How We Are Humbled

It hasn’t been that long since I was in Honduras volunteering as a Doula with the Dar a Luz project, the work of my dear friend Silvia’s heart, at the city hospital in La Cieba and then to the hospital on the island of Roatan ~ not even a year. How life can move at such an accelerated pace sometimes, and at others, slow, so slow… drip……drip……drip. So much has been happening and evolving. Which is why I never finished writing about my experiences in Honduras. By the time I got home, I was so relieved, tired, full, and overwhelmed that I almost needed to forget about it for a minute, or a month, or 8 months, just to process and assimilate what I had experienced and learned. Not just about birth, and birth in a third world country, but also a culture. In a country where there are so many problems, so much corruption and poverty, I learned of things that go on that I could hardly bear to hear. The exploitation of poverty and youth is beyond words, but there are also incredibly bold, courageous and huge hearted people there doing their best, working with the communities to support, encourage and educate those in need, and bring about change. For instance, in Roatan (having the 2nd highest HIV rate in the western hemisphere next to Haiti) the HIV transmission rate from mothers to babies was approximately (I’m trying to remember now, and I know my numbers are way off, but you’ll get the idea) 60%. The main reason being the extreme poverty that keeps families from being able to buy formula. So the options are, baby starves or drinks contaminated breast milk. If you have a hungry crying baby and a full breast, and nothing else…..what would you do? The wonderful midwife (social worker/activist) I stayed with on Roatan has a fundraiser every, EVERY Sunday to raise money for formula, and the rates of transmission has dropped to the single digits in 3 years. Wow! People make a difference in big and small ways everyday. Which is why we must all do our part. This world, with all it’s people is a whole functioning organism breathing its collective breath. We are not just cogs in a mindless wheel, turning and turning ~ we, through intention and action can create change. This is why I never give up. Because I know that by living truthfully, in a good way, with good action towards myself and my community I can be a positive piece to the puzzle of life. One tree in a forest, in one season can give off enough oxygen for 10 people to breathe for a year. That’s pretty awesome. We support each other.

After being at El Hospital Atlantida for two weeks in La Cieba, I was transferred to the island of Roatan (I always am more comfortable on islands!) to deliver a birth ball (think large excersize/yoga ball) to the clinic and demonstrate/teach with the nurses how to use it and other comfort measures to help the women in their labors ~ and also to attend births for the week I would be there. There were only a small handful or births during my stay, two of them being very intense, powerful experiences in very different ways. One was a thirteen year old girl, tiny, skinny, barely any pubic hair, scared, and in a lot of pain. She was very difficult to reach because of the state she was in physically and emotionally, and the language barrier. I think she also had no patience for my troubled Spanish. Part of me wanted to walk out and leave, she was hysterically wailing and screaming but I couldn’t help. I felt helpless, useless, and in the way. As I had to do everyday, I had to sweep my ego aside, stop looking for validation and remember that this little girl is terrified, and probably has no idea what is really going on. As I’ve written before, it is sometimes during their births that a lot of these women first learn about anatomy and the hows and whys. In some moments with this young mother, I was able to get her to focus into my eyes and breathe. I could feel her become grounded, and anchored, her breath becoming deeper and stronger. I would think, Okay, good, she’s here, she can do this. As quick as the moment of strength and peace would come, it would be gone and she was lost, her legs squeezed tightly back together. The nurses were saying to, me….’She will not deliver. She cannot open. It will be a cesarean. You can go.” “I’ll just stay a little longer, I think she can do it.” I kept saying. Eventually, I took their advice and left. I was confused and sad and tired. I felt like I had failed this child. When I came home and told my host about the experience of the day, she started grilling me with questions….”What did you do? Why did you leave?” I felt like I was being judged, I felt terrible and in over my head, and said as much ~ which opened up a dialog for a great conversation where I learned, yet again to stare that ego in the face, be humble, listen and learn.

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The next day, I arrived to the hospital where I learned our young mama delivered naturally, a healthy baby within two hours of my leaving. I was so relieved, though I wished I had stayed. This day was to be my last in the hospital, and my last as a volunteer in Honduras. I would next be going to the island of Utila to relax and get my SCUBA certification. My confidence level was down a bit and I kind of didn’t want to be there. There was a young mama, age 17, laboring alone behind the curtains. The nurses were trying to give her oxytocin through her IV but she wanted no part of it (pretty much all labors are ‘enhanced’ with oxytocin, one of those things that is just done, routinely, without thought). They would come in, turn up the knob on her IV, she would jump up out of bed and turn it off. I liked her spunk. He labor wasn’t progressing, and her sister came in to give her a pep talk, which was more like “you’re so stupid, why won’t you take the medicine, stupid!’ and then turning up the knob. There was a little battle of turning it up and down. I said to the sister, ‘I think you can go now”. I won’t use this mama’s real name, which was lovely, so I will call her Mani. Mani sat on the side of the bed weeping, one of the nurses gave me a crazy-eyed look like, “Go to her, dummy! Isn’t that what you’re here for!?” I snapped out if it and sat with Mani. She had a bit of an attitude and was like, “I don’t wanna do it! (she spoke some english, which was wonderful) I’m not gonna do it! Gimme a cesarean!!” Here comes that, The Only Way Out is Through speech! I explained that a cesarean might feel like a good idea now, but after it’s over you will have more pain, a lot more pain and for longer,  and while trying to take care of the new baby. I explained that “the cervix is like a flower that needs to open, and that the pain of the contractions is what is making that flower open. It is purposeful pain, but you need to go into it and allow it to happen. If you fight the opening, the pain will be worse. I will stay here with you and help you get through it. And probably by the end of the day, you will have your baby and your pain will be gone. You will feel like you made a big accomplishment” She looked at me and I could see her processing that information, taking it into her body, seeing it making sense, and after a few minutes she looked at me, straight in the eyes, and said, “Okay, let’s do this.” She suddenly turned into this force of strength. She listened to and tried suggestions, she didn’t do what she didn’t want to do. Eventually, she started telling Me what to do, which was awesome. I was like, Okay girl! You tell me what to do and I’ll do it! Labor got intense, she was up out of the bed, pacing back and forth, squatting, having me lift her belly during contractions, doing the ‘doula hula’ which is kind of a swaying dance where the birth partner supports the weight of the mama. She was like, “Do this!! Do that! it was great. I could feel her energy, it was so powerful, she was so strong and focused. Finally, I think she was fully dilated and was needing a rest so she got back in the bed, I sat on the bed behind her and she laid back into my chest. She said she felt so much better, and thanked me for being there, and could we stay like this for a while. We rested until she felt the urge to push. She began pushing and was like, “I can’t push on this bed! It’s not right! I can’t lay down!  Bring me to the delivery room!” Again, I was impressed with her clarity of mind and desire. She asked me what time it was. I said noon. She said, “I will have this baby by 1”. Everything she said, she would say directly into my eyeballs, as if to anchor it there. We moved to the “expulsivo’ room where she gave birth to a gorgeous baby boy, ‘her king’ she said. She was happy and comfortable and her family was there so it was time for me to go. She asked for my email address so I gave it to her, wished her well and left the hospital for the last time. A few days later I got this message from her. It was so awesome.

   “Hi melinda how or u doing u hope ur doing verry well you remember me ——– the girl that u was with in the hospital the monday wen I was given born to my baby boy I thank u for everything u did for me that day u make me feel good that day wen u was with me I was verry happy to have u on my side thank thank thank u u u u very very very much”

I am forever grateful that I was able to end my volunteer time on a positive note. I will never forget her, or the other mamas I had the opportunity to work with. Now that I’ve started writing again, it’s hard to stop, but I will leave it here today.

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This is me with little Julian, beautiful son of Silvia, who made this all possible.
http://www.darlaluzhonduras.wordpress.com

http://www.islandmassagetherapy.co ~ This is my local Holistic Bodywork and Doula practice.

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The Only Way Out is Through

April 21 2013

Ah, Whew…so I think I may be falling in love a little bit with Honduras and this little city of La Cieba. I just realized it, maybe a little bit the other day and yesterday, but definately just now. It´s been really challenging finding my groove….between the heat, warnings of an exteremely dangerous city, navigating it with not so accurate maps and very few street signs, missing my man, language barriers, and the challenges of working in this hospital….I pretty much felt like I was in over my head and, ‘No, seriously…..what am I doing here?’ 

I really couldn´t connect myself with my surroundings, I felt overly cautious and was only going straight from the house to the hospital, to Spanish class, and home. No detours, no explorations which is so out of character for me. When there would be a busy shift at the hospital and it felt like the work I’ve been doing there was truily useful and needed, that felt good. But then there are shifts that are slow and nobody really seems to want you around, and I´m not sure if my presnce is appreciated or annoying……it´s then I do my ego check and remind myself that I am here for the mamas. It´s not the other way around, they are not here for me and neither is the staff. Nobody owes me any appreciation or thanks. It´s cool when I get it, becuase then I know I´ve been helpful. Tonight was good, I was making my rounds and a laboring mama started to seriously freak out, so one of the interns (who I thought didn´t like me probably becuase when I feel shy I can seem really aloof and can put people off, thinking they don´t like me when really they think that I don´t like them. But we had a nice conversation after and he helped me with my Spanish, I think that broke the ice a bit) called me to come over and help. I tried some things with her and nothing was really working, what was needed was the ´Take Charge’ routine. When a mama gets to a certain point of pain, fear and not breathing it can really go into a cycle of feeding itself….the more fear, the less breathing, makes for more pain…….more pain, more fear……..more fear, less breathing….. …….less oxygen, more pain, and on and on and on. Sometimes you just have to get tough and take charge, get up in her face, make her make eye contact with you, make her hear you to bring her back to her breath or moaning or what ever works for her. That was my first real take charge moment. Intersting with not speaking the same language. But one of the interns who I think is really nice came in and was super helpful in explaining some things to the mama. She was certain she couldn´t do it, ‘Ya no aguanta! No puede!! I cant, I cant!!’ (Yo se, pero, se puede, se puede….I know, but you can, you can) She was trying to get away, but obviously you cant escape your birth……the only way out is through, and I think that´s what the intern was explaining (with my limited understanding). It felt like the three of us were a little team and once we gelled, that little niño decided to come right out! A otra parto! Another birth!

There are always light and dark sides to everything. I came here with the impression that the conditions were going to be horrible, the Drs mean, uncaring and not seeing these women of a poorer class as worthy of good treatment, and I´m really glad I was prepared for the worst. Granted in the old hospital which is right across the street from where I am living, there was no water, the room where all the women labor is much smaller with no curtains, really dark. The new hospital is bigger, brighter, cleaner, with AC and running water. It´s not nearly as bad as I had imagined. Looks can also be decieving, though. There’s no toilet paper, rarely cups for the women to drink out of, often times a shortage of sheets. Sometimes a woman is laying on the bed on her sheet in a pool of blood, amniotic fluid, urine and shit and there are no more sheets. You want to get that situation rememdied but have nothing. I once just found a pillowcase size peice of cloth, donned my gloves, got rid of the mess, tried to clean under her as much as possible (no paper towels, no rags) with a facecloth I had in my pocket, and throw down the pillowcase under her. Sometimes there’s no sheet at all and she’s just in her johnny right on the vinyl table. Sometimes there’s just blood everywhere. Sometimes the smell of everything that can come out of every orifice of a body mixed witht the chemical sweetness of whatever cleaning supplies they use is enough to make me not want to walk through that door. Sometimes the language barrier seems too much and for everything in Spanish I learn, everyone decides to say it a different way with a different accent and I can never understand, I just don´t want to go. Sometimes it’s just so hot and I´m in this beautiful country that I´ve hardly explored and I just want to find some travelers and vagabond it. But for all those reasons to not be doing this there are infinately more reasons to keep showing up, to keep being there for these women, to keep up the work.

I think local practices have really been on the upswing in the last couple of years, and I know it has a lot to do with the work that Silvia is doing with Dar a Luz. Even more than bringing in doulas for the births, she´s educating, bringing in midwives and teachers from all over. Educating those in the medical field here and their educators so that the ripples can spread and spread. So that the ones teaching these new interns and nurses are immensely improving the culture of birth here. Poco a poco…little by little. A friend who did this same thing as me in the same hospital a few years back had stories that really scared me (not for myself but for the women). I was prepared to be angry, horrified, ready to fight, and extraordinarily saddened. There some things that make me cringe, but after thinking about it, some of those same things are often practised in US hospitals. Things that women/birth rights advocates are trying to get changed. It all depends on who the drs and nurses are on duty and what the individual hospital practices are (and some in the US are pretty nasty!) I really cringe to see them pulling on the cord to get the placenta out. But I really love to witness the nurses suggesting self nipple stimulation to help with the uterine contractions that naturally get the placenta moving (often time the mamas can´t breastfeed for awhile unless there is an negative AIDS test result, if there isn´t one, they have to wait). I’m so relieved I haven’t seen (maybe once or twice) what used to be a normal practice (skip this part if you think you need to) of manually going back into the uterus all the way to make sure everything is out, which can cause dangerous hemoraging, not to mention the shock of the woman who after doing all of that hard work to get everything out suddenly has a whole hand in her uterus. That’s just trauma and it’s painful and cruel. I heard horror stories of really bad hack jobs of episiotomies as a regular practice, leaving countless women never able to function normally again, becoming incontinent and unable to be sexual (one of the Drs who would make these horrible cuts is now offering surguries for a small fortune at his private hospital to ‘Put you back together again’ as the advertisement says, after his bad episiotomies). That makes me so sick there aren’t words. But, more than I see cuts, I see good use of perineal support, mostly with the young interns, not cutting and less tearing. And more and more they are bringing the babies right onto the mama immediatly after birth, before doing all the things hospitals have to do to newborns. These are all pleasant surprises and make me really hopeful that the model of education is changing, will continue to improve, and that the young doctors and nurses are learning more compassionate and healthy birth care.

What I’ve been thinking about while I’m here with these women in such an intimate way is just the thread that connects us all as women. We all have the capacity to give life, whether we do it or not. Therefore we all have this capacity of tremendous strength and power ……every women. That our bodies can create a perfect marraige of hormones, signals, and contractions to push a baby out is truly phenominal. And birth is birth. Whether you have your music and candles in your bedroom, a hospital environment, dirt floor in a hut, soft blanket under a tree, water birthing tub……it’s still a birth and it’s going to require you to call on the part of you that Can. The only way out is through, and you have to find your own way through, nobody else can. Every birth is a different journey, a different story. No one woman does it the same.

I don´t know the stories of the women I see here at the hospital. Sometimes they cry with joy. Yesterday a new mama didn´t want to see her new little niña (daughter) and pushed her away. She labored so quietly all night and would hide her face in a washcloth for each contraction. She was so quiet, I walked by her bed and just checked in , only to see the baby’s head crowning! I looked up and motioned quickly to the nurse (who’s name I forget, but she’s a good one, very kind) I couldn’t remember the word for birth in the moment (parto! The nurses say when one is on it’s way) but she knew what I meant….We all moved quickly and the baby was born within a few minutes. I always wonder about the really young ones. My little 13 year old…I couldn’t help thinking, ‘Did she choose to have sex? Was it a boyfriend, a neighbor, an uncle?’ It’s so common here, sexual abuse and inscestial pregnancies. And there was a 15 year old who just radiated sweetness and was really excited about her baby, saying ’15 is so young to be having a baby, no?’ But she was smiling so radiantly, she rode the waves of her contractions with such grace……I felt that she was surrounded with love in her life.

So, as it often happens with me, my body has a deeper wisdom than my mind. So my body gave me a migraine the other day, which means I don’t/can’t do anything. I called Silvia to say I wouldn’t be at the hospital becuase of the migraine. She suggested I go to this hotel beach and pool where we had once walked to be relaxed and do nothing. It was an easy walk from my house so I took her advice. I paid the $10 (muy caro/expensive) to use the pool for the whole day, set up my nest on a lounge chair beneath a palm tree and chilled the “%** out. Swam in the pool, napped, checked out FB. Enjoyed the 80s throwback tunes they were playing (80s US pop is super popular here, I hear it everywhere…think WSRS) and once my headache mellowed, read my book. It was an Oh-so-lazy day. But I was so refreshed after that I went to the hospital for a night shift 6/7 pm- 2am and it was the busiest ever! More than 12 babies delivered while I was there, 4 that I attended. Really intense labors, lots of massaging of lower backs…it was a full house! But I felt renewed. I was thinking of what my friend who had been here before had said in so many words. “Make sure you take care of yourself. Rest, make sure to enjoy yourself, have fun. Whatever your spiritual practice is at home, keep it up here, you’ll need it. Stay grounded”. So I’m learning that dance of balance. I was going to go to the hospital for another night shift last night, so I went to take a brief nap beforehand at around 6pm. I didn’t wake up until this morning around 8am! Okay, I guess I needed that. So I took the day today to wander the markets and really feel the vibe of this place. I bought a beautiful hammock that I’m pleased with. I relaxed and people watched. I felt good with my feet on this part of the planet. I really felt my body sink into the rhythm of where I am. I had been feeling such a resistance, all becuase of fear, I just wanted it to be easy. But I am finding my way….

Mucho Amore!!

xoxo

 

…………and as I go to sleep tonight I hear the occasional Thud! of ripe mangos dropping from the huge tree in the yard, and in the morning I know I will hear this one bird sing his song outside my window as he’s done every morning since I’ve been here. Ah, and there’s a nice breeze just now taking the edge off the heat. Ah! And last night I dreamt of rain and now it is raining!

 

 

Dar a Luz en Honduras

Hola~’Hi everyone! So, I’ve been here in La Ceiba, Honduras for 5 days working as a Doula in Labor and Delivery at the Hospital Atlantida with 2+ weeks to go (I will stay on another week to enjoy some travel) It’s through the organization Dar a Luz created and run by Silvia Bahr (originally of Germany, now of Honduras)that I am volunteering. I’ve been staying with her, Alberto and their beautiful little son Julian. I will be moving to stay with my host family on Sunday, but Silvia has been so amazing with helping me to settle in and integrate  my experiences in the hospital, and understanding the honduran culture and attitudes about birth.

  Silvia began spending time in the hospital with the woman about 5 years ago, truly through heart guidance. She just somehow found her way to the hospital, to the birth clinic and, finding women in need of support during their labors she began staying with the laboring mothers, holding their hands, breathing with them, offering words of encouragement in a place where the women aren’t really seen as worthy of notice even in their most extereme pain. The pain and fear is only exemplefied by the conditions. It is in one big room that all the women labor, with a row of beds along each wall facing the center where the doctors, nurses, and interns have a desk. There are curtain to separate the beds and to block from the center but alot of the time the curtains are left open so the staff can just look up and see the progress of the birth. All these womens ‘vaginas are just open to the whole room. A lot of what I do is going around and closing the curtians and diming the lights. I see the women visibly relax and even smile. They aren’t allowed anyone with them, no friends, family, or partner, no personal belongings, they leave everything and get a hospital gown, and then they are left alone to labor even if it’s over 24 hours, which was one of my mothers the other day. Near the end they are brought to el Expulsivo room where they have to get up onto this delivery chair even if the baby is already almost out.  I can give more details about that later, it can be not for the squemish.

It seems that the mindset of the staff is a little softer and a little more condiserate than 5 years ago. I would most definately say it is directly due to Silvia’s presence in the hospital. It’s not a very open culture to outside education and suggestions are not greated warmly even though a lot of the medical practices are downright scary. Like, “Seriously,where did you learn that? And how could that possibly be effective? Or even safe?” What Silvia and her volunteers have been doing is leading by example. By showing a model of more humane care and how the women respond to it. It’s such baby steps but it works. Even since I’ve been there. I noticed one of the nurses doing the same thing I had been doing with one of the mothers, rubbing her back just like how I was doing it, speaking in a calming way. That felt like a little victory. So it’s by continuing to lead humbly by example, continuing to show these women respect that change can happen.  It feels so big and so overwhelming, especially since there is such a rapid rotation of staff that the whole staff could be onboard with a better standard of care, but then it changes over, and maybe there’s a lull in volunteers, maybe a new doctor with a bad attitude comes in and it’s back the the beginning. That’s why this project needs to keep happening. This is a very poor country and the project needs funds to continue. Right now is an especially difficult time. Funding is what’s going to keep this alive. Yesterday, at the clinic some women wanted water…….there were no cups. Nowhere. I couldn’t even find spare paper to make a funnel……I finally found one plastic cup in the break room, washed it and gave some water, washed it again and gave water to someone else, washed it again, ect. It is new that the women are even allowed water and there is still resistance to it by some of the doctors. Funds can be for basic supplies, not directly for the hospital but for Dar a Luz to use in the hospital. I had to bring my own little cloths to wet and cool their foreheads. Funds can be for making photocopies, for educational material, for transportation to teach workshops. It’s so important. I can’t even tell you what it’s like to see how birth happens here, to know that it needs to be so different, to know that it’s really going to take a revolution, but that we are just doing what we can.

So, yeah……I am totally asking for donations for Dar a Luz so Silvia can keep doing her good work. I’m going to set up some kind of Donation link through this blog or Facebook very soon.

I feel like my writing is very bad right now……I’m inbetween languages, modifying my English and speaking only Spanish in the hospital (my spanish is bad but I’m taking classes). So it’s a little challenging to find my voice in writing. It’s also really hot! And I’m just like, blah……I think when I move to my host family’s house there is an internet cafe nearby with some AC where I can relax and write more.

Mucho Amore!! xoxoxoxo

 

“We have a secret in our culture, and it’s not that birth is painful. It’s that women are strong.” ~ Laura Stavoe Harm

“Birth is not only about making babies. Birth is about making mothers ~ Strong, competent, capable mothers who trust themselves and know their inner strength.”
~ Barbara Katz Rothman