Eating mangos and sharing birth stories

So, I guess I haven't figured out the picture upload thing yet, or else the internet here is just too slow. Sorry about that. You will have to wait until I try again, or I get home (whichever comes first).

Just wanted to write a little about my morning yesterday. It started about a week ago, when 2 traditional midwives (sometimes known as traditional birth attendants, but they didn't refer to themselves that way, so I won't either) transfered their cousin in to the clinic in labour. We spent the birth sharing ideas and ways of practicing in broken French/Creole. Since the translator wasn't able to be there that night, it was whatever I was able to communicate/understand that ended up being exchanged (this has happened more often lately, in part due to the difficulty of a translator getting to the clinic in the middle of the night - there is no transportation available from our end as we only have one scooter for whole clinic and there is no public transport available after about 10pm).

In any case, it was an 70 year old experienced midwife with her 20 year old grand daughter who has been apprenticing with her for a few years. They brought their cousin in, we found out today, due to 'mystical problems'. They believed she wasn't able to deliver because of some type of spiritual issue. And yet when she got to the clinic, she was almost complete, and really only took a couple of hours (normal for a first time mama) to push out her baby.

As all who know my interest in all aspects of midwifery, registered and unregistered/traditional, I was drawn to these women. We essentially managed the labour together, all the while confirming or challenging each other on management type issues. One that was hard for me, was the plugging of the butt. They do this, they said, because like so many women the world over, they are afraid to poo during birth. Mechanically as the baby passes down the birth canal, it pushes past the rectum, thereby pushing out anything there, so its not really something that can be avoided. It is so common for us to wipe up, change gloves and carry on, we barely think about it anymore. The young apprentice was plugging her cousin's butt to help prevent the sensation, but then when it didn't stop the inevitable, she would, without changing gloves, continue to monitor the progress of the delivery of the head. It was a teachable moment, but hard to do in my broken Creole/French. We gifted them bags of gloves when they left the next morning, healthy mama and baby on the back of a motorcyle, midwives walking back to their community, about 1 hour away.

This morning we went to visit them at their 'birth centre'. It was a 30 minute crazy uphill motorcycle ride, followed by a 30 walk up hill. We left at 630am to avoid the heat and soon we sitting around in front of the little house that is their birth centre, being introduced to the 3 mamas and babies who were there. One had been born 5 days before, one 10 days ago and another was 3 months old. The older babies were there for 'mystical' reasons, the younger one just hadn't gone home yet following his birth. The 3 month old apparently comes and goes, because he is 'possessed'. These midwives are known for being able to see things, as well as catch babies. They have 2 temples that they pray at to assist in ridding these babies of their possessive spirits. This again, is the best interpretation I can give based on the translation we had. We spent the morning holding the babies and asking questions/exchanging information about birth, local plants and remedies and meeting all their extended family members (the young apprentice is one of 11 children!). We brought gifts of baby blankets and more gloves. They fed us lunch and loaded us up with mangoes, coconuts, breadfruit and corn for our trip back to the city. The elder midwife, Toune, kept telling us how happy she was to have had us visit. Adrianne, the young apprentice is eager to come and learn with us at the clinic once a more formalized educational program is available and was so proud to introduce us to anyone and everyone who came by.

On the way back down the mountain, we stopped in at the cousin's house. She had a uterine infection (likely due to the issues described earlier) and had been in the clinic on Friday for antibiotics. She was doing much, much better yesterday and was planning to come and visit us today for a check up anyways.

This collaboration between midwives, traditional and western, was one of the nicest interactions/transfer I have experienced in working as a midwife here, in Canada or Zambia. Yes, we all practice differently. Yes, there are cultural beliefs and practices that are beneficial and/or inconsequential and/or harmful across the board. And yet, as always, there are universal concepts re birth that can be shared and styles and practices that can be expanded upon. I hope that this transfer and exchange will create an opportunity for these women to continue to connect with us at the clinic.

I dream that this type of transfer and mutual respect will become more and more possible between homebirth midwives and hospital staff both here and in Canada. Our clinic is considered a hospital by the women who come to birth with us, but for us to transfer to the 'real' hospital, we too go, as I feel these midwives may have come to us, with some trepidation and fear. We have our own practices/beliefs/styles which differ dramatically from the local and Medecins Sans Frontier (MSF/Doctors Without Borders) doctors/obstetricians who run the maternity and pediatric wards at Hospital St Michele. Each time I have transfered to the hospital here, I strive to explain why I am there, what has happened to lead to me to bring this patient in and then I have to let go, in order to appreciate the expertise I have come to seek. My last transfer to the local hospital was of a very sick baby 48 hours old, with a very slow heart rate, temperature 40 degrees C (that is > 102 F), lethargic and a greyish tinge to his skin. I just went to see him 36 hours later, and already, after a few doses of antibiotics IV, he is looking so much better. All the nurses I met along the way were friendly and took into account the history I had for the mama and baby. Other transfers have not been so smooth. One thing that is reassuring, every time we have transfered the women and the babies have come back to the clinic to let us know how they are, tell us their birth stories and receive follow up care. To me this means that despite and/or because of the decision to transfer, they trust us and appreciate the care we offered all the way up until and during the transfer process.

Here's to greater interdisciplinary collaboration, from traditional midwives practicing in small, remote village situations, to homebirth midwives or registered midwives or nurse midwives or family doctors doing maternity, to obstetricians and pediatricians practicing at hospitals, both those small, underfunded, undersupplied institutions like the one here in Jacmel, to those larger, well equipped ones in cities throughout the world.