The Birthday Gift

The Saturday after my birthday I went in to Labor and Delivery. Julia, one of the Midwives from my radio show group was working. When I came in she generously supported me in attending our patients and births that day.

When the shift began there was a 17 year old first time mom. Her labor had been moving slowly throughout the night and she struggled to keep her eyes open between contractions. On exam she measured 5cms, the same as the night before when she was sent over to labor y parto. As I've mentioned in earlier posts there is currently an initiative to include traditional practices in facility-based birth in an effort to respect and humanize birth in the RAAN. The young woman's mother passed a Styrofoam cup half full with brownish liquid, green particulate flowing throughout. The girl took it down in one drink. One hour later another batch of the brew was passed back to Labor y Parto where one of the maternity nurses bathed the girl’s abdomen and sacrum in sweeping circles with the tea blend. The tea herb, Escoba Lisa, is also referred to as Oxy-casera, a powerful labor inducer. It is rumored that the women who come into labor and delivery with powerful contractions and booming labors have been drinking these traditional remedies to hurry the labor process. Our patient moved slowly but surely though her labor to arrive at 8cms by the afternoon. An IV was started and oxytocin flowed at 8 drops per minute into her vein. The girl’s mother came back and held her hand as she cried out 'mamiki, uba latwan, mamiki, uba latwan' over and over during contractions; her own mother´s tears slipped down her cheek watching her daughter's pain. Another woman was called back to assist in the traditional healing of this young woman. She was a large (hermosa) woman with milk-chocolate skin and peroxide orange hair. She held a bundle of green plants waded into the palm of her hand. She crushed the plant she told me was named Africa, then rubbed it over the laboring woman's abdomen repetitively making the sign of the cross, then moving to her sacrum. The plants were squeezed and squeezed until a thick green juice was extract and dripped on the girl’s forehead. This was followed by fanning the patient and tucking the bundle of herbs between the woman's breasts.

As we awaited the birth of this woman's babe another adolescent patient was brought into the labor and delivery suite. She was 15 years old, measuring under 5 feet tall, and thick. Her black eyes stared out of her round face with fear, but she also had a look of control about her. She was a patient with preeclampsia, a disorder of high blood pressure that only affects pregnant women and puts both mother and baby at risk for complications and death. In the United States a high-risk patient like this would be receiving medications to prevent seizures, as well as strict vigilance of vital signs…but things are different here. She had an oxytocin drip going to induce her labor...the only cure for preeclampsia is delivery. I took her blood pressure which measured in at 140/100, high, but not so high that we were giving her the PRN blood pressure reducing medication that she was prescribed. The baby's heart rate was very reassuring. Soon after her arrival our traditional medicine patient was complete and ready push. The 15 year old was temporarily abandoned [or allowed to labor without intervention] as we attended to the birth of the other patient's little girl, petite at just 6 lbs and covered in creamy-white vernix, a protective coating that develops in the womb. After finishing up the suturing and writing a note about the birth I turned my attention back to the wide-eyed fifteen year old. I sat at her side and traced small circles on her lower back during her contractions. She would tell me that they hurt very bad when they were over, but she appeared to be coping very well. I checked her and she was 7 cms. About 30 minutes later her bag of water broke on its own revealing clear fluid. Most women's water is artificially broken here when they reach 7-8 cms. It was nice for me to witness her body taking on the process of birth without too much intervention. Shortly after the other midwife checked her and said that she was complete but that the head was still high, that it would be best for her to labor and let the head reach the perineum before getting her on the birthing table. This is also not commonly done as most practitioners are ready to get a woman pushing as soon as she is complete. I checked the baby's heart rate again and it continued to be reassuring. She lay onto the bed and I witnessed her begin to push. I guided her to push when she felt the need, that it was okay. After a couple of pushes she looked at me with her large eyes, grabbing her perineum saying 'its coming out'. I peeked down between her legs and knew she was feeling the pressure of the baby, but was still distant from delivery. No bulging, no crowning. I went into the delivery suite and grabbed a pair of gloves...just in case! As I walked in I started telling one of the doctors who was relaxing along the wall that I was actually more accustomed to attending deliveries in a bed rather than on the birthing table with women in the 'obstetric position'. He was surprised by this as well as the fact that more physicians attend births in the US than midwives, both cases being opposite her in Nicaragua. I went back and sat with the patient again, fanning her with the package of gloves. After about 15 minutes I went to check on my postpartum patient: firm fundus, normal blood pressure, nursing her baby. Her sister was back with her and asked me how much longer the laboring young woman had. I told her that she was close, but not yet. As I turned to walk out of the room the drawstring on my scrub pants got caught on something, coming undone, threatening to reveal my bottom to everyone present. I grabbed the strings at the exact same time that I looked up at my 15 year old patient bearing down with a two inch slit of her baby's hair peaking out. I dove into the room and struggled to get the gloves on that I had left there...I don´t know why that latex gets so sticky and uncooperative when you really need to get them on. I squatted next to the bed trying to keep my pants up as I flexed the baby's head and helped him arrive for his birthday. Julia arrived with a tray of instruments and graciously tied my pants back on for me. The young mother looked so proud and strong bringing this life into the world. The only things I know about her are that she is an adolescent, she doesn't know how to read or write, signing her chart with a thumb print, that she had preeclampsia, and that she was totally in love with her baby at first sight. Her big eyes filled with a pride and joy I haven´t seen in months as she reached out to touch her son laying across her abdomen. Her birth was simply beautiful. It was the most that I have felt like a midwife since I arrived...it was my best birthday gift.