckily, I had a lot of water nearby because it was muy picante (very spicy)! While I was in class, we discussed the circulating theories about what causes babies to take their first breath and whether this is inhibited by being born in the water and how there has been some movement to take an Apgar at 1 minute 30 seconds with water births instead of the usual 1 minute since it takes a bit longer for newborns born in water to turn pink (babies born in the water usually look pretty purple, which is normal, but can be worrisome to parents). The midwife asked pairs of students to be either for or against water birth and advise her whether or not to do one hypothetically. I noticed a gray-haired woman sitting in the class and wondered who she was (I later discovered it was a student’s mom who was visiting and doing 24-hour shifts with her). The midwife teaching the class was leaving in just a few days to move to Germany to get married and the class all talked about how much they had enjoyed working with her and that she had a special spirit.
Class got out early around 3:30pm and I took a cita immediately upon my return. It’s strange, but this is the only cita I’ve done where I couldn’t and still cannot visualize the woman’s face. She had given birth at MLL before and was pregnant with her second son. There was a lot to do during this cita, from changing her due date (this happens all the time; if there is any question about dates, the woman is sent to a doctor with whom we work and he gives her a date, which is the final say-so; nice $100 for a dates consult, by the way) and giving her recommendations for reducing constipation and hemorrhoids, to giving her a diet sheet for gaining 4 pounds in one week (if clients gain more than 4 pounds in a week, there is concern over pre-eclampsia) and giving her some lab results. When the staff-in-training midwife checked all that new students must have checked – fundal height, heart tones, baby’s position, and blood pressure – she asked me why I still needed everything checked because I was doing such a good job and we had gotten all of the same things. While I appreciated compliment, I attributed it more to the fact that some bellies and babies are easier to palpate and listen to than others.
After washing some dishes and helping grate some cheese for bacon ranch potatoes (seriously, love this student!), another cita came in. I had just seen her on Monday and while I hesitated to take the cita at first (I was really excited about eating), I eventually decided to because of continuity of care and because I felt we were forming a closer relationship. The client was now at 40 weeks and SO ready to give birth to her fifth child. She seemed just as tired as last time and frustrated because she had been having contractions for a week and a half and was already 2-3 cm dilated (very normal for mom’s who have given birth before to be dilated for a couple of weeks prior to giving birth because their cervix has done it so many times). Based on the last cita, I knew this one would take awhile because this client had to have her glucose checked every time (her glucose was too high during her glucose tolerance test), a fetal-well being check per pre-eclampsia checks, going through the 40-week protocol, and doing all of the normal parts of a cita. I felt terrible that she had to lie on the plancha (exam table) for extended periods of time to have her belly checked by both the midwife and me and for the fetal well-being check because she said lying down is so uncomfortable. Her daughter and friend were patient as always waiting for the two or more hours it took to go through all of her cita, but I couldn’t help thinking how hard it must be each time to come in knowing you’d have to go through these various steps in a “higher-risk” pregnancy for midwives. I kept hoping she’d give birth by the time I returned to the clinic for further shifts, but as of right now, I still think her son is waiting inside. She thinks he doesn’t want to come out because of the violence in Juárez.
I spent the rest of the evening enjoying two big pieces of pork tenderloin with bacon ranch baked potatoes and a beautiful salad of broccoli, carrots, and green peppers drizzled with olive oil and garlic (yes, the healthiest thing on my plate :) I wasn’t around for too much of the cleaning inside because the other students had started it while I was finishing my cita and eating dinner. I had the chance to speak to both my mom and Sam, which is always so nice on shifts. When I returned inside, I helped clean up a lot of the dishes and mentioned my interested in drawing blood to the student who had made dinner and the staff midwife. They said I could practice on them and so I did! They taught me how to put on the turnicate, prepare the needle, and how to insert it into the vein. I didn’t draw blood from the staff midwife (she said I had probably missed the vein, but that it didn’t
hurt), but did from the student. They each said it hadn’t hurt and that I had done a great job. The student told me I could have pulled out the needle a bit faster, though.After this, it was time to get ready for bed. I was going to do couch with another student, but first helped the student who had made dinner take out some trash and laundry before lying down on the futon to the ticking sounds of the swamp cooler and fan. It was about 11pm when we went to bed and we didn’t rise until 7 am. There had been no births or labor checks, although I had had a strange dream about eating a cat (maybe something to do with drawing blood – really weird, I know, but at least I slept well). The last time I had done couch with this student there had been no labor checks or births either. It was nice to have had a relatively good night of sleep (a few phone calls to the clinic that the student answered, but calm other than that) and I felt ready to embrace the day visiting a local birth center, getting tea with the student, visiting the El Paso Museum of Art, and interviewing the staff midwife with whom I had just worked later in the day.
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