La sexta semana/The sixth week Part II

I finished the initial around 1:30 and hurried over to Birth Talks since I had missed the last one. Two of the students were presenting today and I felt bad going back and forth to check on my boiling water for macaroni and cheese and missing a lot of the first student's presentation. She was discussing Aztec and Mexican traditions in relation to fertility, pregnancy, and birth and discussed temascales, which are sweat lodges that women use during their pregnancy and for fertility purposes. The second student (both of the students presenting were fourth quarter students, which means they have been here for nine months) presented an article that was written by a controversial midwife who has gone to jail who believes that tactos (dilation checks) are unnecessary and that midwives should pay more attention to the external signs of labor and impending birth. This led into an interesting discussion among students regarding the necessity of tactos (and telling women how many cm they are dilated), clocks in the rooms, and whether labor support is helpful or disruptive in a woman finding herself and her way through labor and childbirth. While I believe (and another student expressed this verbally) that every woman's needs and desires are different during labor and birth and that midwives and doulas must mold to those rather than their own expectations and beliefs, it is an interesting thought to ponder and the Director of the center and school commented that this time period (when the students have been here for 6-9 months) is a special one during which students feel more comfortable questioning protocols, approaching birth in different ways, and expressing and putting their beliefs into action.

When I returned to the clinic, I was disappointed to find that a woman I had done two citas with (pretty rare at MLL since you work on so many different days) had been transported to the hospital for either a kidney or UTI infection. One of the staff midwives had come in during Birth Talks saying a student needed to accompany the woman to the hospital and I felt I had a special connection with the client. I especially wished I had gone when I discussed how the transport went with the student who had gone and she said she had felt she couldn't offer much to the woman because she had not done any citas with her and she was quiet. I discovered on my next shift she had been given antibiotics for a UTI and that she had not been in pre-term labor at 34 weeks. This was yet another instance during which I missed having continuity of care with clients and being able to see the same woman over and over again and develop a deep, open relationship with her. She was definitely on my mind, because I had a dream about her that night at the clinic and in it, she told me she did not have an infection and was alright. At least I got that she was alright out of it!

I've returned from doing laundry now (big downpour on my way back!) and my plans for the afternoon have changed a bit because it turns out the mariachis are not playing this afternoon and that Mercado Mayapan is closed. I called MM and the housekeeper from Maternidad and she confirmed that a friend told her it was closed. We've decided to try for another Sunday in July and are going to get a meal there Tuesday afternoon. She also sounded enthusiastic about doing an interview with me and it will be great to have her perspective of work at MLL since she does so much of the cleaning that I always talk about all day long.

Back to Tuesday...A few more citas trickled in as the afternoon went on and I shadowed a postpartum cita with one of the students with whom I spend a lot of time. The Assistant Academic Director is going to teach me how to to PP citas, but since I've just gotten back, she hasn't had the chance to yet. I thought I would shadow one in the meantime just to understand the flow of it. This woman was coming for her 12-day PP cita and it seemed like she was doing very well. Her entire family came with her (her husband and five-year old son) and it made me think about how coming to MLL is always a family event; the majority of women come with their husbands/boyfriends/partners, one or more of their children, an in-law, or a friend and it is comforting to witness that level of familial support. Yet again, the learning we had done in the classroom really complemented this PP cita because just the day before we had learned about what to go over in PP citas. The students have already been doing them for a long time (so for them, it was probably a bit repetitive), but it really helped me feel ready to shadow and conduct them on my own. I helped with some interpreting (the woman was asking about the paternity acknowledgment and birth certificate) and took her vitals after we discussed her birthing experience. The funniest thing that happened during this cita was that just a few seconds after she removed her son's diaper, he started peeing everywhere! This reminded me of all the times my mom and aunt had told me about this happening with cousins when I was little and I we were all laughing so hard together. It was a really genuine moment; she kept saying Disculpe!/Excuse me! but I told her it was the best part of my day.

Once she left, it was time to do list, make dinner, and get ready for bed. I am trying to learn how to check more rooms of the birth center than my favorite, the rose room, and so I helped clean and restock the front cita area with one of the other students. I made a steak for dinner (surprise, surprise) with broccoli and enjoyed sitting at the midwives' table and chatting with everyone. It felt extremely relaxed and I was starting to think we wouldn't have any births in the evening/early morning. After talking to Sam and my mom a lot longer than I usually do, I got ready for bed and was doing couch by 10pm. The other student who asked if I would do it with her soon after she finished a chart review and we talked for awhile before drifting off to sleep. I could barely believe it when it was light outside but we had slept for 6-7 hours! There had been no births or labor checks, which was the first time that had happened on one of my shifts. We cleaned up around the clinic for the incoming shift and appreciated the many hours of sleep we had been able to get. They would come in handy for the shift on Friday!

Friday, July 9

The way I have been describing Friday in my fieldnotes and to those with whom I have processed it is that it was a strangely configured day, with barely any citas all day and then a crazy twelve hours between 5pm and 5am. Today was also the first day in the clinic that truly felt like 24 hours and it was long. In the morning, we all sat in the sala together chatting, which is a rare sight in the clinic! One woman came in just to have her PG (plasma glucose) test done and blood drawn and I had only two citas all day long. My first cita was with a first timer who was 36 weeks pregnant. She was so patient with me when I checked her hemoglobin - I had to prick her finger twice because the test strip will not give you an accurate reading if there's not enough blood and because it was out of range, the midwife had to check it again. She didn't even flinch, though, and said it really didn't bother her. She's the first woman who's told me that! We reviewed the signs and symptoms of labor since she was technically in dates to give birth now (even though a baby born before 37 weeks is considered premature under Texas laws) and I was excited to find strong fetal heart tones right away. The other prenatal cita I did was for a woman who was a third timer and had given birth at MLL twice before in the rose room. She had just had her initial a week ago and during the cita after that, there is always a lot to do. All of her family had come with her - her husband, her fifteen year old son, and her five year old son, and her five-year old really wanted to be with us the whole time. I couldn't understand why he kept laughing during the cita, but she said it was because of nervios (nerves). He seemed to calm down once I weighed him after weighing his mom and felt included :-) During this cita, I realized that despite the fact that I cannot do pap smears or physical exams, I was becoming more and more able to operate independently during citas and that my comfort level with reviewing necessary information, conducting the cita, and just conversing with the woman was getting better and better with every cita I did.

Lunchtime and the afternoon were extremely calm and I had time to sit down to lunch before washing a lot of dishes. A woman came in for a labor check around 12:50pm and she had just had her initial cita with us yesterday, which meant we had not received any information from the lab regarding her bloodwork. The staff midwife was a bit distressed about this because she said if a woman has problems that we do not yet know about, it can potentially be bad for her license, the students, and the clinic knowing so little about the woman's medical history and any conditions she has. There was another woman in labor in the purple room and I was up to be shadow assist for that birth and shadow primary for this one. I was excited to learn that she wanted to have a water birth and helped one of the students prepare the peach room for her. The rest of July 9 is continued on Part III; I never said I was concise, especially on busy days :-)