Posting from Colorado

I can't believe it has taken me so long to post! You would think being away from the clinic would have opened up a heap of free time for me. However, it seems just getting back into the normal routine of life and catching up from my time away is very time consuming. I feel as though I left everyone hanging when I left Bali. Matt arrived in Bali while I was attending a birth that ended in a transport to the hospital....and a beautiful cesarean birth.
I realize the true meaning of "cesarean birth" now rather than "cesarean section". When the circumstances change and we have to shift our birth plan we have to make the current situation the best we possibly can. We should mourn the loss of a vaginal birth, but at the same time we should try to lessen the trauma of the surgery as much as possible. We need to adapt to our new found situation by insuring that breastfeeding begins as soon as possible, getting baby and mama together so that bonding can begin right away, managing pain well and getting the mama comfortable, insuring that she has good information about what to expect from the healing process, and that she is supported in her joy and sadness. It is so important for her to know that she didn't fail...we just had to change course. I can honestly say that all of the births I managed where a cesarean became necessary, the surgery was truly necessary. I noticed a few births at the clinic where the mother was coached into pushing way too early, before she had a natural urge to push, which caused problems such as poor position of the baby.
I was honored to be able to attend the c-section of my patient pictured here, the doctor allowed me in to observe and take pictures of the birth. The mama, named Ati, was one of the most wonderful women I had the pleasure of working with. I have pictures of her cesarean birth, however I don't want to post them because it may be too much for some of you. However, I do have this picture of her breastfeeding right after the surgery. I got to bring the baby back into the surgery room right after the nurse assessed him and got him bundled up. Ati and I both had tears in our eyes when I brought her little dude right up to her face. She smothered him in kisses and we got to spend a little time just adoring him while she was stitched back up. It is really tough for the mama to not be able to see the baby right after a cesarean birth, but papa was waiting for him to arrive in the other room. The doctor actually chose me to attend the surgery instead of the father, which was a little strange at first, but after I spoke with the father we agreed that he wouldn't have wanted to see the surgery, it would have been too disturbing for him. Instead he welcomed his baby in the other room and was there for him when he was being "tortured" by the nurse:)

Now, I have to change gears a little bit to show you what I got to return home to! Here is my client Sabrina and her daughter Natalie. I am acting as her doula during her homebirth with another midwife. This is Sabrina's 3rd baby, and I will have attended all three...how lucky am I? Little Natalie was a footling breech born at home with no complications! Her first, a son Lucas, was a beautiful homebirth too. Number three is supposedly a boy, according to ultrasound, and his name is Liam...one of my favorite names for a boy. It just happens to be the Scottish (or Irish?) version of William, which is my father's name. Sabrina is from a great big family that is so supportive and loving, I am so lucky to have clients like these!!! I just wanted to give you all a little glimpse into my home life as now I think I have some readers from elsewhere in the world. One of my goals is to get more of my clients to post their own birth stories and photos, a work in progress.
Now, back to the conclusion of Bumi Sehat Clinic...I left Bali a little bit numb. Maybe I was preparing myself for the transition by detaching and putting my head down to forge ahead. When I arrived back home I had a serious case of, "Now What?" Life was so rich and engrossing at the clinic, I felt such a strong sense of purpose in what I was doing. That hectic pace had forced me into a beautiful place, where I was very focused and confident. Here at home I felt uncertain and bored...then the phone call came on Mother's Day! It was Bill, my mentor and my fellow midwife calling to ask me to rush over to a woman in labor. He needed me to attend to his client who was 45 minutes away from me and almost 3 hours away from him. He needed me to back him up. I drove as fast as I could to arrive at the home of Candace and Rusty, Candace had given birth to a beautiful baby girl just 10 minutes before I arrived. Quickly, I was back in my element..."oh, yeah, that's what I do!" Identity crisis solved, I was back in the game. I helped get everyone get settled and performed the immediate postpartum care for the mother/baby. What a great Mother's Day! Fortunately, it was a great birth to occur unattended...there were no complications. Everyone was a bit shaky when I arrived, but other than that, everything was great! I had attended this couples first birth several years before with Bill, so it was nice to reconnect with this family. Here is a picture of the family...sorry it is a little out of focus.


I am going to sign off for now. I realized that when I was at the clinic blogging was my social life. It was the only thing I did other than work, sleep and eat. Here at home there are so many distractions, relationships, projects, work and play...I have lost touch with the blog! I realize it was such a valuable sounding board for me, it allowed me to debrief to all of you and helped me process everything that was happening. Thank you all for listening...it means so much to me. Keep reading!!! More birth stories to come.

Maybe my last birth?

Let me ask you...how would you feel about these women staring at your crotch all night? This picture is taken from the mother's perspective one night toward the end of a very long birth that ended in a transport to the hospital where Dr. Widegama performed a successful vacuum assisted delivery. Hooray...no cesarean! The cesarean tends to be the solution for most transports around here. In the states, women have the luxury of maybe receiving an epidural and inducing labor, among other possibilities depending on the circumstances. But here they don't use pain medication so loosely. It is only implemented when a cesarean is in sight. Ibu Ketut is on the far left, Joe is next, then Ibu Robin in the foreground in pink and Kadek on the right. Robin was falling asleep sitting up and the rest of us had been up all night. We usually only call Robin at night for special circumstances, in this case the mama was just stuck at 8cm! We had a tough go of it, and of course, so did the mama. We had run out of ideas and now it was time to make the call. So we transported. The head was so low it was really frustrating to not have her dilate all the way. But in the end the Dr. just pulled the baby's head right past the rest of the cervix. She just couldn't push past it herself, which normally you don't push past an un-dilated cervix at all... weird and interesting. At one point during this birth the mama was on a birth stool and Robin set up camp below her crotch, resting her head on a pillow and falling asleep below the mama. Just staring up, hoping for some sign of change and descent. It was a tough one!


Here it is May 3 and I am awaiting the arrival of Matt who should be here in about an hour. We have 2 mamas in labor, one who has been here almost 24 hours with a very tricky labor, but now we seem to be making some progress and another who is having her second baby. Ati, the first one I mentioned may be my last birth here. My enthusiasm is waining dramatically, I can say I may just be officially burnt out. (Can you tell I really don't want to admit it.) But of course, I have see this last one through. I have been with them all night and we have a really nice connection. What a luxury when the mama speaks English.
I have to tell you all that my departure is bittersweet. This has truly been an incredible experience and I feel as though I have done so much good, learned so much and fine tuned my practice...however, I feel as though it took me 3 weeks just to hit my stride and then, the time quickly vanished. I am now comfortable with the methods of practice, I understand more of the culture, I have an excellent rapport with the other midwives, I am beginning to understand the quirky nature of Robin, the director, but now...I have to say goodbye. I guess I have just made a good case for a longer stay for a trip of this sort. The course I set for myself was not sustainable for a long period of time though. I basically attended every birth I possibly could. The clinic did 74 births in April and I reached 62 births in 5 weeks. About 6 of those were transported to the hospital. Pretty good stats though. I believe I was in attendance for every birth that was transported, so 6 out of 74 were transported.
I think I will sign off for now. Getting a bit busy here...love to all.

A little crispy...but not quite burnt!

The title of this post describes me...a little crispy, but not quite burnt! I did another 48 hour stint at the clinic so last night I had to get home to sleep. It was so hard to pull away with 4 mamas in labor at about 8pm last night. My right lower back was so tweaked from hunching over 2 difficult perineal repairs yesterday, it is a little sad to be sore from doing births! My exercise has been squatting with the mamas to show them what to do or to get down on their level, holding mamas up and bending over tubs. Not exactly the same as a hike or trip to the gym. I was more emotionally drained than physically tired last night. We have had quite a few transports and some difficult births that have really been testing me. I am looking forward to just sitting down with Matt and some friends and just debriefing on everything I have experienced here. I don't have time to process the intense moments because I am just on to the next thing immediately. Speaking of the hospital, here is a pic of the nurses at the maternity ward desk...I couldn't really get any good pics of the hospital, regretfully.

Today I will go do a home visit on a couple who just had their baby 2 days ago. We resuscitated their baby and usually first time parents stay 2 nights, repeat parents only stay one. The father wanted to be released because it was a special ceremony night the next night so he convinced the local midwives to let him go early. Not such a big deal if the baby hadn't been resuscitated! He needed to be observed. We called them and checked on them and they are doing fine, however I will go with my friend and co-worker Ayu who will translate for me to check on the mama/baby. We had a pretty intense night the other night with this resuscitation. It was a strange course of events and I think it would be educational to hear about for many of you. This mama came to us in very light labor saying that her water had broken. A few hours later, no real changes. The protocol here is that the mama needs to be in active labor 12 hours (preferably she would give birth by the 12 hr mark) after rupture or, left to the local midwives, she will be taken to the hospital. So, she hung out all afternoon, still nothing. One of the local midwives checked her again, her membranes were in tact! Her water had not broken, great! At this point her labor was virtually non-existent. I thought, let her sleep here and if nothing is happening in the a.m. we will send her home. Her due date was in 3 weeks so it may not even be time yet! But no, for some reason, the local midwives and Robin gave her castor oil to get her labor going that morning and burned moxabustion over points on her feet. Moxa is a chinese herb that is burned over certain accupuncture points in order to get certain results, in this case it was to stimulate labor. So there I was, not quite sure why we were trying so hard to get labor going, but I went along with their call. She was in light labor and then I think the castor oil kicked in in the afternoon, she was making frequent trips to the potty to poop (a normal result of castor oil) and contractions were light but consistent. In a couple more hours something shifted and she was pretty much getting solid contractions with very little break in between. The uterus needs to be in a good pattern of contract/relax in order to keep the baby from getting overworked from constant contractions. Also, constant contractions are very exhausting for the mom. The baby began to stress, we had some very low decelerations in the baby's heart rate so we put the mama on oxygen. That seemed to help temporarily, but the decels came back. Fortunately, the baby was about to be born. Anticipating a problem I readied the resuscitation equipment. I believe the stress resulted from an "overdose" of castor oil that created an overactive labor that was too stressful for the baby. Good lesson: even natural methods of induction can be too hard on the baby. In addition the mom passed out during labor...that's right, just decided to go out cold for no apparent reason. She wasn't even exhausted or dehydrated. A passed out mom who was low b.p., low respirations and low pulse means insufficient blood flow for the baby, another cause of stress.
Side Note: I have never seen women go so far away from their bodies in labor until I came here.
The women here get really spacey and lethargic during labor. It is very hard to get them to walk or change positions during labor, they want to lie down the whole time. Lying down during labor makes labor longer and is bad for circulation for mama and baby. Also, we don't get gravity to help us out! When a mama doesn't move, neither does the baby and this can result in a poor position or presenting part for the baby.
Am I boring you yet? To try to wrap it up here...the baby couldn't clear the fluid from his own lungs so we suctioned and assisted respirations and now all is well. I got to visit the family in their home today and I am happy to say that everyone is doing well! Here is a picture of my visit

I know the family really looks thrilled:) but they never smile for pics here. Maybe that goes without saying, cameras are a pretty expensive luxury.










Here is a lovely picture of some of the offerings that are made for ceremony, and ceremony happens a lot here. I include this picture here because the above family took their newborn baby out of clinic care in order to have the mama/baby pair at home for this particular ceremony day. They are a particularly devout young couple. "It just wouldn't be right", he said, about not having the mama/baby home.


I thought this was a really nice pic of the placenta and how we treat it. I think I mentioned that we wait to cut the cord until 3 hours postpartum and cover it in flowers as soon as it is born. A nice tradition don't you think? One papa last night wanted to make sure he could take the placenta home for ceremony. Of course, we said. Apparently, the placenta is placed on a certain side of the family compound according to whether the baby is a girl or a boy, burned and buried with a pencil (so that the baby will be clever) and a few other things I can't remember:)
That is all for now...too tired. Need to go lie down now, I am on call tonight here at the clinic. Only one mama here, so maybe it will be quiet? Only about 2 more days here! See you all soon...

Placenta Post-Graphic!

Sorry for the graphic post, but I had to include this incredible placenta. Check out the vessels on this thing! Now that is one healthy placenta. I know most of you don't have other images of placentas in your mind to compare this too, but trust me. These vessels are so plump, all the better to transport oxygenated blood. This placenta came with a great big juicy cord, the biggest I think I have seen here, or maybe ever. That picture is available upon request because it includes a very graphic post-birth yoni picture:) Had to include this...Selamat Sore! Good Afternoon!

More fun with midwifery...

Hello again...I always know that when I sit down to blog that we will get busy. I was right. We now have 2 mamas "on deck". Two first time mamas. The first was here all night, just sleeping mostly, with very light contractions. We gave her castor oil to get things going and now she seems to be having stronger contractions. The other mama was here last night for her regular exam. I did the exam, so it was cool she came in today while I was here. Now, we wait.
I wanted to show you this picture of a family waiting for their turn at prenatal clinic. I love her belly in the foreground. We saw 40 women last night in just over 2 hours. Rockin!
One pet project of mine has been to train the untrained birth assistants that are here. As I may have mentioned, there is really no structure for education. Technically, it is not a training facility. And yet, the clinic asks for untrained people to volunteer. This is a shame in my eyes for volunteers to be here without getting the least bit of basic childbirth education...so, of course, that is where I come in. Megan and Emily are participating in an "internship" that has turned out to be very unstructured and without a real preceptor. I am trying to get them more involved and educated. It is a shame to be attending births and not even understand some of the basics. So, Emily did her first vaginal exam today. She was so excited, and she did really well. She was dead on, the mama was at 2cm and slightly effaced...and she called it! We have been spending a little time most days just talking about birth, I answer questions, demonstrate things, etc. It has been great to offer this because now they are getting so much more out of their time here.
Up next...pics of the pediatric clinic. Here is Yvette, she is a massage therapist that does infant massage. She is massaging Komang, a sweet little dude who is almost 4 years old, believe it or not. He was born without event and then around 3 months, something seemed wrong. His muscles began to atrophy and his growth slowed dramatically. He can't speak, his head has flattened from spending so much time on his back, he can't crawl. He can only eat softened foods. He doesn't seem to have any very serious health issues otherwise. He is mentally disabled. It was so wonderful to watch him be massaged. The first thing he did was urinate because he got so relaxed. He made beautiful eye contact with Yvette and seemed positively stimulated by the massage. She also did some therapeutic exercises with his arms and legs and taught the mother how to do them herself at home. He needs to be massaged, exercised and stimulated because he is incapable of normal movements that develop the muscles, strengthen the bones and encourage blood flow.

I had such a great morning working in the pediatric clinic. We had lots of babies come in with miscellaneous, minor problems. Some conjunctivitis, a small fatty cyst on a penis, colds, flus and fevers. Here is a little cutey patooty (below)...This is a chunky little breastfed baby. Most of the mamas breastfeed for at least a year, often for 2 years! In the hospital the doctors get $20 US from the formula company for each mama they successfully convince to formula feed! Can you believe it? They also tell anyone who has had a cesarean that they should not breastfeed because they have had a surgery...this is horrendous! I may have mentioned this before because it is so crazy. This little one stole my heart. She loved her massage. She just had a stuffy nose, so we gave her some herbs and a massage and off she went. We sent 4 kiddos to the hospital for problems that were above and beyond our natural ways. One little guy who had jaundice ended up having Hepatitis B...poor guy! We are hoping he gets good treatment. One mama came in with her 2 year old and here new baby that was born a month ago with me! It was great to see her again and she was doing really well. Her 2 year old was the one with the fatty cyst on his penis. Poor little dude! I tell you what, there are few things more difficult than trying to get an ornery 2 year old to show his penis to perfect strangers!


















Just wanted to show you all this funny picture of me...Amazon Woman and my friend Ayu who works here at the office at the clinic. She had just returned from a funeral so she was in her temple garb that looks so pretty. Isn't she gorgeous?! It is so strange here because much of the female population here wants to lighten their skin. Skin lightening creams are heavily marketed on television. They are envious of my skin and tell me that my skin is so beautiful. Ironic isn't it? White women all want to go to the beach and get a suntan, go to tanning beds and put on tanning creams to look darker! No one is ever happy with how Mother Nature made them. Ayu isn't really one of those women. She seems comfortable in her own skin. Ayu is the aunt of the woman who had the VBAC here where we had to resuscitate the baby and was present at the birth. That was very traumatic for her. It was great that days alter, one of her cousins came in to have her baby. That second birth was a beautiful, uneventful, waterbirth which was very healing for Ayu. I have a soft spot in my heart for Ayu because we shared a very intense and troubling birth, that fortunately turned out well. I think we both feel healed now. Time to go now...love to all!

Just Checking In

Hi everyone,
Just thought I would take this opportunity to check in with you. My time here is running short and I find myself in an introspective mood. What have I learned here? What have I accomplished? What could I have done better? What is next? The clinic is very quiet right now, in fact, it is empty! All the mamas have gone home. We had no births yesterday and none so far yet today. It feels nice to clear the energy of the place. It is very intense for us as care providers to be around all of this birth all of the time. Even the actual space of the clinic seems to get bogged down by all of the emotions and activity. Now we have room for new birthing energies! I will be leaving here in about 5 days. I can't believe it! I have such a beautiful life at home, wonderful clients and incredible work...I am looking forward to returning to all of that. But there is also a big part of me that wishes I could invest more of my time and energy here. I am already thinking about the next trip I will take. I would like to go serve in a Spanish speaking country, as one of my primary goals is to develop Spanish as my second language. This trip has reminded me of the definition of "midwife", it means to be "with woman". I have certainly been with woman. In so many ways. I snuggled babies and waited anxiously at a mama's feet. I have wiped poop from a woman's bottom and cried with her when her baby died. I pat the father on the back and breathe with the mama during labor, one contraction at a time, breath for breath until the baby is born. I have sat down to dinner with a blood clot stuck to my leg and not cared one bit, I was too hungry and tired. My legs have gone numb and my back got sore after crouching over a mama's torn perineum, diligently suturing until she is back together. There is a part of me that wants to return home and just open a free clinic. Let all the women know that they can come to me anytime, for any donation and I will help. There is a part of me that sees here that if you just serve, everything else will fall into place.
When I first arrived there was a lot to process, there was so much to get used to and so many intense births. Now I find myself longing for that intensity. In a sense I can't believe I was actually overwhelmed, I have developed a new hardened self that can handle more now. An interesting develpment to experience. I have always known that I was cool in emergencies, but this trip has been a real test to that coolness. In a recent birth where I was the primary midwife we had a serious shoulder dystocia in the water followed by the resuscitation of the baby. It was a pretty intense birth but there was this inner voice observing and commenting on my actions. A very intentional and collected voice that was so reassuring. I am pleased to recognize that instinctual part of myself, which is so reassuring when you are in this work! My assistant later said that as things were happening and she was getting stressed she realized I was actually staying "positive" and that reassured her. I recall asking her to hand me things in a positive tone, not a fearful one. I guess that is a big reason why I came...to develop my "emergency self" to learn to maintain a degree of calm thourghout emergency where the entire birth team, including the parents, remains grounded so that I can continue my work in a good environment. I hadn't thought about it before...but it is kind of like making sure the scene is safe when you enter an emergency scene. You can't work in an environment that is in chaos and you can't help anyone else if you yourself become a victim.
I am really just writing all of this to process what I am feeling. I deserve very little praise. If you saw how things are here you would realize that I am not the one that deserves the praise. Really it is the women themselves that deserve the praise. To allow a white woman who they have never met before to catch their baby. To allow me to examine them, to suture them, or walk away with their baby. They are so trusting and open and that is to be admired. This was a great warm up to more challenging missions, which of course I want to take (Sorry, Mom!). This has been, "Medical Mission Light" as we like to call it here, but I wouldn't have missed it for the world. It is very politically complicated here and is neither overwhelmingly busy, understaffed or understocked. We are 10 minutes from a hoispital and have plenty of help. There is very little structure for volunteers and very little definition of the boundaries or expectations. I was told to just jump in. Births can get chaotic, with several midwives trying to direct the show. The births can become a sort of "show" with the mama as the star attraction. I have really worked on modeling how to hold a sacred space for the mama, which has been a challenge. It took some time to earn the respect of the other midwives, but once I proved myself, things fell into place.
Thanks for letting me journal all of this...I really want to get as many of my feelings down so that I can have a record. This blog is really my only recreational exercise, my social life if you will. Love to all...

Adu! Sakit! Long Post

I thought I would fill everyone in on some of the subtleties of life around here. The title of my post is "Adu! Sakit!"...so I should explain. Adu means "ouch" or "oh my goodness". It is not uncommon to go through a labor and hear "adu" 200,000 times! Women here also feel a very strong urge to tell us that they are in pain..."sakit" means pain, in this case, contraction. The answer to every question is "sakit". "Adu, sakit" is pretty much all you hear from many of the women, the entire labor. These women are so strong! However, there is an interesting dynamic here. Despite their strength, the women here don't usually believe they are strong and often are convinced by their husbands that they are not strong. Women like to be catered to and adored and the men know this, but rarely are they actually adored. Public displays of affection are non-existent. Many of the first time mothers here have had sex once, gotten pregnant and then (because sex during pregnancy is taboo) not had sex again since. The guys are either very involved and catering to their every need during labor, or the guy is not around at all. Many of the guys hang back until labor gets really hard and then they are there through the end. Usually first time dads stay with the mom through the entire labor. I hate hearing the men say that their women are not strong because it is so untrue. However, the ladies do seem to enjoy playing up the "whoa is me" aspect of birth. I think this is because they don't get enough adoration on a daily basis, so now, in labor, this is a good opportunity to get everything they need!!!

Well, this blog is up to the minute, I tell you what! I just returned from a birth, just this moment! Another teenager, 17, who just spit the baby right out! She had only been here two hours while quickly dilating from 3cm to complete with about a 5 minute pushing phase! I am telling you ladies out there who are thirty-somethings (me included)...we missed our calling. Who says teen pregnancy is a bad thing?! From what I have seen it pretty much guarantees a quick and slippery birth and often with no tearing because the mama is so young the poor nutrition habits and toxicity of old age haven't caught up with her yet. The family is very happy. We often don't see the mama smile at all during labor, unlike in America, until the baby is born...then, she beams!

The above picture is of a first time mom I had the pleasure of helping. This baby was another nuchal arm baby! A nuchal arm is when the baby is born with its hand up by its head or neck. So, it only makes sense that more baby parts in addition to the head makes birth a little harder. In comparison, when the umbilical cord is around the neck it is called a nuchal cord. We seem to be having a run on nuchal arms lately. Things certainly do occur here in groups. We have also been having a stream of first time moms transported for "failure to progress". Really, it is very unusual for a woman to just stop dilating for no reason. It seems as though a poor head presentation is almost always to blame. Recently, we have had several first time moms whose baby's heads were extended rather than flexed, which is not a position conducive to birth. I have never seen so many women get "stuck" at more than 7cm for so long. These situations have required me to do a lot of vaginal exams to try to determine the baby's head position and troubleshoot the best course of action. So I have gotten a lot of practice determining suture lines, the lines where the bony plates of the baby's head meet. If a midwife can determine the position of the baby early in labor or when a problem arises then she can potentially solve the problem.

Here is the promised picture of the super tanker baby Antonio. This was the most interesting labor I have ever attended. This was an attempted homebirth that ended in a cesarean birth. This couple did such a great job! This picture doesn't do the baby justice, he is huge...4.5 kilos, 10lbs. Combine a 10lb baby with a really long labor, a rather flat pelvis and maternal exhaustion, and, well... For a first time, Asian mom this is a big deal! Check out her husband...he is 6ft and I am guessing over 250lbs.

Here I am doing fundal height measurements at our prenatal clinic that meets from 5-7pm on Sat, Tues, Thurs. Yesterday, prenatal clinic was nutso because we were a little short handed, we had 2 ibus in labor and we had all had a very busy few days, so we were dragging. We had two ibus that were more than 7cm dilation so I had to stay close. So I hung with the ladies while clinic happened. Of course, it was really busy because all of the pregnant mamas had skipped clinic 2 weeks ago because of full moon ceremony. I think we saw over 30 women in 3 hours, usually it just takes about 2 hours for the same amount.
That evening one of the babies born was born "in the caul". I think I explained this before? That is when the baby is born in the amniotic sac. It was a beautiful quiet, gentle birth by a mama who I could barely tell was in labor half the time. She seemed a little crampy most of the time and only got visibly uncomfortable during the last couple hours, this was her second baby. The first had apparently been a 3 hour labor! When she pushed, it kind of looked like she was just pushing out a little poop:) She didn't have to work hard at all. But there was the baby...hiding its head behind a bulging sac of water. In fact, a big fluid filled bubble the size of a softball was born before the head. The sac looked like a snow globe, you know the kind you shake so that it will snow inside the globe. Little sparkling specks of vernix (a cheesy white coating on the baby that protects her from the watery environment) were floating around in the sac as the contraction pressurized the water behind the sac and made it swirl. Beautiful! And auspicious.
This is a great representation of the birth rooms. This is the first time mama I am holding hands with in the above picture. The two birth rooms have these bamboo ladders in them and each has a birth tub. Each birth room can accommodate two women. When we get really busy we can do births in one of several other rooms, but not preferably. The ladders are really useful for support during squatting and for propping up a leg in a lunge. Most of the women like to just lie down during their labor. We really have to work to rally them to get up and be active. As you may know, being upright, changing position often, eating, drinking and urinating regularly are all very important to keep a labor functional and progressing. So a lot of what we do is encourage the mom to do all of these things. The local midwives tend to just leave the mama on her own...often they don't care if the ibu lies down the whole time, until the labor become dysfunctional, then they spring into action.
tears! Yeah! So I try to show by example how to improve things. Another great example is suturing. I believe I have described some of the problems with the techniques here previously. Briefly, the midwives here use techniques that increase scar tissue production and future tearing. I have been showing them more gently ways of suturing that reduces scar tissue and promotes better healing. Fun stuff! A prime reason for having the birth assistant volunteers is to provide labor support for these mamas who would otherwise have very little. They also provide comfort to the family by showing them that everything is normal, many families are very nervous about the out of hospital setting, despite that fact that the statistics for the clinic are much safer and healthier than the hospital. I have come to learn that the primary purpose of the volunteer midwives is to bring a little bit of the best of I haven't really explained how things work here. There is a paid staff of local midwives who hold Indonesian Licenses. Their training is hospital based. So here at this holistic, out of hospital birth setting some of them are a little lost. Overall though, this clinic is the shining light in the midst of a very dark health care situation, so beggars can't be choosers right? I guess, but as many of you know me...I always see more that can be done.
A big reason why I am here is to relieve Robin, the founder of the clinic and primary midwife. Although, Robin doesn't keep regular hours here or see clinic clients regularly. She kind of pops in as she sees fit. She also has a regular homebirth practice that mainly consists of western clientele. Robin, in my opinion, needs a sabbatical!!! She is the definition of a birth junkie. For more on Robin Google "Robin Lim". Another reason I am here is to relieve the local midwives and give them someone else to lean on when it gets busy. I am here to role model gentle birth practices really. Even though the care the clinic provides is highly superior to the hospital care...there are some problems here. The local midwives like to get the mama into lithotomy position (basically lying flat on their back) and crank their legs back with force. This position stretches the perineum taut and increases the likelihood of tears. It also is likely to cause fetal distress because this is a poor position for good blood flow to reach the uterus/baby. In addition, as if that weren't enough, you don't have the benefit of gravity in this position and it is not empowering for the mama. She is flat on her back...like a helpless little bug:( They also like to coach the mom into pushing as soon as she is completely dilated, which in my opinion is not appropriate ( really can't go into that here and now.) It has become a joke around here...the local midwives run around all of the time asking me, "complete?" They are fixated on 10 centimeters!!! If the mama isn't complete, they got nothin'. I called one of the midwives on this the other day and now we laugh about it, always asking each other, "complete?" A large part of my role here is to gently show the local midwives what can be improved, using laughter and lots of love. Because most of the women are poorly nourished and eat a lot of MSG they have poor tissue integrity and tear easily and severely. So it makes sense to try to use positions that prevent tears. I have had several first time moms give birth on hands and knees, with pretty big babies and no perineal tears. The volunteer midwives bring a little bit of the best of homebirth to Ubud every time we visit. Hopefully! Honestly, it was hard to figure out exactly what I was going to be doing when I arrived here. There was virtually no structure for integrating me into the system. I won't go into it now but, it is not what I expected and I was a bot disapointed. But here I am now..loving life, a full tilt birth junkie. We are a bunch of birth junkies, who need to get our fix!
Have to leave you with this lovely pic of one of my favorite couples. I just did a home visit for this couple yesterday, they just live around the corner. The parents were concerned about the umbilical cord and breastfeeding. A note to you new parents out there...as a general rule, there is usually nothing at all wrong, however sleep deprivation and a general lack of knowledge often makes you feel as though EVERYTHING is wrong. So a big part of what I did was to just reassure the couple and give a few pointers. I gave some breastfeeding postioning advice, provided some lanolin for sore nipples and checked out the naval, which was doing just fine. So fun going into the homes here. The families create compounds surrounding beautiful gardens that are meticulously cared for. In fact at this home, there was a lovely, small garden and the father said, "Please excuse the garden, the gardener is not good." But of course, it was lovely! Love to all...

Pics of the Latest Here at YBS

Thought I would shoot some pics your way...Here is one of the beautiful young mamas I helped with her birth. She is just 16 years old! She had really flat nipples so I worked with her a bunch on good latch-on and getting nursing up and running. I was working with her the other night and I showed her how to hand express...she was amazed when little bubbles of colstrum starting coming out of her nipples. I don't think she thought there was anything in there at all. She is a natural. Her mother was right behind her, literally, during birth, holding her up on the bed. It was really sweet.
I named this one "happy family" because...they are!!! This mama was really working hard during labor. At one point she set up her "labor camp" right by the public bathroom near the kitchen area, complete with chairs and pillows and her support people because she had been told to walk around, but didn't want to walk anymore:) We finally got her into the tub for some relief and her husband got in too! This was so cute, he was down to his undies, very unusual for this area. I hope you can see the little onion that is placed above the right shoulder of the baby. This is to protect the baby from evil spirits because apparently evil spirits don't like the smell of onion! When the baby leaves the home the parents place an onion skin on the forehead, hands and feet to continue the protection away from the home. The mother/baby pair do not leave the family compound for 42 days post partum and the child is not to touch the ground for the first 150 days.

Mom really wanted to see my room...and I don't think I have yet showed a picture, so here it is. This is my bed. On either side are two other beds, my roomies. The ashram is really my second home, the clinic being my first. Today we had a very eventful day at the "ashy" as I lovingly call it. First, a dog, most likely and hopefully, peed in my duffle bag which I keep on the floor. He managed to soak several items. I think he is the neighbors dog, who basically roams the vicinity looking for trouble. So off to the laundry I go tomorrow. Then, this evening, I climbed the stairs to see blood splatter and bloody kitty paw prints all over the floor of our room. A cat had most likely hunted down a mouse, had its way with it, and then escaped via the balcony! Life in the great outdoors. There is an open access point to our stairway from a courtyard behind the ashy so it is an easy access for critters unfortunately. Tomorrow I think I will construct a barrier...this is too much!


Just got back from a birth...2nd time mom, no tears. Very interesting placenta. Parts of it were virtually undeveloped and most of the placenta was calcified, which often signifies that the placenta is old and is a poor transporter of nutrients. It was fortuitous that the baby was well developed, however he was a little small for his gestational age. On her chart her due date was supposedly May 26 but she couldn't remember when her last period was, so we were a big concerned that we were getting a preemie. However, the mama seemed to be at least 38 weeks, but with an old placenta that was deficient and a baby who was probably not getting all of the nutrition it needed. This baby is better off on the outside, where he can get lots of booby milk.
Here is a pic of locals in ceremony, a common occurence around here with the Hindu religion. This is the reason why we have had very few women at prenatal clinic the last few times. Every month there is a full moon ceremony that basically lasts a week. The people are in ceremony constantly, well, at least weekly. Thought you might like to see what "church" is like for them.
Right now we just turned away a first time mom who was having light contractions and was 0cm dilated...they live 5 minutes from the clinic. So cute, and very excited...but they need to rest. As you new mothers can attest to, resting in the early hours of labor is so important! Meanwhile, we await two first time mamas, pertama bayi as we say here..."first baby". I am hanging out in the office, catching up on e-mail stuff, blogging and joking around with the girls I work with, my birth assistants.

Here is the bucket brigade I mentioned earlier. We hauled a bunch of dirt that day. Fortunately, today it was busy at the clinic so I had to be at births rather than hauling dirt...ahhh, sweet reprieve. Here you go mom, you asked for pictures of me...how is this? Sorry!








Here is the open clinic I told you about earlier. I had to include this great photo of Endang demonstrating the use of the syringe as a douche of sorts to treat a yeast infection. The patient is receiving acupuncture as well.

OK that is all for now. I really need to sleep, it is going to be a long night. Two first time moms simmering at 2 cm...love to all.

Work Day at the Clinic

I think it has been about 2 days since my last post. Things are pretty quiet around here. We are having about 1-2 births a day rather than seven, like last week. This is a relief actually. The clinic was granted some money from a client so there is an additional birth room being added on to the clinic as we speak. I was part of the bucket brigade, hauling dirt with our staff and crew. This is actually kind of interesting...the young man who donated the money for the additional room is a recent client of Robin's. He and his wife recently had a homebirth. The couple has their own line of clothing that caters to celebrities. This guy designs clothes for Madonna apparently and has quite the international reputation...of course I had never heard of him, he is from Israel. Anyway, he donated some money, so ground is being broken!
There are only two mamas in house right now, one 16 and one 20. Of course, I don't have to tell you how sweet they are...I will post pictures soon. Both of them I sutured so I feel especially close to them. When I go through suturing with them I feel a particular intimacy with them. Also, they are so young and impressionable, I want their births to be as gentle as possible. The young girls are incredible birthers. The 20 year old last night went from 3cm to pushing in 3 hours!!! Incredible. A really quick pushing phase resulted in a pretty big tear that took me about an hour to repair, which is unusual because I have gotten really fast at stitching. Around here, the midwives do a pretty functional job at stitching, they are not so concerned with aesthetics. I am! In fact, a note to Bill, my teacher, that I was complimented yesterday on my suturing job...so I have you to thank for that Bill. Bill taught me always to do subcutaneous sutures on the outer closure to reduce scarring, scar tissue and improve appearance. Here, the midwives, do a lot of very tight, puckering cutaneous stitching that binds the tissue and causes clumpy, lumps of scar tissue that has a tendency to become re-injured. I have been trying to teach the other midwives by example and show them how a suture job can have great integrity, but look good too. The way the midwives approach suturing is probably related to the cultural attitudes surrounding genitalia here. Apparently women here never look at their yonis, they are discouraged from touching themselves or inspecting themselves. Many women have no idea what their yoni looks like, before or after birth. So honestly, most women don't care how they are sutured. Most have no curiosity at all about their tears or sutures. But good suturing has so many more benefits than just aesthetics! In fact, I can segway into another clinic story here...
Yesterday I got to "play doctor" at the Acupuncture/Open Clinic. You never know who will walk in and you get to spend the afternoon troubleshooting, counseling, dispensing herbs and vitamin/mineral supplements and assisting the acupuncturist. I got some really great client contacts. One was a vaginal yeast infection. This was a cultural eye-opener. After discussing with my translator some cultural norms I came to realize that there was no way that this 40 year old was ever going to actually clean out the inside of her own yoni with her own fingers...never had, never will. Despite her condition. Endang, my super translator and I worked with her a bit and made some progress. We think she might give it a try!? Very interesting.
So it was a great day to mix it up a bit and do some general medical trouble shooting. We got a sweet little white boy with chronic nose bleeds, a possible breech baby and some infertility issues. More fun stuff! I didn't want to miss yesterdays clinic because it was my last chance to work with Dr. John, an awesome acupuncturist from Australia. I have really been blown away by him and wish he wasn't leaving. All the students scramble to work with him because he is a natural teacher, so positive and gentle and works really well in this chaotic environment. Another highlight of my day was working with Endang, a hopeful acupuncturist and volunteer translator for the clinic. Her husband showed Matt around when he was here looking for woodworking contacts.
Well, lunch break is over...gotta go back to the bucket brigade. Love to all...

News from the Birth Zone

Hello Again...would you like to know what i have been doing for the last 48 hours? Sure you do! I have been sleeping on floors, hanging out in hospitals, playing with nipples and getting bitten by mosquitos...what have you been doing? I have to tell you what a real honor it is to be allowed into the lives of these families. Birth is such an intimate experience for the couple that I feel humbled every time I am allowed into the circle.
I had the honor of being asked to attend a home birth, away from the clinic, with Ibu Robin, the founder of the clinic. We were attending to Patricia and Roberto, the cutest couple! She is from Singapore and he is from Italy. To make a long story short I will fill you in on a new theory I have developed: Asian women need to be careful when they marry tall, hulking, broad shouldered, big-headed, heavy-set white men and want to bear their children!!! We labored at home for 30 hours, all the while a champion baby chugged along happy as a clam. I was at the home for 24 hours. I slept in the same bed with the couple and on their floor, shared meals with them, showered and made tea. All the while working on keeping this labor cooking and mama/baby happy. It later became evident that this baby was just not going to come down any farther and mama was exhausted, we decided to go to the hospital before baby became exhausted. This little guy (pics soon:) was NO little guy! 4.5 kilos!!! Our special super Doc, Dr. Widegama performed a cesarean to reveal a super tanker of a baby with the head and shoulders of a linebacker! The baby's head was not molding at all, so not only was he big, he was hard-headed.
Three of us ladies from the birth team attended the family in the hospital because you have to keep a constant eye on things at the hospital around here. They will give the baby a bottle just because the baby was born by cesarean...which is no valid reason at all. Mama Patricia was so relieved and papa Roberto could not stop kissing Antonio, who loved the attention despite papa's whiskers. Mama definitely earned this one! This was one of the most interesting labors
I have ever been exposed to. Her labor literally stopped for 7 hours during the second day of labor. I mean it just stopped when she was 8 centimeters! She slept, showered, ate a full breakfast, joked around with us. Then we called in Dr. John, the acupuncturist, in the afternoon who expertly got labor restarted in under an hour and were back in action. (Working at this clinic has taught me so much about acupuncture. I really have a newfound belief in its capabilities.) Labor resumed and we got to 10 cm, mama pushed for hours and the baby would not descend. So we found ourselves at Clinic Mas or the Rumah Sakit (Pain Rooms) for a consult with Dr. Widegama that resulted in the c-section.
Very educational. Learning to work with what the body provides, and not against it is a crucial aspect of midwifery that I love. My time here has been a valuable lesson in listening to the signals the body gives you and not ignoring them.
That beautiful birth occured after a bit of a lull around here, I had just spent the day baking dozens of cookies for the Earth Day Celebration that was held on April 19. Of course, I missed Earth Day because of the birth...but of course I didn't mind! After all, I am a birth junkie who needs to get her fix! The energy is truly contagious. Although, I was talking with Robin about how intense it is to be around all of this birth energy all the time. She is headed to Italy for a month in June, getting away from the clinic should be therapeutic. Being around new life is invigorating, and the joy is contagious and you would think that that would make you happy all the time...however, it can be incredibly depleting and draining. Interesting to think that part of the training to become an excellent midwife could be to be around so much birth, all the time, so as to actually become immune to the intensity of birth so that you can always perform calmly and without volatility during emergencies. It will be such a luxury to come back home and focus on my small client base, one birth at a time. Unlike today, when I kept wondering which birth I was going to miss because I was in the other room. I had another 16 year old mama today. Sorry to all my thirty something mamas out there...another 6 hour labor and 20 minutes of pushing! Although, Robin and I missed another homebirth because we were so tied up at the long one where a student midwife had to catch the baby because he came so quickly. This 37 year old mama went from 1cm to birth in 3 hours! Another testament to the power of acupuncture because she had a lot of acupuncture done to stimulate the onset of labor because she was over her due date. Who knows? The nice thing about acupuncture is that why not try it...there are virtually no side negative effects! Gotta post...battery running low...ciao!

OOPS, forgot to mention...

sorry, but the next post has a sensitive birth story in it...for those of you who can handle it only!!!

A moment of peace at the clinic

Whoa...I feel like I just got run over by a truck! The past 3 days have been a whirlwind. Actually, there were two days where we did 9 births in 48 hours. I am now up to 34 births here at the clinic. On day three, I crashed, coming down with a cold that everyone at the clinic seems to be passing around. So, just to give you an idea...it was a slow day of rest for me yesterday...so I only attended two births:) We started out with an interesting VBAC (vaginal birth after cesarean) which I think I mentioned previously. The local midwives wanted to send her to the hospital because she kept saying, "I am not strong." More importantly, her husband kept saying, "She is not strong." She was four centimeters at the time. I encouraged them, supported them and explained that if they went to the hospital they would still have to labor because cesareans are only done in the morning here, unless the clinic calls in their special doctor who will do them on call. But even he lives over an hour away in the mountains and because it wasn't an emergency, it was unlikely we could get him out of bed! So I ran a warm bath with some nice essential oils and called Mandi, a Canadian student midwife for some extra help. Ibu Ayu quickly went to 8 centimeters and then to 10 in a couple more hours. I was thrilled! But pushing was a different story! It was really tough for her. We asked if we could take pictures of her because of her cesarean scar. I hope you can see in these pictures how intense the scar is. In the US I can't do a VBAC with a woman who has a midline vertical scar like this. After 1.5 hours of pushing she gave birth to a little peanut of a baby. After assessment, he was most likely only 36 weeks, a month shy of term. As I mentioned earlier, due dates are so inaccurate here...very frustrating because we really don't know what we will get at a birth. This was evident when he was born because he did not breathe and his size was very small! When he did begin to breathe, after resuscitation we could see his chest retracting, another sign of underdeveloped lungs. He could have had a developmental disorder of some kind, but we will never know. We suctioned a lot of meconium stained water from his trachea because he wasn't able to cough or clear it himself. After getting an airway we used the bag valve mask but to no avail...time for mouth to mouth. I was the lucky one to do mouth to mouth on this little guy and I am telling you I will never be the same. The beauty of it was...It Worked! I was so happy!!! The baby is doing really well, nursing well, but is jaundiced, which is common in pre-term babies, so he is under observation at the hospital. I hope they don't screw anything up! The hospital, as I have mentioned, is a bit lacking! That event was the beginning of nine births in a row. Some of them happened on Tuesday during our regular prenatal clinic where we had a packed house of mamas waiting for exams. In fact, at one point I was giving another Midwife a break by doing exams when a birth assistant ran in and said, "Rebecca, I need you now!" I ran in to barely get gloves on while viewing a bulging amniotic sac, with a head right behind it! I caught a beautiful little girl born "in the caul" or born in the amniotic sac. You have never seen something so beautiful until you have seen the amniotic sac draped over a bay, peeling them back to reveal a slippery little newborn! Wow! So, as you can see, life is rich here and overwhelming.
After our rather traumatic birth the rest were wonderful. I had a lovely first time mom that I cared for who had a beautiful waterbirth with no tearing! We "white" midwives are getting really good at preventing tears around here. Which is no small feat, considering that poor nutrition makes tissue integrity poor. Unfortunately, this mama left this morning before I got to say good-bye...:( So let's look at pics, shall we?
Here is Ayu and her husband Kadek. Once we turned him around and he saw how strong his wife really was...he was a real champion! He was right there for her the whole time. She is the VBAC.








I wanted you to see this scar because it is so intense! They don't even do this kind of c-section in the US anymore, not since the seventies. Even emergency sections in America are low-transverse and much healthier for mama.


Here we are, after we got baby Putu stable. I wanted to include this picture in order to show you the placenta. Here, we do not cut the umbilical cord until three hours after birth. Here, Ibu Robin asked us to put a heat lamp over the palcenta to keep it warm during the final moments of transfusion. I have been learning a lot about the placenta and the benefits to delayed cord clamping. I won't go into it now, but really cool stuff that is now being confirmed by research about not cutting the cord immediately after birth. We also put fresh flowers over the placenta and the family takes the placenta home, along with all the other bloody trash from the birth and burns it and then buries it in the back yard of the family compound...pretty cool! The birth team and the baby were blessed by priests because this is a family of priests.

Well, I think that is about all for now. Love to all...

Single Mom Awesome Waterbirth!

Here is a very sweet first time mom, 16 years old! Above her is her best friend, who has a baby herself and has been to a few births. Surrounding her is the birth team! Our team of birth assistants here at YBS, we are all here because Ibu Robin told us to "love her up" although only two of them were at the birth. This was a two birth day, so after I assisted at another birth I was able to pop in for the end of this one. Really, it was a pretty sweet, fast labor, only about six hours total. Teenage moms really put the pedal to the metal! She is a single mom, dad hit the trail when he found out she was pregnant! Her family has really been supportive, but the road has been tough and long. But here we are...and now they all have a beautiful baby boy to be distracted by!










































Need to post these quickly because I am needed. A second Ibu just arrives...third baby, 2cm and 50% effaced. It is 10:30 pm here...looks like a long night ahead! Lots of love to all. Check out this true knot in the umbilical cord! This baby was truly blessed because a true knot can be devastating for a baby in utero. Fortunately, it is very unusual for a true knot to become so tight that the blood flow is totally restricted. That is what the Wharton's Jelly is for. Also rare to see a true knot at all. This is the result of the baby swimming through a loop of cord when it is very small and "swimmy" early in gestation. The jelly creates a buffer of cushion around the vessels so that some compression is possible without obstruction of blood flow. Of course, some compression of the cord is a given because of how much the baby grows, squirms and compacts itself into the womb. The Wharton's Jelly keeps the precious jewels inside, the vessels, flowing. See you on the flip side of these births...think happy birthing thoughts!

More from YBS...

So I started a post earlier to fill you in on the latest, however the electricity went out! The computer I was on shut down and then a family came in with a feverish/fluish kiddo, so I watched the local midwives treat the little guy. Anyway, here I am again. I think I left off by saying that it looked like we might have another three baby day. Well, we had a four baby day and then we had a two baby day right after that! So, needless to say I got a bit distracted. Now here we are. I had a nice evening last night, out to dinner with some of the other volunteers. Then this morning my co-volunteer Meredith, a chiropractor, and I went to Cantika, a "spa" where we were treated to massages and hair and scalp treatments with homemade lotions and potions. It was a much needed get away, really the only significant trip away from the clinic since my second day here! So now I am hunkering down for the second half of my trip. My appetite is back with a vengeance so I have been enjoying local food again and cooking for myself with local goodies.
As for the above picture, some of you may recognize the tall black man in the middle. That's Michael Franti. If you don't know ho he is Google him...he's famous! Really he is an incredible singer/songwriter and an advocate and activist for human rights of all sorts. Also, he is a major supporter of YBS. He is apparently moving here and has taken up the cause of YBS. He recently did a promotional concert here and was shooting parts of a music video here at the clinic the other day. He really is a lovely guy and has access to a lot of money and resources that can benefit YBS. A great friend to have! So I had to put in this cute shot of him with some of the mothers from the clinic. That is Ibu Robin in the middle, the creator and director of YBS.
Here is a really nice photo of me attending a beautiful waterbirth. This was the baby I caught in the tub that ended up being a shoulder dystocia...sound familiar? She ended up having a tricky little labial tear that was reminiscent of a tear Bill and I struggled with last Fall in Colorado. It was awesome to see this same problem again and to be able to repair it well after seeing something similar before. Getting the skills honed is key!
As for now, we just received a new Ibu. She is 1cm dilated, light contractions, second baby, Vaginal Birth After Cesarean. She is hoping to have a vaginal birth this time after the hospital gave her a c-section for "failure to progress". Apparently, she didn't dilate past 3cm last time. But of course, we are skeptical. You just can't be sure what was going on last time and the assessment of the doctors at the hospital is always suspect around here!

Hope You Enjoy!

Hope everyone is enjoying the blog, I really am! So, last I left you I went to check on an Ibu, a young 18 year old named Komang. So beautiful! Her family spoke a good bit of English and revealed to me that they were all very disappointed with her for getting pregnant out of wedlock and loosing her chances to go to college. This is a more privileged family who sent their other daughter to college here on Bali, she was also attending the birth. I tried to share with the grandmother and the sister that we are already in this place, and here we are at the birth...so let's support Komang and focus on the here and now without dwelling on mistakes! We are gonna have a baby!!! They agreed, we all have a special bond after that. The mother moved quickly, as I mentioned she might and by 9:15 am we had a beautiful water birth! The mama was making better progress squatting in the tub rather than reclining so she delivered the head in a squat in the tub. When the head popped out she instinctually rocked forward onto her hands and knees. Fine by me...especially since I ended up dealing with a shoulder dystocia, where the shoulders are "stuck" and need some coaxing/assistance to be delivered. The hands and knees position is very beneficial for birthing a baby who has "sticky shoulders" so the position was excellent. It is ideal for the shoulders and body to be delivered before 5 minutes after the birth time of the head. So I worked the shoulders a bit and...voila! A chunky little bugger emerged...who was actually mostly chunky in his head and chest only and more petite toward the lower body. Beautiful birth with a minimal but complicated tear that I hope responds well to the stitching. I have gotten so much faster with my suturing skills here, which is a sweet relief b/c spending time hunching over a mama is tiring for me but also interferes with mama/baby bonding. So now my clients will be able to get to mothering sooner, rather than later! Nice! Also, there is no time for slow stitching around here...b/c we need the beds:) No sooner did I wrap things up with this family before I found myself at another birth! It wasn't the other Ibu who had showed up last night, we actually sent her home b/c her labor fizzled out, it just wasn't time.
I ran over to the ashram to grab a shower and breakfast. I sat here at the clinic eating my breakfast, filling out paper work and debriefing about the birth. Then I headed into the post-partum room to put away some breast pump and bottle parts I had cleaned. I heard a commotion outside...whe you hear a commotion around here you grab gloves, it is instinct! So that is what I did. Just in time to help a groaning and sweating Ibu out of the taxi with her husband. BabyTime! Fifteen minutes later I was catching another little chunker. I guided the sister-in-law who accompanied her to get behind Ibu to help prop her up, she was pretty much a wet noodle! She pushed so gracefully and delivered a sweet little dude with a perfectly round head. Five baby boys in a row around here. Good Luck for sure!!!
I guess you could say this is my ideal day so far...but next walked in a sweet old guy from a village 3 hours away. He had gashed his wrist big time! Time to put on the gloves:) I just helped this guy clean his wound, changed the bandage and gave him some bandaging supplies for later and some anti-biotic ointment. The local midwife gave him some antibiotics as a preventive measure. Preventive measures are big around here b/c infection is pretty much a given! The local midwife didn't want me to send him home with a roll of the nice first aid tape that is waterproof, I tried to convince her but she wasn't going for it. We have a ton of the stuff and we just told him to change the bandage regularly. So what is he gonna do tomorrow or the next day!? When the midwife walked away I snuck a roll into his friends breast pocket and winked. The guy looked at me and winked too and said, "Makasi (thank you)." Enough Said!

Post you comments!

Selamat Pagi! Good Morning! Upon the advisement of my wise father, I have resolved to improve my punctuation and capitalization habits. I have to admit, as a member of the e-mail generation I have gotten so comfortable with sending e-mail that it has become a bit like a conversation to me. A conversation full of run-on sentences, weak sentence structure and ... if you know what I mean. So, I resolve to improve with the intention being that I would like for the blog to be easier to follow and understand. So, here we go! With that said, it is morning. I wanted to make sure you all knew you could post comments, b/c I had no idea:) My dad turned me on to this. I am just getting the hang of this "blogging" thing. Just click on comment at the end of the post and let me know your thoughts and feelings. You don't have to send an e-mail separately, you can just "post a comment".
After sleeping at the clinic, so as not to miss any of the action, we had an Ibu (mama) arrive at midnight, 1st baby, 2cm. We told her to rest and we didn't hear a peep from her until i went in to check on her at 5:30am. Now we have her up and walking and she seems a little nervous, she is going to need some TLC. Then at about 6am we received an 18 year old Ibu who is at 7cm with broken waters. The young ones go quickly around here, and I think in general. Her mother (the grandmother) told me she hopes I can help her daughter give birth b/c she is so young she doesn't know what to do. I told her that her daughter's body is working just fine right now and that we should trust that her body knows instinctually what to do. Sometimes, as we age, our minds get in the way of what is best...when we are young we are more primal and raw...and that is excellent for birth! I am going to poke around and check on everyone. It is raining now so it is a beautiful morning for a birth...or two! xoxo

wow..this here blog actually works!

here is the outside of my humble abode, lovingly known as the ashram. right now 5 ladies live here, all volunteers.1 midwife, 1 chiropractor, 1 student midwife and 2 untrained volunteers. i can show you more later. but for now lets finish the birth story from last time. so, the mama in early labor did some castor oil (ladies don't try this at home w/out midwife advisement) and we hung out and waited...all day. at 4pm she was 2-3cm, her water broke, at 5pm she was 4cm and at 5:30pm we had a baby! i was gloved and ready, attending to her in her room. she went to the potty and she got up to walk back to the bed, i stepped out to grab my water bottle and heard a yelp...i walked in to find a head being delivered and student midwife, mandy, catching the baby with no gloves on! the mama even delivered the placenta without a single contraction or grimace and with the most minimal blood loss i think i have seen yet! wow! talk about a natural birthing mama....she is it! i do think the baby is a little early...maybe by 3 weeks...however, he weighs 2.5 kg. he just weighed in at the "limit" for a low-birth weight baby. tedak apa apa, as they say here...no worries! we just did the 3 hr check which involves cutting the cord, giving vit k shot and measuring and weighing the baby. in this case we weighed the baby at birth b/c we were concerned...but he isn't having any breathing difficulties and everything seems physiologically correct, so...oh, and yes, they leave the cord attached until 3 hrs p.p. and then it is cut.

let's see what is next?
this is what we like to call...the baby package. parents arrive with a lovingly purchased baby set...if it is your first baby the set is brand new, usually still in the plastic. if it is your 2nd or subsequent baby...maybe the set is used and a little faded. i will offer you more pics of these sweet little baby get-ups. but for now this will have to suffice.. here is a proud new papa and his new package. all bundled up and ready to go...you would think it was 30 below here, but no, it is a cool 80 out today.



now for my favorite baby ever!!!
i think all of us want to snuggle this baby, but don't want to give birth to her!!! i knew the parents were going to think i was crazy...otherwise i would have buried my face in her cheeks and just snuggled her like there was no tomorrow. this baby was a lot of work for the mama and resulted in a 3rd degree perineal tear. the woman was very small and we worked with her a lot to help support her in the delivery. she also, has a pretty severe hemorrhage and a prolapsed uterus. ugh! however, all is well. the mama and baby are doing well...they went home yesterday. no i.v. necessary and the mama really bounced right back. the highlight of this birth for me was the older brother, who is now 3.5 yrs. his father brought him into the room just as the head was born...he looked down and saw this giant purple head and burst into tears. he literally jumped into the arms of tonya, one of the student midwives, who held him and rocked him and told him everything was going to be alright. it was the most beautiful thing! needless to say tonya had made a buddy for the rest of their stay and the little guy could be found listening to tunes on tonyas laptop while tonya was checking her e-mail:) gotta love it!

this one has got to be shared...since i arrived the place in the back of us has been doing some new construction. most of the construction is homemade cement and local rock or cinderblock. over the past few days loads of black sand and black lava rock have been dumped onto the street and then carried by hand, or by head i should say, by some of the strongest women i think i have seen in my life. here you see one of them, who is pregnant, carrying a couple lava rocks on her head! oh and yes, she is barefoot...so if any of you pregnant ladies think you can't get up and get out for a walk today...well...it goes without saying that i am constantly in awe!
one last pic for tonight...here is mandy, student midwife doing an exam on one of the mamas...this mamas #1 bayi (baby) was a little concerned about her mama being so far away...so i put her up on the bed and she stoically looked me in the eye with what i think was a thank you? mandy is measuring the mamas arm. we do that to check weight gain and monitor potential malnutrition. it is amazing to learn that many of these women who live very close to the land as farmers eat very nutrient rich foods, even though maybe not much food at all...but a little bit of nutrient rich food goes a long way. i still amazed by how they pack these 7lb babies into these tiny little tummies!!! that is all for tonight...sleeping at the clinic tonight so hopefully we will have some visitors...