Birth Center Tales

Kathleen: When Tait and I decided that we would spend the first half of our trip in Central America, I fully expected that we would get through the whole area... Guatemala to Panama, and perhaps a chance to stick our toes into South American soil as well. However, I at least, barely made it out of Guatemala (aside from our Honduran scuba sojourn) and suspect that I might have left part of my heart there.

To recap, we spent the first month in Xela, a city in the Guatemalan highlands, attending language school and living with the warmest, kindest, funnest family to be found. We spend the next month traveling throughout the country and covered a fair amount of ground. It was at that point that we decided to bust a move to Honduras, or risk derailing our trip. While we were in Honduras I contacted a midwife working in Guatemala and asked if I could work with her for a little while... and, grateful for any sort of help, she said yes. (at this point Tait went south to Nicaragua, and I headed for Antigua).

Hannah, the midwife I was working with, is German, and has been living in Guatemala somewhere in the vicinity of 20 years. She has 4 kids and one grandkid, and her mother has retired to Antigua, so she is blessed with lots of family around. She has two clinics... a full-scope women's health center (about 15 minutes out of Antigua) that receives outside funding and is thus able to serve the poorer women living in the villages surrounding Antigua (actually, women come from all over the country, as her services are cheap (about $3 for a pap, and around $100 for a birth) and more importantly, respectful and responsive). She also has her own private clinic, a natural water birth center in Guatemala City (about an hour away from Antigua). I lived at the clinic close to Antigua but also worked with Hannah at the birth center two afternoons per week.

One of the greatest parts of this experience was the chance to stay in one place for a while and really get the feel of it... but most of that was getting to meet so many women and their families. Obviously the women coming to the water birth center were of a very different socioeconomic class than the women at the clinic, so the range of patients AND services I observed and assisted was amazing. I don't like to generalize, and there is of course an exception to every rule, but I LOVE Guatemalans. They are funny and friendly and a little bit shy, and incredibly devoted to their families, and the kids are without a doubt the cutest kids on the planet. They were also incredibly patient with my blundering spanish (I finally learned the word for sleeve after telling hundreds of women to take off their arms so that I could take their blood pressure) and nervousness (one woman told me to breathe and relax while I was giving her a shot).

Hannah's practice is really amazing, as she is able to do so much. She attends births and provides prenatal care, but also performs ultrasounds, does routine gyn care, prescribes birth control, inserts IUDs, provides fertility counseling, tinctures her own natural medicines, and has a devoted following of clients. She also consults on a million other things (there is always something new walking into the clinic), and I have never seen more "full-scope" midwifery care. The rules governing midwives in the states are just a frustrating bundle of hoops and regulations, and Hannah has managed to bypass all of that foolishness by practicing in Guatemala. And believe me, if I didn't have a bundle of student loans, I would be right there with her!!!

I had never attended a birth before, and I was anxious to do so... I knew that I wanted to be a women's health care provider, but without having been at some births, I didn't know for SURE if I wanted to include those in my (future) practice. And the answer is YES, I do!! (but not exclusively, which brings us back to the hoops and regulations of U.S. midwifery care).

With Hannah I attended 5 births and they were all different from each other. The first was a little 17 year old named Pati, and she came in with her mother, her husband, and someone else but I can't remember who. Hannah could tell from the beginning that the baby had some other part than its head coming first, but couldn't figure out what part (and the baby had been head down at its last prenatal visit a week before). Pati labored quickly, in about 3 hours she was ready to push, and she barely made a sound. She was just focused, breathing, working SO hard, and towards the end napping between contractions. The next time Hannah checked her, she felt a foot... and indeed, Juan David came foot first, (actually, one foot and his balls) with both arms over his head. It is an extremely rare presentation, and an extraordinary birth to witness, both for the technical skill that Hannah showed and for the bravery of the mom. Pati's mom was really cool, and so proud of her, and Pati's sister will have her baby with Hannah next month.

The second was at the water birth center, and it was a woman (Emilie) who came late in her second pregnancy for care. Emilie had had a cesarean with her first birth (they induced her, and after 4 hours of labor said that she wasn't progressing fast enough and cut her open) and the doctors were threatening another cesarean due to "lack of fluid." Hannah thought it was B.S. and agreed to care for her. Emilie came to have her baby with her husband and sister, and it was a really FUN labor... they laughed and told stories and giggled the whole time, and Emilie labored much of the time on the toilet (and she recommends it!). The labor and birth were fairly straightforward, and they had a beautiful baby boy, Andre. The two things I will never forget are: 1) I messed up draining the birth tub and it overflowed, leaving me crawling around and mopping up fluid for hours!! and 2) Emilie and her husband came back to talk to the childbirth class that they were part of before the baby came (that Hannah teaches). Emilie had been transformed by the birth, and by her own power... her husband (almost 20 years older than her) told the group that he looks at her totally differently now, and is amazed by her strength, and Emilie said that she felt like she could move mountains.

The third and fourth babies came on the same night!! The fourth showed up early, a young girl of 15 (Nancy), because her water had broken but she was not having any contractions. Officially, her baby was premature, but there were some conflicting ultrasound dates, she wasn't sure of her last period, and the baby felt (to Hannah) to be about 8 months along and safe to deliver. She looked like she was going to labor all night, so we all went to bed to rest up. Pretty soon after, Sandra, another assistant at the clinic, woke me up because another woman had come in (Ana). This was Ana's sixth child, and she was as calm and focused as Pati had been a few weeks before. Ana was at the clinic for less than an hour before she delivered her daughter (5th daughter... they were a little disappointed!). By this time Nancy's labor was heating up and she was quickly spinning out of control, as she had no idea what to expect and was just freaking out, and screaming her head off! She also brought half of her village with her, and because the night was freezing cold, they were all in the room. When she finally started to push, she would jump off the bed, squat, jump back up on the bed, jump to the other side of the bed... just back and forth like a frightened animal. In hindsight it was funny, because she was pooping at the same time from all the pushing, so there was poop EVERYWHERE. She finally delivered a beautiful baby boy.

The last birth was with a woman named Maria. She had had two babies, both delivered by cesearean. This was an interesting one because the babies heart rate was really low and not changing at all (it can be low, as long as it is fluctuating). We gave her oxygen, we had her squat, lie on her side, stand up, any number of things to try and get the baby's heart rate up. Nothing, and things were getting tense, to the point where it was almost time to talk about transporting her to the hospital. Finally, we had her roll over to her hands and knees and VOILA... heart rate back up and healthy. The cord must have been compressed in all other positions. One more baby born wailing and healthy.

One of the biggest things that I took away from all of this is that four of those five women would have had a cesarean if they had been in a hospital, particularly a public hospital. The c-section rate in Guatemala is shocking, and seems to largely come from doctors being in a hurry (lots of patients!) and having inadequate training in obstetric techniques. They also get more money for performing a c-section than a vaginal delivery (as is the case in the US as well), so that might have something to do with it too. But these babies were gorgeous and healthy, and got to snuggle with mom a milli-second after coming out. They also didn't leave the clinic until they were feeding okay, and I watched Hannah spend an hour with a new mom helping her coax her baby to take her breast. It was really amazing, and I learned SO MUCH.

Three weeks into it, Tait came back and joined me. It was a lot more fun to have him there, although we did have to sleep in twin beds (we would start most nights out in the same bed and then one of us would kick the other out in the middle of the night... and let me tell you, those first moments of having the twin bed to yourself were heaven.... so much room... you could streeeettttchhhh!) There was a kitchen in the clinic where we cooked most of our meals (Tait would have food cooked for all of us when we were up all night with a birth). One of the funniest things happened when Tait found a speculum (used in vaginal exams) that had been sterilized in a pot on a stove. He was so excited because he thought he had found a garlic press (he loves pressed garlic), but just couldn't quite figure out how to make it work. I almost fell over laughing when I stumbled upon this, and am still snickering to this day.

Since this is a food blog, let me leave a footnote on food... there is a bakery in Antigua that makes the best banana bread that I have ever had. You could also buy a half-loaf (which we did, regularly) for about $1.50. Tait loved a bakery that had lots of fresh, chewy buns stuffed with meat, and spinach, and cheese, and any variety thereof. We went to a falafel place a few times and loved it, and often stopped for jalepeno bagels at the "Bagel Barn." While we cooked our meals with market ingredients, it was also a special treat to have these little luxuries. Hannah used a lot of teas in her practice so we drank a lot of hot tea (it was also freezing). My favorite was Rosa de Jamaica (or just Jamaica, pronounced "hai-my-kah") which is made from boiling a handful of dried hibiscus flowers in a pot of water (and adding a little sugar... it is also good boiled with a cinnamon stick). It is bright red, and is chock-full of iron and vitamin c (and you need vit. c to absorb iron, so its a perfect combo). For all of you from Abidjan, it tastes just like bisap. We found some in the Mexican grocery by Tait's mom's house, so if you're curious, go out and get some!!

We are now back in Northern California, for a brief stay before heading to Asia. It is cold and rainy, but so nice to see friends and family. Jennifer (Tait's mom) has tangerine and Meyer lemon trees in full bloom, so that is a nice burst of deliciousness amidst the cold and grey. Jennifer is also feeding us within an inch of our lives, plying us with butter and wine... and we are doing very little to resist. Tait is starting to look for teaching jobs for when we come back (reality is starting to come calling), and I'm trying to figure out what I'm going to do about school. Whatever way I cut it, I have quite a few years of school left before I will be able to practice as a midwife, and will most definitely also have to find some sort of job. But, we can put off pounding the pavement for a few more months. We will spend February in Thailand, Laos, and Vietnam and/or Cambodia (Tait spent quite a bit of time in Thailand as a kid but hasn't been back in 20 years or so). In March we'll head to Indonesia, where my parents live, and spend some time exploring there, and will also travel through Malaysia (where I was born) with my Dad. We can't wait!! Tait was very excited that he had "skinnied up" in Guatemala to prepare for the food frenzy of Asia, but a week in Northern California might have derailed his plans!! We'll keep you posted....

Here are some pictures of the Northern California January bounty!

The Clinic and Antigua Reevaluated

We´ve been in Antigua for a good three weeks now and have two more to go. I never thought that Antigua would be the place that we ended up spending most of our time in Guatemala. When we first arrived we came here because it was safe and beautiful, that colonial city that every country in Central America seems to contain and boast of. It had bagels and good coffee and easy places to eat. It was comfortable and truthfully, it turned us off. Not that we aim to be Sir Edmund Hillary going boldly into the darkness or even hippies on the trail, camping and cavorting their way down into the banks of Lago Atitlan, living on tortillas and herb. But in some way we were looking for something that was more of a challenge. Everyone had on flip flops and board shorts and the locals talked to you in English and then Spanish. The shops were expensive and a beer cost three bucks. We left and enjoyed ourselves in the other parts of Guatemala and I think that is where we would rather still be, but something about Antigua this time around has grown on me.

Partly it is that Kath has this amazing opportunity to work at Manos Abiertos. Every day she is getting to experience midwifery on a level she couldn´t in the States. She is observing and learning and becoming a midwife. Partially it is the life of living at the clinic. Now the clinic isn´t in Antigua, so that is a bonus, but there is something to be said for shitting on your own pot for a minute (all credit to a Miss Renee Robinson who once told me she had to go home for that very reason). We have a kitchen to cook in and matching twin beds to sleep in. The bus is 15 minutes to Antigua and the creature comforts offered there are just that, creature comforts. I don´t mind a good grocery store and the ready availability of internet in comfortable chairs, though I still do resent three dollar beers.

The weekends are when we usually have time to spend in Antigua, and it is also the time everyone else has to spend in Antigua. It is smothered in tourists from all over, including people from Guatemala, and that is what has struck me about the place this time. Despite the fact that it is full of students studying abroad, people doing volunteer work, expats working bars and hostels and running NGOS, and of course, the ubiqutious language students (of which I was one, though not here), it is at heart a very Guatemalan city. The people here aren´t much different than in other cities, though more of them speak English, and the market is nearly the same, though there are more of the trinkets in the brightly colored motifs of Guatemala. The stores sell more expensive things but outside the city center it´s all the same homemade tortillas and coke in a bag that you get everywhere else. The houses are old and crumbling and on the deforested hills shacks cling precariously while alleys zig zag moreosely towards dirt roads where chicken buses burp and belch black exhaust. People sit 4 to a seat in old school buses meant to hold to two children and the ayudantes yell just as loud.

It is in the last couple of days I´ve spent in Antigua, while Kath works, that by walking its streets and getting to know it past just appearances, it has taken on a different mein. Antigua has its charms and its beauty. The hotels are there that cost a fortune and the meals that would rival New York (although nothing compared to this little spot on Utila called the Wooden Spon...best meal I´ve had in ages). There are weavings costing hundreds of dollars and masks and bags proclaiming Guatemala. But also there, in plain sight if you look, is Guatemala. The women are in huiplies and the men in trajes, the mountains are covered in maize and coffee, the chicken buses run nonstop, the volcanoes are as high and as beautiful, the people are friendly and warm, the tortillas delicious, there is fried chicken on every street corner and the stores close for lunch just like everywhere else. There is something to be said for watching it all passby with a good bagel and coffee in hand.

I leave you with two pictures from New Years. While New Years involved lots and lots of wine, it also involved cashew green beans, cucumbers and star fruit with salt (spectacular, you gotta try it), homemade tomato soup which then served to poach eggs, make baguette pizza and great pasta sauce, and also cheesy garlicky toasts.