7 posts from December 2007

Dear friends,

If you are still deciding which non-profits you would like to give your year end tax deductible donations to I just want to put a plug in for Bumi Sehat

I am continuously amazed by the workings of this birth center. Robin Lim, the founder, visionary, midwife, and mother behind the project, has created a gentle, safe, and free place for women to give birth to their babies in a country where families who are poor cannot take their babies home from the hospital unless they can pay. The daily wage here is $1.50 and many of the families here have never slept on a bed or eaten brown rice until coming to have their babies here at the clinic.Once they are here they are encouraged to birth in the water, receive acupuncture treatments, and heal from prior experiences such as episiotomies and repairs with no numbing medication. They are given whole food vitamins donated and brought over by volunteers from the states in the hopes to supplement their poor nutrition. They are nurtured and supported as they grapple with losing their babies because of genetic defects and being poor. Since I have been here 4 babies have died. One because of the hospital system and being  impoverished, one from anencephaly ( no brain and skull).

The clinic has a wonderful staff of Balinese people, along with international volunteers always passing through. When the Tsunami hit Robin started a sister clinic in Aceh where they would treat 80 people a day at the beginning of the disaster.

There are many amazing organizations doing life-changing work in this world. I feel blessed to have found this clinic to generate my desire to impact the world in a loving and graceful way. It is an honor to welcome babies into this world with gentle birth.

Robin has leased the current clinic for 5 years but it is small and at times women are birthing in the office! There is a piece of land for sale across the road that is 120,000. She has 35,000 donated so far and I write to you today in the hopes that you might help make Bumi Sehat clinic a permanent fixture in Bali. It was voted the best non-profit out of 700 in Indonesia. It has a great deal of potential but it needs money to survive.

There are also the basic supplies that are lacking like quality blood pressure cuffs, dopplers, breast pumps, and baby blankets if you would like send donations with volunteers when they come.

I will be here until the end of February and  and I would love to see any of you here and welcome you into this sweet community of inspiration.

Many blessings,
Chanti

To make a donation go to www.bumisehatbali.org and donate through the sakthi foundation with a special request for the money to go to Bumi Sehat. All donations will be matched by 25%.

One of the Acupuncturists here has a beautiful blog you might want to check out: www.mytripjournal.com

I got a text this morning from Robin that one of our babies died. Baby Ketut.

I think I mentioned him in an earlier blog. He was the baby that had the shoulder dystocia ( stuck shoulders delaying delivery of the body by about 5 minutes) that had gotten chiropractic/craniosacral care a few times after the birth. So I will share more of the story now. It was when I first got here and I was just learning the flow at the clinic. This was the mom's 4th baby and an accident at age 40. Her labor was long and the pushing stage especially long. There was a lot of us in the room and it was a bit overwhelming for me and probably for her too - Robin, 2 midwife volunteers, 2 balinese midwives, and 3 acupuncturists who had just arrived for a 2 week class on acupuncture, obstetrics and pediatrics. If I would have done anything different I would have had less people in the room. But there we were. He needed quite a bit of traction to be born and  when he finally came he breathed after just a bit of oxygen support ( blow by) and stimulation. He was enormous ( I can't quite remember but at least 4.5 kilos, around 10 lbs). The largest baby ever at Bumi Sehat. And his head was huge and quite swollen, so much so that there was a question if he had hydrocephaly ( water in the brain). His jaw was misaligned so we called Dr. John the chiropractor right away. This helped Ketut nurse and he nursed like a champ for the next few days. We watched the babe and watched the family bond and love him. The family I live with is a wonderful and respected family in the village and one evening Made Wena- the father whose compound I live in, came by the clinic as he is a supporter of bumi sehat and was checking in on me as well. It turned out he knew Ketut's father- they worked together when they were 17 doing wood carving for an english lady. Made Wena- an excellent english speaker explained that Ketut's father was a master woodcarver. Who would have known?

The baby was a bit jaundiced when he left so they told them to put him in the sun and follow up with free craniosacral care. They also had them take him to the doctor to check things out. The doctor wasn't concerned. I guess a day or two later the family got worried and took him into the hospital.

So I understand why the family took him into the hospital. They wanted answers, they wanted to make sure their son didn't have any kind of condition. The problem? They were poor.

Robin and I went to visit them the next day. The hospital is about an hour away in the city of Denpasar. We found the family and went into the intensive care unit. Ketut was in the incubator with blue lights and hooked up to an IV of glucose water and antibiotics. The mother was not allowed to nurse him. They hadn't done any tests or given him any medicine because the family was poor and they were waiting for their letter of poverty to be approved by the government or something. The family was sleeping on a mat outside the hospital. Robin gave them the 30 dollars she had in her pocket to buy food. They called her later to let her know they would use it to get tests done on the baby. For some reason the tests were never done and the baby sat in the intensive care nursery for 16 days. Robin talked with them on the phone everyday and sent someone else to visit at some point but nothing was done for this baby and he was not allowed to nurse.

At 6:30 this morning Robin texted me with the news. I started chanting om mani padme hung to help Ketut's soul pass smoothly in between being furious and heartbroken. I continued to text with Robin as she shared what a typical day this was. I have so much admiration for the work she is doing here. And I am so glad she has as much support as she does because otherwise it would be crazy making.

So I sit here with you - christmas eve, the end of the day, holding baby Ketut in my heart. I helped a beautiful little one come into the world a few hours ago and two more women are laboring now. The cycles are so clear here in Bali, here on this full moon, this full moon that the balinese celebrate with colorful ceremony every month ( there was an offering outside my studio this morning and on my bicycle seat as well!). It is time to rest now and give thanks.

Love, Chanti

So because there are a lot of midwives volunteering at the clinic right now we created a shift schedule so that 5 of us  aren't trying to catch a baby at the same time. And I have found that with all the volunteers, the acupuncturists, and the balinese midwives the births can start to feel a little like UCSF ( teaching hospital that always feels like there are too many residents present at the birth). So we each get a day off every 4 days, then we come on as assist for 2 days and then primary for 1 day. I am learning a ton from all of the other midwives not to mention the brilliant acupuncturists at our beckon call. I love being able to offer our moms acupuncture inductions rather than transporting to hospitals that they can't afford to pay for, as well as postpartum balancing treatments.

The 24 hour shifts are fun and a tad bit grueling. Fun in the sense that this is my time to bond with the Balinese midwives - practice my Indonesian, learn Balinese dance ( attempt to learn), and try to kill the mosquitoes. Oh yes, mosquitoes. That is the grueling part. It is so strange- the Balinese midwives don't like mosquito nets and every morning that I leave the clinic I come back home with at least 20 new bites. And the midwife room is so hot that I can barely cover myself with a sheet but I know I have to in order to protect myself from the little bloodsuckers. The Balinese midwives also have an affinity for loud music or blaring TV with the florescent light kept on all night. I do my best to embrace it all and laugh as much as I can because even though we don't understand each others language very well we can always find some to laugh about.

And I feel very fortunate to be here. The women are poor and the clinic has many needs but a midwife just visited from the states who had been in the Dominican Republic working for a month. The clinic she had been at didn't even have running water! And by the way I asked her about trailing membranes and she said she saw it all the time when she was there.

So I was talking about shifts. It's awesome to have set times I am on and off call - I can get a massage, see a dance performance...and no I won't get called. But this morning I was reminded what I love about homebirth and just being plain on call- the continuity of care! Yes, it's true, I got attached to the 3 women who were in labor in the night. But at 8 am the new midwife arrived and it was time to leave. 2 of the moms asked me to come back for their births  but I had to let go and tell them they were in good hands. So here I am now with you with the time and space to write this note and in my minds I am visualizing all of them holding their beautiful babies in their arms.

love you all, Chanti

So here I am a new midwife in a foreign country. On average the births are similar to births in San Francisco - as Nancy always says when people ask what labor will be like: you have a bunch of contractions and then you push your baby out. : )

But I am noticing some trends here that I have not witnessed thus far and am wondering what you ladies think about all this back home. 3rd stage ( post baby until placenta). It is a different world here when it comes to hemorrhage because of the malnutrition so everyone gets yu nan biao ( chinese herbs ) immediately after the birth. Of course I love this part, but then I have noticed some pretty agressive maneuvers to bring the placenta. I always thought the number 1 rule was no fundus fiddling while waiting for the placenta but it seems to be the norm for the balinese midwives. And a couple of times I have seen the midwives go in after a placenta 10 or 15 minutes after the baby- yikes! I have heard that fundal pressure is the norm at the clinic in Africa that students go work at as well. It is tricky because when I talked with Robin about it she agrees it isn't necessary but she wants to respect the local midwives - it is very important that she maintains good relationships with them.

What I am looking forward to is doing some perinatal psychology birth sessions with the midwives. I have told Robin about the work that I have done with Ray and she would like me to do sessions first with the volunteers and then the Balinese midwives - she knows they are bringing trauma to the births. And the beautiful thing is that there is a volunteer here from the bay area who has done a process workshop with Ray so I have an assistant!

Anyways - the other trend I have noticed with 3rd stage is trailing membranes. Trailing membranes..... okay Nancy maybe I saw them 2 or 3 times in the 3 years that I went to births with you? I think 7 out of the 9 births I have attended the women have had trailing membranes. Oh, sorry to the non-midwives reading this, trailing membranes are when the placenta comes but the membranes ( the "bag of waters" that surrounds the placenta) trails behind and takes forever( well hopefully not forever - a few minutes usually)  to come out. Is it malnutrition? I am sure Anne Frye has something to say about it but I haven't looked yet. 

One cool remedy for postpartum hemorrhage - okay it might gross some of you out - when a woman hemorrhaged last week we gave her a bit of her placenta with a bit of honey. Robin makes sure to use lots of honey and basically disguise it because of, well, it not being the most acceptable cultural norm. Stopped the bleeding right away.

Blessings to all back home, 

love, Chanti  

Well....I am sorry if I left any of you hanging. It is tricky getting into town to the internet cafe. So much to say but I will start where I left off last....

The homebirth: So this momma labored so beautifully for 3 days and nights and was complete and pushing like a goddess....with no descent. The baby was not coming down despite every trick and position one could imagine. The babe was, you guessed it, OT ( occiput transverse, not an ideal position for fitting through mom's pelvis, and one of the most common reasons for a labor arrest). We tried to help the baby shift into a better position but the baby didn't like it and had a deep decel ( the heart rate dropped) with a slow recovery. The baby stabilized with change in position and oxygen for the mom but it was time to go to the hospital and get some more help. Wow - my first homebirth in Bali and my first transport - all in the first week of being here. Lots of rescue remedy later we were at this fancy hotel looking hospital ( where one takes their shoes off still). Robin has excellent relationships with a couple of docs who will meet her at the hospital and they all treated her with the utmost respect. But it definitely had that CPMC feel ( CPMC is the posh interventive hospital in San Francisco). I got why Robin said there was a 90% cesarean rate in one of the other hospitals.

So even though the baby had stabilized, she was high in the pelvis and they were concerned so they went ahead with a cesarean but get this....THEY DID A LOTUS BIRTH!! It was pretty phenomenal. The couple had been planning it for so long and made up a story that the mom, Japanese, was from a special clan on a small island where it was the custom to leave the cord attached and it was very important to them. It worked. So there I was with dad standing by the door waiting for the baby to come out of surgery. They resuscitated the babe outside the operating room and we held the door open so we could see and talk with the baby. It was a lengthy resuscitation and my heart was leaping out to this little one I had grown so attached to her in the last few days. I kept grounding and thinking about what Robin had told me earlier about one of her teachers humming while she would resuscitate babies. The baby came in and I saw she was still attached and was just so shocked they had actually honored their wishes. The doctor was actually kind of into it - injecting lactated ringers through the cord. And blessed be, they didn't want the baby in the nursery because of the placenta so mom and baby were back together within 25 minutes and nursing shortly after.

They called me a couple of days ago to tell me that it had separated at day 7. It was interesting to watch their recovery process. Of course an unplanned cesarean is traumatic for most anyone and they definitely had some grieving to do. But I noticed that the fact that they were able to keep the placenta was very healing and grounding for them.  A small victory.

Much more to say - and if i can ever figure out how to put pictures up i will send a photo of baby Chiyo with her placenta, Lien ( lotus in chinese).

Back to the clinic now. There is a group of acupuncturists here training for 2 weeks. Any healers wanting to travel and do service- this is the place!!! There are a lot of babies, children, and moms in need. We had a shoulder dystocia the other night and Dr. John, a chiropractor, and I have been doing some craniosacral with the baby and it is so helpful.

Lots of love to you all and more stories to come.

Chanti