So I was telling you all about the 2 women with ruptured membranes...
The first mom did amazing. She got into a groove with her labor, started believing she could do it, and pushed her baby out around noon that day.
The second mom, the 4th timer, never got into labor on her own. Eventually she went to the hospital where she received pitocin to induce the labor but it didn't take and she had a cesarean. It was interesting- she had had 3 normal births but this one was the biggest baby she had ever had- 4800 grams - that is equivalent to 10 pounds 9 ounces.
For those of you who don't know what releasing of the waters means it is when the "water breaks" or in midwifery terms we call it SROM- spontaneous rupture of membranes. If it happens before labor begins it is called PROM- premature rupture of membranes. Many people think that this is the first thing that happens to initiate labor but actually most waters release ( as the hypnobirthers like to call it- a gentler term;) ) when a woman is pushing. The other day we had a baby born in the caul, meaning the waters didn't rupture at all- a sign of good luck in many cultures.
Anyways, last night we happened to have 2 moms come in with PROM. The first mom arrived at around 1am with her family, per Balinese custom. I usually love having the sisters, aunties, mothers, and children at the births but this time it was a bit of a nightmare. The challenge being that once the water breaks in the tropics there is a very limited time a woman can hang out not in labor. In the states in the hospital it is often a similar problem, the fear being risk of infection for the mom and baby. In homebirth we have a longer amount of time to work with ( times vary for midwifery practices but usually fall between 24-72 hours) because we know that the mom is the healthiest and most protected in her natural environment and that we are keeping in constant communication and helping to support her immunity, etc... So here in the tropics things grow like crazy- yep, it is pretty gnarly some of the staph infections that people have come in with ( not the moms so much but folks coming into the acupuncture clinic). Anyways, the deal with Bumi Sehat and the hospitals here is very interesting. There is a government hospital that is free but only allows a woman to have ruptured membranes for 2 hours before they begin an induction! 2 hours! So of course Bumi Sehat encourages patients to have their back up be at a local clinic which is not free but Bumi Sehat explains they will help pay for the costs if the patient chooses to go there. If they choose this clinic they have 12 hours at Bumi Sehat before having to transfer. This is still a short period of time considering the research shows that most woman go into labor spontaneously within 24 hours post PROM, not 12 hours. But the reality is here we are in Bali.
So it is 1am, or at this point 2:30am. I am alone with Ibu Ketut, a lovely senior midwife who speaks very little English. I am trying so very hard to understand what is going on in my limited understanding of Indonesian, as well as listening and watching closely to read the subtle dynamics occurring. It seems the family wants this sweet 1st time mother of 22 years old to go to the government hospital. Ibu Ketut just sits there patiently explaining the situation hoping that this family wakes up and smells the reality of what will happen to them if they go there. I decide I better act whatever the decision is to try to help this mom along in some fashion ( oh did I say she was barely 1 cm., long, and posterior). I start her on homeopathics as well as digging into her acupressure points ( because sadly the acupuncturists from NY have all departed and left us barren and distraught without them - just kidding, though we do all miss them a bunch). However, while they were here we did get a lesson in needling in the case of emergency, i.e. hemorrhage, retained placenta, and I was in absolute heaven due to my obsession with Chinese Medicine and love of sticking needles in people - not to mention how much easier it is to insert an acupuncture needle into a specific point filled with chi as opposed to an IV catheter of a dehydrated woman!
Sorry, I digress- I guess that is what happens after 3 hours of sleep.
So where was I? Oh yes, I began doing acupressure on the mom while her mother began splashing holy water on her. I kept hearing the words rumah sakit ( the word for hospital, which literally translates as house of sick) and thinking alright, gotta let this one go. Ibu Ketut finally decided to call Ibu Robin to consult which made me very happy to get the skinny in my own language. Robin laid it out clearly and recommended the usual. If they decide to stay we can do castor oil in the morning and start antibiotics now. So it had been a couple of hours at this point and the mom had started having contractions - yea! She was learning how to breathe through them and even beginning to show some signs of a personality other than the daughter of a very opinionated mother. So they decided to transfer to the clinic if need be and settle in at Bumi Sehat. It is 8:30am now and she is doing well. Will keep you updated.
Mom # 2. Nothing very exciting yet but I am curious how it will go. She is a 4th timer who has a history of macrosomic (very big) babies! So again I heard Ibu Ketut get on the phone with Robin and consult. And of course Robin gave her stamp of approval because she had had 3 successful normal births with a midwife. I have started her on the homeopathics and happily I called Jenny, one of the volunteer midwifery students here who is also an acupuncturist, who agreed to come over to do an induction treatment. Jenny is very clearly here to learn midwifery, not to practice acupuncture, but will do it on occasion for situations like this - and I knew she was awake!
I hope that life is treating all of you so very well. Thank you for reading my blog. I wish that in my spare time I had also received a masters in creative writing to make this more exciting for you all... I hope my love suffices for now : )
Well it has been awhile since I've posted because it has been super quiet for the past 2 weeks. Maybe the new moon in Capricorn, maybe the rain - who knows, but last night the action started up again and it was easy and joyous. Yes I know all the moms reading this know that it isn't quite fair for me to use the word easy, but as a midwife, it felt like the moms birthing last night were in the flow and it was sweet.
The first one spoke some english and we developed a rapport right away. Even though birth transcends language it is still so much easier to be able to communicate! So it was her 3rd baby and she wanted a water birth this time. It was the middle of the night and the Indonesian midwife was happy for me to do labor support and wake her when she was completely dilated and ready to push. I wish I had my camera because she ended up birthing her baby in the caul ( in the bag of waters ). It was gentle and smooth and soon mom and baby were happily in bed nursing.
The second mom came in ready to push! It was her 2nd baby and everything happened very fast. There was a tight cord around the baby's neck that we thought we might have to clamp and cut but she pushed and pushed and the baby was born with the cord. We easily unraveled the cord after birth and the baby started crying immediately ( which is a good sign of a healthy baby).
So both moms had baby girls, a disappointment in this interesting culture I have submersed myself in. Thankfully for these new babies, both moms had already had boys so they had fulfilled their duty to their families and could enjoy their little girls. I and the other volunteer midwives have all talked about how much this affects us and how we each cannot help but talk to these girls and tell them how special and important they are.
So there is a quick note from Bali. So much more to say about the clinic, the culture, life in general.
Soon I will write again but for now it is my day off and I am going to start it with a nap!
So maybe this year we will turn things around politically and environmentally since the first baby born at Bumi Sehat this year was born feet first!
Yes it is true - I witnessed my first breech birth. A double footling breech born in the caul ( in the membranes). It was a third time mom who came in complete and pushing. She had had two prior babies breech and so she was the perfect candidate to have a breech birth. Not to mention there was no time to transfer to the hospital - this baby was coming and coming fast!
I wasn't on call that day, I was just hanging out in one of the birth rooms with an acupuncturist doing moxa on a sweet little baby that needed a little more chi to wake up and nurse, when Robin swept by announcing an imminent breech. I carefully left the little babe in the arms of Jen, the gentlest acupuncturist i have ever worked with, and swiftly slid into the birth room, camera in hand. The feet were already starting to come but looked so strange as they were, yes, as i had mentioned, in the membrane. The body came soon after and was posterior so Robin gently encouraged the baby to rotate which it did. The membrane broke and the baby was almost completely born. Everyone was calm and excited and as I snapped photos I saw the nape of the neck appear and the head slide out so so smoothly. Oh a sigh of relief and joy spread throughout the room as the mom held her baby tightly to her chest. And that was it. Seamless. 15 minutes at the birth center and new life had slid into the world without a glitch. And...no tear!!
So a few of us reflected on the toast we had made hours before at New Year's. It was a hope that this year things would turn around politically. So there you go- starting out on a good foot- hee hee
Chanti
