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...