La segunda semana/The second week Part II

Coming back to the casita brought me from the extreme of fullness and happiness to loneliness and sadness. I never anticipated living alone would be such a tough experience, but I never have before and was unaware of how important the physical presence and proximity of my support system is. It was hard to come back and not be able to process the day with anyone or share a breakfast with them. It is very difficult to come to a place and part of the country you have never really spent time in before and make roots for yourself alone. Living alone has made me realize just how important the connections I have with my family and friends are and parts of myself that had not been challenged or absent from me before. These feelings lasted for the next few days in between my first and second shifts and I eventually shared them with the Assistant Academic Director at our meeting on Thursday.

I had scheduled a meeting with the Assistant Academic Director so that she could provide me with some feedback on my research and to receive her final permission to get my interviews underway. She was extremely helpful and gave me some advice about useful websites, showed me around the MLL library (a doula and midwife's dream space), and said we could meet once a week to discuss the progress of my research. She also gave me some sound advice about my living situation and told me that she could tell I had never lived alone before. She advised me to come to the birth center more often to write up my fieldnotes and be in the presence of people. She was understanding about how I felt and it was nice to connect with her. It is so easy to do that will all the women at the birth center, though, and it really is an incredible community. I have a break in between the June and July sessions and will visit my family during the last week of June to restore and rejuvenate myself. I had a leftover voucher and used it to buy the ticket - I think it will be an important time for love, reflection, and sleep and will ground and center me before going back in July.

Saturday, June 12

My second shift felt amazingly balanced, steady, and downright great. It was today that I really saw myself potentially becoming a midwife and felt more capable of conducting citas, providing recommendations, filling out paperwork, and feeling integrated into the birth center. I had heard from one of the short-term students and at circle that morning that shifts had been a bit slower the past few days, potentially due to the World Cup, the border shooting that took place a few days ago, and the hot temperatures (the women do so much walking and waiting). Our day was steadily busy, but not overwhelmingly so like Tuesday. I conducted five citas all day (some took longer than others) and really became much better at taking fetal heart tones, blood pressure, and explaining recommendations. My Spanish is still limited in some of these areas, especially when I compare myself to the students who have been there for nine months or longer, but MLL is all about being hands-on, making mistakes, learning from them, and then trying again. It is so nice to feel trust and support from the midwives and other students, and especially from the women who are so patient and gracious when you are trying to explain all that you are doing and finding. I shadowed an initial cita (that was SO much Spanish and I definitely want to build up to that) and was also able to observe portions of my citas I could not do (pap smears, venipuncture, physical exams).

At the end of the day, I was able to make a nice dinner of scrambled eggs and broccoli and talk with one of the staff midwives about the special energy and people at MLL. I was shocked I had time to call Sam and my mom to check in before cleaning up and lying down for awhile. I was doing "couch" (which means you sleep in the sala and get up if there are labor checks or sits) with one of the other students and had trouble falling asleep, worrying I needed to be up and helping. I finally did though and was able to sleep between 4 and 5 hours before being awakened for a birth at 4:58am. I was literally in the room for 3 minutes and the baby was born. I was up to be shadow primary on the birth rotation and stayed with the student and woman for the rest of the time documenting and providing support in whatever way possible. My role as a doula is so different here and it has been difficult not to play a more active role in the births. I enjoy helping in whatever way I can, but I am not really serving as a doula unless a woman requests support (she generally has someone with her). I am learning how you can provide support just by being present, though, and am learning how crucial the third stage (the birth of the placenta is) in terms of blood loss and managing it. I spent the rest of the morning in and out of the room with the primary until it was time for me to leave again.

Overall, my second shift felt natural and right - I am so happy when I am at the birth center and I sometimes can't believe I am here, doing what I'm doing, seeing what I'm seeing, and playing an active role as a short-term student. Despite the pain and hardships, I feel that I am supposed to be here and that I am experiencing a type of education and lifestyle that I have never experienced before. I am grateful for my time here and hope I will be able to feel better and better about the lonely parts each day. Thanks to all of you for making me feel so loved and supported from afar! Until next week :)

La segunda semana/The second week Part I

I hope this post finds everyone happy and healthy! I was waiting to update the blog once I had completed my first two, 24 hour shifts at the birth center. I just finished my second one this morning and am now halfway through the first session of the clinical intensives. I am really enjoying my time at Maternidad. I am extremely happy about all of the hands-on work I am able to do conducting prenatal citas (appointments), assisting at births, shadowing other students/midwives, and getting to know all of the amazing women and families who work and receive care at Maternidad. I am having a hard time with my living situation and am feeling very lonely when I am not at the birth center, however, and this is, unfortunately, affecting my experience, mood, and motivation. I will talk about my shifts, these personal struggles, research updates, and various realizations throughout the rest of the blog. I have included some pictures of a surrounding thunderstorm from a few nights ago (the sky was such amazing shades of pink), my box that I take to all 24-hour shifts (it holds all of my food; all students decorate their own), the rose room of the birth center (which can be divided in half if necessary), and of the casita. I am bringing my camera to most shifts to try and get pictures inside, but the quantity of pictures I can take is really dependent on the number of people in the center and how busy we are. Thank you for all of your continued support - I will be updating the blog again next week with details from my next 24 hour shifts, a class, interview progress, and a response to some questions APPLES (the service-learning program I have worked with all throughout college that has provided me with a portion of my scholarship) has asked regarding our experience.

Tuesday, June 8

I entered my first shift on Tuesday with a mix of nervousness, anticipation, and excitement. While I felt the 12 hour shift had given me a taste of what to expect, I was still nervous about being more on my own, speaking Spanish constantly, and giving off a bad impression of MLL's students to clients. I had gotten to know some of the students working on my shift the week prior during orientation and was excited to share more time with them. Little did I know what kind of day we had in store! The birth center was extremely crowded and constantly busy. I first shadowed a prenatal cita and then did two before eating lunch and going to Birth Talks from 1-4pm (I will explain what that is in a little bit). My Spanish felt a bit garbled trying to accustom myself to new vocabulary words and in conveying information to the clients, but I really enjoyed having the personal time together. And taking blood pressure wasn't nearly as bad as I thought it would be, although I did get a little distracted when someone yelled "car birth" and kept thinking I heard those words throughout the night! All of the staff midwives must check students' citas and we were so busy that the women were having to wait a long time. I had also not gotten into the habit of providing recommendations if something in a woman's cita was awry (protein in the urine, which can lead to a UTI infection; swelling; back pain) and had to revisit the client before the midwife would check my cita. I thought about how patient and resilient the clients are, waiting at la frontera (border) and at MLL to be seen and checked by students and licensed midwives.

I was happy when we made it to the afternoon (I had only been able to eat bits of food and was pretty hungry) and it was time for all of the students to gather together for Birth Talks for three hours. Birth Talks is a class at MLL in which all of the students (from different quarters and levels of study/experience) gather to discuss working in the clinic and recent births. There is a blank white sheet of paper in the staff area/kitchen on which students can write suggestions, comments, or concerns to be shared and addressed at Birth Talks. One of the students reads through all of these, allowing time for others to provide constructive criticism. We began this Birth Talks by dancing to Macy Gray and then getting down to business. The environment was extremely relaxed and open. Everyone had their shoes off, some people were eating, some were sewing. It became especially relaxed when we were taken through a visualization and relaxation exercise by one of the students. We ended with discussions of two recent difficult births from which we could all learn about clinical and emotional techniques to best support clients. I made an announcement at the end about my interview intentions and everyone seemed very interested - one of the students next to me told me she would do one and I have had positive responses from many of the students who are willing to participate.

The latter portion of the day and evening didn't let up. As I was conducting my third cita, I was called to observe a birth and about two hours later after doing my last one for the day (women come all the way up until 8pm for citas), I was called in to document (important for legal purposes) yet another birth. With two rooms occupied and the car birth woman who had left just a few hours before, there was A LOT of laundry to do. I spent a lot of time with another student learning how to do laundry at MLL. They wash everything twice, spray the blood with hydrogen peroxide, put hydrogen peroxide into the first load, and then bleach into the second. With all of the laundry, list (making sure everything is restocked in the entire center), mopping, and dish washing, I wasn't able to go to sleep until 3:30am and I was awakened again at 4:30am to help bleach a room a woman had just left. This is when I really noticed how tired I felt and as I cleaned the room with another student (we had done all the laundry together), she told me that midwifery wasn't a glamorous profession, but that she liked helping women. She put it so simply, but her words truly conveyed the passion and devotion the women who work in this field possess for women and their reproductive health.

After taking out and folding yet another load of laundry, I was able to go back to sleep at 5:30am and woke up at 7am just in time to tidy up the birth center before the next shift came in. My birthing documentation wasn't over yet, though. A woman who had come in for a labor check the night before came in at 7:30am with extremely strong contractions and had her baby by 7:51am. I recorded all that I could bleary-eyed and joined circle (time when everyone holds hands at the beginning of the day and the midwife provides an update on the night before) before gathering up all of my things and heading back to the casita.

La primera semana/The first week

¡Buenas tardes! Good afternoon! I just finished my first week of orientation at the birth center and feel saturated with so much amazing information. In this week, I have learned the condensed version of what students learn in their first three weeks of orientation at Maternidad. I will describe a bit of what I learned and experienced each day along with some pictures I took of the school, birth center, and a local mercado (marketplace) we went to today.

On Monday, the Assistant Academic Director provided us with the history of MLL and midwifery in Texas. The vision of MLL has always been to be accessible and affordable to both students and clients and it is the only school in the country that has a birth center a house away for students to do their clinical training. We also got a tour of the clinic and learned about infection control and the different clinical items in each of the rooms. Judith gave us our clinical schedules and shifts (when we will be in the clinic) and told us we would be allowed to conduct citas (prenatal appointments), initial appointments (getting a woman's medical history when she first comes to MLL), and attend births as documenters, go-fers, and shadowers (I will explain what those mean in a bit - we learned that on Wednesday). Judith also gave us prenatal and postpartum books in English and Spanish that were made at MLL and we will use during citas to provide recommendations and informational support.

On Tuesday, we were with one of the staff midwives for the entire day. She taught us how to conduct a prenatal cita, including how to take vital signs and make recommendations depending on what a woman is experiencing. We learned how to check blood pressure, pulse, respirations, a urine sample for glucose and protein, weight, height temperature, and the belly for position, size, and gestational age. We spent a long time practicing these skills on one another and going to the clinic to try then out on all of the patient midwives and students! We were back and forth a lot between the school and birth center this week and MLL places a huge importance on making learning truly hands-on, which is crucial with the sort of skills we are learning. At the end of the day, we practiced citas in English and Spanish together and learned all about assessing a baby's position and size and how to listen to fetal heart tones. The midwife who taught us Tuesday is currently pregnant and graciously allowed us to practice on her belly. I am a bit nervous about conducting my first cita next week because there is so much to remember and taking blood pressure is really tough, but the staff midwives fortunately check all students' assessments once they are finished.

We spent Wednesday learning all about birth at MLL and the roles that we will be playing at births. We spent the day with two students who have been at Maternidad for 9 months. I felt so fortunate to meet many of the women with whom I will be working during my 24 hour shifts this week. It is an amazingly patient, gentle, calm, open, kind, and passionate group of women and they provide incredible care. It is evident that they are truly present for all of the citas, births, and all that happens in between. While at MLL, the other short-term students and I will be documenters, go-fers, or shadowers at births. The documenter documents everything that happens from the pushing stage until the baby is born. The go-fer is available to run around the birth center and get anything that the student or licensed midwife may need during the birth. As shadow primary or shadow assist, we are able to either shadow and help the primary (responsible for the mother's care) or the assist (responsible for the baby's care). If a woman desires a doula for labor support, we are also able to play that role for her. We are essentially observers at the births and our level of involvement depends on which role we are rotated through. Today felt a lot like my doula training and was my favorite day of the week. We spent the afternoon with another student who is from Canada and reviewed the stages of labor, labor support positions, and different items within one of the birthing rooms again. All of this reinforcement is so helpful!

On Thursday, I did a twelve-hour shift in the clinic from 8am-8pm. This is only half of what my days will be like and I was so exhausted! I saw my first natural, non-medicated birth and it was incredible. The familial support was sensational and I felt very fortunate to witness my fourth birth. I knew that it would be a special experience witnessing birth in such a different setting and it was both emotional and empowering. I was shadow primary, which means I spent the entire active stage of labor, pushing, and postpartum with the student midwife who served as primary. Once the woman was pushing and the student midwife was set to catch the baby, I became the documenter, documenting the birth time, calling out when to take the 1 and 5 minute Apgar scores, the birth of the placenta, and other important information. I was able to see the entire process through, get to know the family, see and learn about the placenta, see how often the woman and baby are checked on throughout the day, the newborn screening, and the pile of paperwork involved with a birth (and just in general). This was my main role the entire day, so I did not see any citas. I was thankful to be a part of this birth, though, and it was a good first day bringing together all of the skills we have been absorbing.

Today, we focused on learning how to conduct an initial cita. It is a lot longer than a prenatal cita and requires a lot more time from both the student/midwife and client. It can last anywhere between 2-4 hours and allows the midwife/student and client to discuss her entire medical history. We practiced calculating estimated delivery dates and learned how to check for hemoglobin. We were pricking and practicing on one another all over again! In the afternoon, we headed over to Mercado Mayapan, which is a market run entirely by women, many of whom are former maquiladora (factory) workers. Every month, a different state within Mexico is represented and this month it is San Luis Potosí. I ate tostadas con pollo (chicken) and had a licuado (smoothie) con plátanos, fresas y leche (with bananas, strawberries, and milk). The focus of this afternoon was to learn more about the clients at MLL and the issues that they face living on and negotiating their identities along the border. One of the midwifery students who considers herself Mexican and Chicana and has lived in El Paso her entire life discussed the Mexican value of family, but also said we would be meeting a diverse array of clients from many states within Mexico. She emphasized how strong the women are that come to MLL and told us to not feel sorry or hopeless about the challenges they face living in Juárez.

She told us how the clients negotiate their identities (Mexican, American, Chican@, Hispanic, Spanish), languages, traditions, superstitions, and the ambiguity of living on la frontera (the border). Speaking from her own perspective, she reminded me of the course I took last semester on Chican@ and Native American literature and how fortunate I am to be able to listen to and interact with many women in the El Paso-Juárez area. I bought a blanket and camisa (top) from Mexico and am excited to return to this fantastic market alone and with my Dad when he comes later in the summer.

This weekend, I have A LOT of catching up to do writing my fieldnotes, practicing citas in Spanish, doing laundry, and confirming my interview intentions with the Assistant Academic Director. I am meeting up with a woman tomorrow from Juárez who spoke at UNC last semester and will go to a potluck at one of the midwives' houses on Sunday. It can be lonely at times, but I am feeling better getting into the routine of life here and getting to know the city, too. We are supposed to reach triple digits temperatures this weekend though! I will be back in the birth center on Tuesday for my first 24-hour shift so check back for details about that next week!