late night ruminations

3:33am Tuesday July 7th, 2009

My left pant leg is wet with afterbirth but I don't have any clothes to change into and I'm too tired to walk home in the dark right now. I just caught a lovely little boy for a first time mom who I saw for a prenatal on Saturday night. It was neat to see her in labor after meeting her prenatally --that didn't happen for me while I was in Senegal.

I'm slowly, forcefully, pushing my way into the clinic. Sort of like the babies I see being born here. At home, and in Senegal, I've been lucky with intact perineums, but the mothers of the two babies I've caught here so far both had tears that needed suturing. I want to believe its not my technique... I suspect it has something to do with every woman being made to push in a knees-to-chest position --it really puts a lot of strain on the vaginal tissues and doesn't give them as much time to stretch and open. Of course, I'm looking for blame because I'm feeling guilty, especially over this last one. She ripped damn near down to her anus, and I felt it happen under my hands. I am of two minds about being hands-on during the delivery of the head. On one hand, it makes sense to me that you'd want to support those tissues, give the mother something to push against with one hand, while maintaining flexion with the other hand, so the smallest diameter of the baby's head emerges. On the other hand, I like the idea of being hands off. Let mothers push in a way that feels good for them, in a position that feels good for them, let them slow it down when they feel the burn, gingerly let their baby's head emerge and stretch their tissues, let them put their own hands there if it feels better, keeping my damn hands away from the whole affair. I struggled with it in Senegal, when I had to keep my hands near or inside a woman's vagina to keep the bossy, rough hands of the impatient matrones out. But if I was left alone, I kept my hands away, only lending support if I sensed she really could use it. And even then, what did I know? I've been happy to be hands off at the last few births I've attended, and it works nicely. But here, they want you to have your hands on. They practically want you draped over the whole business. So I'm going along with it, because my soapbox has no place here. But its not always easy.

The upside was, like I said, I'm pushing my way in around here and so I managed the entire delivery on my own, with a lovely Indonesian midwife and a brand spankin' new, green-as-a-lime-skittle Balinese midwifery student by my side. It was great. They do a few things here that I would like to incorporate into my own practice, even though it may border on too hippie dippy for my taste. For example, they float flowers in the bath where many women give birth. For many women here, this is the first bath they have ever had. It feels like a profound gesture of respect and reverence to the women giving birth that flowers are floated in the water in honor of the amazing feat she is performing. Further, as the head becomes visible, they begin to sing. It is my great hope that I will learn the song before I leave because it is very beautiful. They sing it softly at first, as the baby is just starting to appear, and then more clearly as the birth is more imminent. I have heard them singing it as a large group when many people are present at a difficult birth and it is stunning, but it is equally beautiful when there are only two midwives in the room. They have sweet voices and the melody is at once an encouragement, and a prayer, and a welcome. Today's baby came and his mother continued the song where the midwives left off, singing it to her newborn as we welcomed him and dried him on her chest. Gorgeous. After the placenta is born, they remove the flowers from the birth tub and place them over the placenta. Another simple, lovely touch that honors the event that has taken place, and the amazing role the placenta played in it. The Balinese are not skimpy on the pretty details, that much is certain.

It looks like I'm moving again, and maybe even a third time this week. My friend Danielle left on a surfing trip today because our next acupuncture clinic isn't until Saturday. There has been some strange political stuff happening at the clinic recently related to the Indonesian government not liking certain things about how the clinic is operated. It looked, for a time anyway, like the western volunteers might need to make themselves scarce for a while (which I wasn't thrilled about), and Danielle nearly had me convinced to take this week off with her and go surfing about 2 hours away. It sounded really nice. BUT, I was responsible, and I remain here, dutifully un-suntanned and un-beachy. Anyway, Danielle's apartment across the compound from my room is now vacant and she's not planning to move back in. Because it has a kitchen and is bigger, I'm going to take it over when its ready for me. But also, my bestie Kira is coming to visit me on the 27th and there are supposedly a few houses coming up for rent that would have an extra bed and some more space for more than one person, so I'm looking into that possibility as well. I had really had my heart set on renting a house, so that would be my preference, but I'm open to whatever is going to happen. It really doesn't matter so long as its shelter.

I had dinner this evening with two of the Aussies --the mother midwife, daughter doctor combo whom I really enjoy. They invited me over and made me a lovely curry and we talked shop for several hours. The daughter was a double footling breech born at home and her mother has gorgeous photographs of the event. She (the midwife) is a pretty well-known birth activist in Australia and she showed me one of the presentations she had given at a conference down there, followed by a video montage of her daughter's birth, feet first. I totally wept while watching it, I'm not going to lie. It was really, really beautiful. I'm a little in awe of them and fantasizing that they'll invite me to come live with them in Australia and attend births with them. Australian homebirth midwives are currently under a huge threat from the government and it looks like New Zealander homebirth midwives are next. Its shameful to see countries that I've looked to for hope and sense when homebirth midwives in the United States are being marginalized and outright persecuted, beginning to slip backward in their protection of reproductive rights. Not cool, Australia, not cool.

The lizards on the ceiling over my head are chit-chitting at each other testily, and I'm having trouble keeping my eyes open. I suppose I'll lie here in my damp pants and get eaten by mosquitoes until dawn and then stumble back to my bed. Ah, birth. The life of the midwife is so glamorous.