Saturday, March 30, 2013

Welcome to the Twin Cities of St. Paul and Mogadishu!*

There are over 70,000 recent Somali immigrants in Minneapolis and St. Paul. A civil war has raged for decades in their homeland and caused millions of refugees to flee and find new homes around the globe. We now boast at least one mosque per block in some neighborhoods here. Little grocery stores advertise goat and camel along with chicken and beef and other halal meats. (Like a kosher label, halal assures Muslims of freshness and safety in the preparation of certain foods.) Minnesota now hosts one of the biggest state fairs in the Nation and you can even find Camel-on-a-stick at a kiosk there. Walking through the streets some days is like being transported to a desert marketplace in Africa. Colorful turbans, shawls, scarves and assorted hijab far outnumber Western dress on the sidewalks. I can hear the call to prayer on Fridays, albeit piped out from electronic microphones, on my street and watch fathers dressed in ankle length robes hurrying hand in hand with their little and big sons in matching outfits all wearing skullcaps, called taqiyah or kufi on their way to prayer.
            In Minnesota over 389,988 or 8.5% of the population speak a language other than English. 66 African languages are spoken in Minnesota school districts. This is more than a tenfold increase since 1990, when fewer than 5,000 African immigrants were estimated to be living in Minnesota. Somalis are by far the largest group of African immigrants; it is estimated that between 1992 and 1999, approximately 29,000 Somalis came to Minnesota. Other African countries with large populations in Minnesota include Ethiopia, Liberia, Kenya, Cameroons, and Nigeria.
            I worked first as a licensed midwife during the past 30 years and later as a doula and lactation consultant. I approached the Hmong refugee population when they began arriving in the Midwest in the late 1970s. That was at the end of the Vietnam War era. The Hmong had assisted U.S. troops in the jungles of Laos and incurred the wrath of the communist Pol Pot regime in doing so. I learned to speak Hmong and immersed myself in their culture, attempting to find ways to make their assimilation less painful, if that were at all possible. I marveled at the resiliency of an entire society uprooted by war and replanted here half a world away from the only home they ever knew.
            Our family remained intertwined with our Hmong friends over the coming decades. Our children grew up with their children, also becoming bi-lingual, which surprised the Hmong as much if not more than it surprised us. I tried to explain that while I was calling landlords and bill collectors, and teaching English classes and scheduling appointments for everything from prenatal exams to visa and citizenship hearings on their behalf, that their grandmas were watching my kids and constantly talking to them in Hmong, a Chinese language originating in upper Mongolia, related to Dao and sometimes called Meo. I said I was not surprised they picked it up. I pointed out that if I were to keep one of their babies for any length of time and they didn’t hear Hmong but only English that they too would speak mostly English. That met with a decidedly negative response: no, Hmong babies are born knowing Hmong. I couldn’t convince my new friends otherwise. Over the years we have laughed and cried together and buried their children and elderly people, often casualties of the war that continued to rage inside of them in spite of the fact that they were here in the U.S., millions of miles away from the carnage.
            So when we moved back to Minnesota three years ago from the U.K. and witnessed this amazing transformation of our hometown, we were intrigued. Soon after we arrived back I began resurrecting my credentials and researching all that would entail that first summer but found I had lots of time on my hands to rediscover this global market I had returned to.
            I heard about a mall that some of the Somalis had recently opened. I thought that might be a good place to start and observe these people that I had never had a chance to get to know before. I found very quickly that they were as curious about us and what Americans thought of them, as we were of them. Every day for the next two weeks I took a bus over to Karmel Mall, dubbed by some Minnesotans, “The Mall of Somalia”, a jab at our own now world-famous Mall of America in nearby Bloomington.
            After a few weeks I was on a first name basis with some of the grandmothers who ‘manned’ the little stalls at the mall. I asked one woman named Fadumo** how to say midwife in Somali. It is umuliso, pronounced, oo-moe-LEES-soe. Now I could introduce myself, except some Africans here spoke Arabic, too, or Oromo, or Amharic. I couldn’t tell yet by their dress who was from where, Jordon or Kuwait, Egypt or Pakistan, Somalia or Kenya. It turns out that many stopped in other countries on their long journey away from the war. Some settled down temporarily and moved on once they had enough money to try to catch up to relatives who had the good fortune to be in the U.S. I even met some Somalis who spoke no English but were fluent in Swedish! They had been offered only Swedish visas when they approached the consulates to escape from Somalia, and grabbed them in desperation. I have met families whose grandmothers are still in Spain, Germany or Denmark waiting for Immigration to approve their visas to the U.S. so they can finally rejoin their families.
            Fadumo and I became close friends. She is also a grandmother. Her little stall boasted some of the most beautiful fabrics from around the world, including wedding robes, matching hijab and under slipsperfumes, jewelry, henna kits for decorating women’s hands and arms for special occasions and an assortment of tea sets, drapery and carpets for transforming an American apartment into a true Muslim home. I found a Somali-English, English-Somali dictionary for the times we hit up against a wall trying to communicate something to each other. We spent hours asking each other questions about the other’s culture and other times just compared what we planned on cooking for our husbands for supper that night. Fadumo had been a licensed massage therapist while her family lived in Nairobi. I found her a book of baby massage which she pored over for weeks. At lunch time she would often order a platter for 2 and bring it back to our little stall and sitting on the floor on a carpet she would teach me how to eat goat meat and spaghetti Somali-style with my hands, or I should say, with my right hand, since the left hand is reserved for unclean things, and not for eating. More often than not we would both end up rolling on the floor reduced to giggles! She has never had to teach a grown woman how to eat!
            During the coming months as I continued to visit Fadumo, I was approached by several Somali students who asked if I could proofread their college homework papers. I gladly did, having learned some editing and proofreading while working for a Hmong newspaper years earlier. Soon I had a handful of students asking for help with their papers. One woman who was in a graduate program getting her degree in economics told me last year that she expecting was baby girl number 5! She laughed when she told me she only makes girls and that they haven’t figured out yet how to make boys. I asked her if her husband was disappointed or if in their culture he could take another wife in order to produce boys. Halima said he couldn’t blame her or be unhappy with her because it is Allah who chooses what kind of baby to send couples. They are taught to be grateful for whatever gifts He sends, so no, her husband will not be sad this time. Then she asked me if I would be her doula. I would be honored, I told her.
            So we continued to meet over the coming months, discussing diet and other things. Many Somalis have adopted our SAD diet unfortunately, the Standard American Diet packed with fats and calories and few nutrients. Their former culture had a wonderful diet full of fresh fruits, vegetables, meat and very little dairy or wheat. But, unfortunately many now ate the white bread, pastries, cookies, snacks, soda and other non-nutrient rich foods they found at their neighborhood groceries and fast food places. And besides, their life style was no longer one of nomads or camel herders who worked hard to eke out a living off an arid land. Now they were often sedentary much of the time.  And this is taking its toll: diabetes and obesity are now rampant in their community. As a social worker Halima leads an older women’s exercise class once a week for Somali grandmas to help them combat the battle of the bulge.
            Finally one night Halima called to let me know she was on her way to the hospital. We had both been so excited about this baby’s arrival and The Day was finally here. I got to the hospital as the nurse was checking her. 5 centimeters already! This wasn’t going to be long. Between rushes Halima introduced me to her mother Ubax, an elderly aunt Deqoand sister named Sahroh. Men were not especially welcomed at births. This was women’s work. All were dressed from head to toe in wraps of one sort or another. Halima wore a hospital gown instead of the traditional robes though she left on two scarves.
            We were quite a team, breathing together, the grandmas happily catching up on gossip in one corner, Halima walking around the room, then trying the birth ball for a while. Things were going smoothly with short naps between the rushes. All of a sudden Halima started shivering. I assumed it was transition, but when the nurse took her temperature, we saw that it had shot up. She continued to shiver as I piled on warmed blankets. Darn it… and when everything was going so well. The doctor ordered blood tests right away and started an IV with antibiotics ‘just in case’ this was a sign of infection. The doctor started suggesting interventions should we not be able to get the fever down. Within half an hour the baby’s heart rate jumped up, too, and more interventions to speed things along were offered.
            Halima and I had agreed that in the event that the staff offered options for any eventualities, that she could suggest she have a few minutes with her family to discuss any suggestions first. So it was time for that. The nurses and doctor all left us to deliberate. Halima again made it very clear that she did not want drugs and certainly not a C-section unless things looked plain too risky. I explained that I could not decide what was best for her, but that an infection could get nasty, that the IV was not a bad idea, and that she could probably ask for a little more time to see how things worked out. She agreed with this plan and let the nurses know. She started to drink more juice to help with the fever and build up her strength. She continued to dilate, which was good. The next check told us she was at 7 centimeters. Then we were alone again.
            She started to feel better; I had peeled back the covers, and was sponging her down with lukewarm wash rags and brought her cup after cup of juice. All of a sudden she said she wanted to push. I was surprised and thought it was just the pressure of baby moving down, but when she yelled, “I AM going to PUSH!!!” I knew nothing was going to stop her. I rang the nurse button by the bed and she came into the room. Oh dear, not their favorite one. When this nurse had taken a blood sample earlier for the lab, she didn’t put enough pressure at the site when she removed the needle and blood had spurted everywhere, all over the bed and the floor. The grandmas clicked their tongues and shook their heads: not a good nurse. Now she sauntered back in, saw the black curly headed baby crowning and whipped on a pair of gloves. Actually she only managed to get one hand covered which she used to support the baby who was coming out. She held her other hand above her head so as not to become contaminated, I guess, and left the baby lying in a puddle on the Chux pad. I could tell she wasn’t breathing, and in slow motion wondered WHO is going to DO SOMETHING? And in slow motion I grabbed the end of the sheet and started wiping off the baby’s face and rubbing her down to get her to breathe. I lifted her up with both of my un-gloved hands as the nurse stuck a bulb syringe into the baby’s mouth with her one good gloved hand and we both moved together over to the warmer which had been turned on earlier. I continued to rub and she kept suctioning for the next few seconds which felt like an eternity, though I am sure it wasn’t. She started pinking up by then, though I didn’t think she was really breathing well yet just as the NRP (neonatal resuscitation program) team ran into the room, looked at me with a very puzzled look (I don’t wear scrubs to births, just my DONA name tag) and started to work on baby who cried within the next few seconds. The doctor was there in time for the placenta.       
            Things finally settled down and Halima was happily nursing her 5th little girl whom she had named Maryan. I was standing next to the bed just taking it all in, so very thankful that everything turned out OK. The grandmas were talking quite loudly at this point so I asked Halima what they were saying. She listened for a minute and told me, “They are saying they wished they had had a doula at their births!” I found out that they had spent most of the time retelling the stories of their own births, even when Halima was trying to rest. She told me later that even their chatter was comforting at the time, being surrounded by other women, even if they weren’t all that quiet. Then the grandmas came over to where I was standing and started stroking my arms and my shoulders, then my head and my hands. Without moving a muscle, I asked Halima under my breath, “Halima, uh, what are they doing?” She explained: “They say you are like a holy person who has made the pilgrimage to the Haj in the East and you love us and treat us like your own family. Now you are our sister.”

**all names and any identifying characteristics have been changed
*Quoted here with permission from Muslim comic Azhar Usman, who tours the United States, with his show called, “Allah Made Me Funny.”

COMING SOON: This and other stories will be appearing in either Call The Doula! a diary© or Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© pending by Stephanie Sorensen


Friday, March 29, 2013

"There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we" 

― Ina May Gaskin

Sunday, March 24, 2013

Christmas Baby

Christmas 2012. We had gone to the midnight service extra early to hear a special hymn and carol singing. It was beautiful and inspiring. The crèche at the church was stunning; I had never seen one quite like it. It was close to life-size, camels and all. I love Christmas, it has always been a special time for me.
            We finally got home and crawled into bed at 2 a.m. I gave thanks for all that was well with the world, especially our deliciously cozy feather bed and was soon sound asleep. I was dreaming that the phone was ringing. Why didn’t it stop? It just kept ringing. I should be answering it in my dream; come on, dream, stop! My husband nudged me. I rolled over and looked at the clock: 4:00 a.m. And the phone was ringing. Why would someone call me now? Oh, duh. It wasn’t a dream. I am a doula. But no one was due for two more weeks at the earliest, or so I had reckoned, and I hadn’t even laid out my stuff.
I picked it up, “Hullo?” The caller was laughing! I didn’t like this joke.
“Isn’t this funny?” she was giggling, even.
“Uh, not really” I answered.
“I’m gonna have a Christmas baby!”
“Who is this?” I demanded.
“It’s Shannon, and our baby decided today is The Day, I don’t believe this! We’re on our way to the hospital.”
“When did it start?” I asked as I leaped out of bed with a sudden rush of adrenaline and ripped a clean outfit out of the closet. Usually I have my clothes laid out on a chair in the order I would put them on during the general time of any upcoming births, and have my bag by the door with my ID tag on top before I go to bed. I also always put a sticky label above the lock on the front door reminding me to bring a snack, my watch, my cell phone, charger cord, and purse. I have arrived at too many middle-of-the-night births missing one of these essentials in my rush to get there. Now I use sticky notes and line up everything the night before.
            This was her 3rd baby so I wasn’t going to waste any time, either. Then I confirmed what hospital or birthing center they are headed to as I tugged my clothes on with one hand while still holding the phone with the other, the usual litany running through my brain all at the same time: coffee, filter, mug, lid, creamer, sweetener, spoon….
            I have actually arrived at the wrong hospital – once. That was a couple of months ago. By the time I figured out my mistake and rushed over to the right one, the baby had managed to wait for me, but I wasn’t going to let that happen again. Since then I always confirm the name of the hospital or center and city or town with the caller, even if I think I remember which one it is. A pencil and note pad live under the phone by my bed to WRITE IT DOWN immediately. I no longer trust my brain to register correctly, often with only as little as 1 or 2 hours of sleep, and this night was definitely one of those. OK, I confess: I am turning 60 in a few days, but there is NO WAY I am going to stop going to births in the middle of the night. I love this work. It really isn’t work, I can’t call it that. It is a privilege. It is an honor to be invited into a family’s most intimate moments and witness this miracle once again. And this miracle would be happening on Christmas.
            Aaron, Shannon and Eloise, their toddler, and sometimes her older sister Lilli were always early for our appointments. Shannon even brought her mom along once. I also enjoyed our visits and looked forward to their birth. She had two previous births which had been plagued by high blood pressure. Combined with that, Shannon was living with Ehlers-Danlos Syndrome which complicates not only pregnancy but just plain daily life. A side effect is hypermobility, when joints over extend. People with joint hypermobility syndrome may experience many difficulties. For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue (as muscles must work harder to compensate for the excessive weakness in the ligaments that support the joints). Hypermobility syndrome can also lead to chronic pain or even disability in severe cases. As her pregnancy progressed Shannon needed to use crutches just to walk. Her pain continued, growing worse in the last two months. A scrupulous, organic diet helped to stave off worse complications, but Shannon knew as much as anyone who has scientifically researched everything that is known to date about her disability and the benefits of an appropriate diet and certain supplements.
            Shannon was dealing with the rushes or contractions quite well when I got to the hospital at 4:40 a.m. She was up, walking around the room while Aaron supported her but didn’t feel able to go further or tackle the long halls. A birth ball also helped since she could be upright but letting gravity move her baby down. During the next hour or so as she steadily dilated she ate and drank and combined short rests on the bed with time up on the ball or in a chair. While she rested we used a peanut ball. It is like a birth ball but shaped like a giant peanut. When she lay on her side, I would put the peanut ball between her knees. It is large enough that the upper leg that is draped over the top of the peanut can hang up and out over the side of the bed. The lower leg is brought up bent at the knee as high as is comfortable. This position opens the pelvis as wide as is possible in a lying position, so as to facilitate the baby’s descent. Every half hour or so Shannon would roll over to her other side and we would replace the peanut again. Her blood pressure was creeping up during this time, possibly because of the added pain she was experiencing in her expanding joints along with the contractions of labor, so her nurses suggested staying in bed if possible to help the blood pressure from rising any more without medications if we could avoid that.
              At this point I made a hasty retreat to the nearest ladies' room. I just remembered that I had volunteered to bring the green bean dish for Christmas dinner later that day. Good thing I had not offered to host the whole dinner! I quickly sent a text to my husband (who had never made a casserole in his life) with directions on how to assemble and bake the dish. By the time I got home it was in the oven and actually looked OK! David was used to half cooked dinners hastily put back into the refrigerator and a note at the table letting him know I had gone to yet another birth. He often put the food back into the oven per my note, but more frequently he would wander down to the corner restaurant and order his favorite gyro or quesadilla to bring home, put on some nice music and wait up for me.
            Shannon was dilating quickly at this point. By 10:30 a.m. she was able to push and Nora Jane was born after a short second stage with perfect Apgars. We didn’t really need those to tell us she was finally, happily here, though she seemed to register otherwise with her lusty cries. She was a very healthy, beautiful big girl at 9 pounds, 11 ounces. And then, before she was weighed or the cord even cut, she held up one pudgy little hand, thumb up, seemed to contemplate this for just a second, and then popped it in her mouth, sucking contentedly! That was a first for me. I stayed on long enough to celebrate this very special baby with her parents and make sure she was nursing well. There was no problem there. She had already made up her mind that today she was going to feast!
            I was home, showering and changing clothes in time to go to our relatives’ Christmas dinner. Although I was tired, I was still on a high from that beautiful birth and felt that with some coffee I should be OK for a nice afternoon and dinner. 
            I called ahead the next day to find out if Shannon was up to a visit. I wanted to see how she and Nora were doing. I was very surprised to find out they had requested an early discharge and were already home celebrating Christmas with their whole family. I couldn’t visit during the next couple of days either, as different relatives of theirs were all bringing over meals as an excuse to see their very special Christmas present: Nora Jane.

                                  Written with permission from Nora and her courageous mother.

Wednesday, March 20, 2013

Emma Hope

Emma Hope
I asked Melissa if she would let me tell her story, a journey that began over a year ago. She answered, “That's not a problem; I would love to share our story :) I am very proud of Miss Emma and would love to share how miracles can happen.
            This is a true story about one of the most difficult but also one of the most moving times I have ever shared with any family.
            I received a phone call a little over a year ago. Dear friends of ours had retired and moved to Arizona after having had enough of our Minnesota winters. They were calling because their own daughter was in a hospital near her home in Wisconsin with a brain aneurysm. Emergency surgery was scheduled for later that day. Her prognosis did not look promising. My friends were still reeling from the news, but that was not all. Their daughter had been caring for her own adult daughter who had her own challenges, including mental health issues and a toddler that her mother felt Melissa was unable to care for by herself. Now that her mother was in the hospital, Melissa was essentially homeless and without a caregiver. And she was pregnant.
            My friends were desperate. Could I help find Melissa a safe place to stay? Would she be eligible for a shelter? She was still staying in Wisconsin and I lived in Minneapolis. Would she qualify for benefits and help here before establishing residency? I couldn’t answer any of their questions without doing my homework, but said I would do all that I could.
            My first day of phone calls dredged up nothing. There were long waiting lists for all of the shelters. Melissa was not technically eligible for most of them because she was not a victim of domestic abuse, nor was she receiving Minnesota Social Security Disability benefits, and she had not been a state resident for the required 60 days. The next day I posted urgent requests on our local childbirth collective resource bulletin board for any help or suggestions. The birth professionals throughout the community here rose to the occasion; I soon had lists of names and agencies to call. Finally, one connection led to another and the grandparents off in Arizona discovered a tiny shelter here – only 7 beds—right here in Minneapolis run by 4 Indian nuns who were members of the Missionaries of Charity of Calcutta, the order of sisters that Mother Teresa founded in 1950. Their only stipulations were that the mother was homeless and pregnant and agreed to abide by their rules. BINGO! Melissa could go there. She could then apply to the local social services and begin the process of finding an appropriate permanent living situation. Being near where I live also helped. I could visit her often and help her negotiate both the welfare system in our county and the medical clinics where she would get optimum prenatal care.
            Her uncle drove her to Minneapolis the very next day and I met her at the shelter with a fresh bouquet of flowers for her new room and to help her get settled. The relatives in Wisconsin, though they were not in a position to house her, did arrange for her to see a doctor before she left. An ultrasound, a routine procedure to help assess the age of the baby and establish a guess- or due-date was ordered but revealed some disturbing results. Within hours, she was being referred to the neonatologists at a major medical center in St. Paul. There were no advanced diagnostics available in that part of Wisconsin so they wanted further tests done in Minnesota. The results were shattering: the baby had inherited a genetic chromosomal deficiency and had a condition termed fetal or lethal anomaly. That meant that this baby may not live, either to term, or if she did make it that far, there was no guarantee that she would live after that.
            The family was shattered by this latest development. They were still not out of the woods with Melissa’s mom, and were focusing all their energy on her. I assured them that Melissa was doing OK. The shelter was able to give Melissa her own room and she seemed to be settling in just fine.
            During the following week we heard that Melissa’s mother was doing amazingly well, which was a huge relief. In the meantime I had lined up appointments for Melissa: WIC, food stamps, social worker, etc., and we had her medical records forwarded to a neonatologist at a high risk clinic that would be able to let us know what her options were, and what the possibilities might be for this baby. We knew by now that it was a girl, and Melissa promptly named her Emma Hope.
            While Melissa and I were getting to know each other and the doctors were putting together a plan of care for her, her family members were discussing their opinions, unbeknownst to us. Some felt that an abortion was the only route for Melissa given what they now knew. Others felt that such a choice would harm both Melissa’s fragile spirit and her future. Angry words were flying back and forth between the two camps.
            About this time I learned that Melissa was married. When she was pregnant the first time with Lexi who was now a toddler and living with an aunt, she and Mike had married. The stress of raising and supporting a family had become too much for Mike who had his own set of challenges, and he had left, though he stayed in touch with Melissa. When he heard about Melissa’s present situation, he again showed up, offering his sincere support and concern, though he wasn’t financially stable enough to offer her much else than that. Even his living situation was tentative – a couch at a relative’s house.  
            During the ensuing weeks we learned all that we could about her baby’s condition which was now confirmed: hypoplastic left heart syndrome or HLHS.*
            Melissa’s grandparents had also been researching HLHS and were sending me emails with their findings several times a day. They concluded early on that perhaps it would be better to bring this baby home after birth and just love her for as long as they had her until Nature took its course. Melissa and I talked about these options and explored every possible scenario. I found her to be fully capable of understanding the seriousness of the prognosis and certainly able to make choices, in spite of all her challenges. She decided right from the start to carry her baby to term. She was barely 6 months along when we first met, and the hospital had presented her with the option of terminating the pregnancy. She was quite aware of the finality of death having recently lost a beloved grandmother.
            Her family was still very absorbed with Melissa’s mother and helping her recover, so Melissa was still very much my constant companion when I wasn’t working. She had never lived in a city before, had never been on a bus or train. She had literally come out of the woods of Wisconsin. She didn’t know how to find out where things were. We had a great time learning all these things those early months. I suggested she pull the bus stop cord on our first bus ride. She hesitated and then gently tugged on the pull rope until a buzzer went off and then giggled and blushed. She had done it! We went out to the Mall Of America by train for the first time. We ate Chinese phÓ, Mexican burritos and her first-ever chai lattes. I brought her to my apartment and we cooked things she had never heard of. She still teases me about making her eat seaweed – sushi – (I actually only made her taste it) and avocados (guacamole) and artichokes. Melissa went from being petrified of the city to being quite street savvy in a very short time. All of a sudden I was getting texts on my phone that she was at a beauty parlor getting a haircut, or out somewhere at a Chipolte restaurant. A friend of mine picked us both up one day and bought Melissa several maternity outfits before treating us to lunch. By now she was bursting out of her men’s cargo jeans and jerseys.
            The neonatal clinic visits were another story. At the beginning of each appointment, the clinic would do an ultrasound. We could see her baby in 3-D, moving and looking terribly cute and very much alive, but of course we had to remind ourselves that Emma was living off of her Mommy’s heart at this point and wouldn’t do as well once she had only her own defective one to depend on. Melissa was presented with all the statistics and possible outcomes of all the procedures. I personally felt that it would be better to have her baby close for all of her short life than be subjected to numerous surgeries and long hospital stays hooked up to all sorts of monitors and not being able to be held outside of her isolette most of the time. What would bonding look like? I told Melissa exactly how I felt and so did her grandparents who were also leaning toward compassionate care while rejecting the surgical route. This also made sense to Melissa at the time. Then came the appointment with the two surgeons.
            Some of the most eminent surgeons in the country who are treating HLHS happen to practice in Minnesota at both the Mayo Clinic and Minneapolis Children’s Hospital. They met with Melissa and her husband and talked to them about “Giving her their best shot!” and, “We want to give her a chance….” Nothing about her having less chance than most babies with HLHS because of the addition of the genetic problems. I don’t know if it is because they are surgeons, that they hoped to hone their skills and hoped too, to eventually perfect the surgery for these babies, but what came across in the end was, to Melissa and Mike at least, a chance to grab at hope and possibly a cure. 
          I tried to explain what that would entail and that no guarantee was being given that Emma would even survive each surgery or the recovery phase after each one. But I also had to trust that Melissa was Emma Hope’s mom, in spite of everything else, and could and should be able to decide whatever choices she had to live with for the rest of her life. In the meantime while the rest of the family decided together that compassionate or only palliative care was the best option in their eyes, Melissa finally decided otherwise. She would give her baby every chance she could… and the differing opinions among the relatives continued.
           About this time I discovered a beautiful book called Waiting with Gabriel: A Story of Cherishing a Baby's Brief Life by Amy Kuebelbeck, (Loyola Press, 2003). Gabriel was also born in Minnesota with HLHS. His parents chose compassionate care and stayed with him for his entire, though short life. He died shortly after birth in his mother’s arms. With my encouragement most of her family read the book. So did Melissa.
            Then then emails started once again. Couldn’t I persuade Melissa and Mike to change their minds? Some felt that she couldn’t possibly decide these things for herself, that she was too handicapped to comprehend the consequences.
            I felt otherwise. As part of my own research I even arranged to spend time at Alexandra’s House, an infant hospice in Kansas City, Missouri and peppered them with questions about how I could best support Melissa and her family. I spoke with providers, exploring everything I thought would need doing: permission from the nuns to bring Emma home to the shelter and explaining how the hospice nurses and I would take care of Emma and Melissa for as long as was needed. The nuns offered to have the wake in their little chapel when the time came, and a priest from the family’s parish in Wisconsin was notified and agreed to be on call to come whenever he was needed. A parishioner lovingly built a beautiful little coffin. So, for Melissa to change her mind and decide she just couldn’t do nothing, which was also a choice, was very difficult for some of her family to accept.
            Finally I added my opinion to the discussion by writing an open letter to Melissa’s family explaining how I felt: that I didn’t have to live with her decision for the rest of my life, nor did they. Only Melissa could ultimately decide what was best for her and her baby and we must not only respect that choice, but we have to continue to surround her with love and support her.
            Emma decided to arrive just before her due date on June 14th. After a short labor she was delivered vaginally and needed little help starting up on her own. She weighed in at a whopping 8 pounds and 3 ounces. We got to see her briefly as she was being whisked off to the NICU where she would be prepped for surgery during the coming days. Melissa’s mother was even there, having made an amazing recovery herself in time to see her little granddaughter for the first time.
            The next six weeks were a blur of doctor appointments, tests, surgeries, and ups and downs while constantly holding our breaths hoping that things would continue to go forward for beautiful little Emma. Melissa was able to stay at the Ronald McDonald House near the hospital and visit Emma. She pumped her milk and delivered it daily to the NICU. Emma just surprised us all and kept growing with very few setbacks during those early weeks. While all this was going on, Mike started looking for an apartment to bring his little family home to. When Emma was finally discharged they moved to a town in southern Minnesota. 
            Part of our concern was if Melissa and Mike would actually manage to learn and demonstrate that they could perform all the various care and procedures that Emma would require. During all of this time Melissa had often neglected her own battle with diabetes, and that alone left us wondering if she could manage that along with attending to Emma’s needs. But Melissa surprised us all. At one point she suddenly rose to the occasion. Not only was she managing to follow her own scrupulous diet and keeping her blood sugar levels within range, but she learned how to suction, tube feed and maintain Emma’s equipment in time to bring her home.
            The second surgery went as well as could be expected when Emma was 4 months old and Melissa moved back to the Ronald McDonald House once again. And again, Mike and Melissa were able to take Emma home after another month in the hospital. Emma continues to do well. She can sit up, reaches for things, coos and laughs and enjoys her big sister Lexi whenever they can visit. Emma is 9 months old now and weighs in at 17 pounds! She is a miracle. She’s gone beyond any one’s wildest dreams for her.
            I have learned from Melissa that I can never say what might be best for anyone else. I have learned to stand in awe of the power of a mother’s love. Mike and Melissa know they might not have Emma forever, but they have learned how to live only one day at a time. I have learned a lot from all of them: Melissa, Mike and Emma. Thank you. Forgive us all for ever doubting you.

*More on HLHS:

Hypoplastic left heart syndrome occurs when parts of the left side of the heart (mitral valve, left ventricle, aortic valve, and aorta) do not develop completely, meaning that the left ventricle of the heart is severely underdeveloped. The condition is present at birth (congenital). Modern technology is actually addressing this with staged surgeries to first close off parts of the heart using what is called the Norwood Procedure which is usually done shortly after birth, and then two further open heart surgeries are done to attempt to reconstruct the heart in order to allow for better circulation. Without life-prolonging interventions, HLHS is fatal, but with intervention, an infant may live with a five-year survival of about 65 % even after surgical repair. Hypoplastic left heart syndrome accounts for 2 to 3 % of all congenital heart disease with a prevalence rate of two to three cases per 10,000 live births in the United States.
            A pediatric cardiothoracic surgeon may perform a series of operations or a full heart transplant. In the meantime, the ductus must be kept open to allow blood-flow using medication containing prostaglandin. Sub-atmospheric concentrations of oxygen are used in the preoperative and postoperative care of infants with HLHS. The Norwood Procedure is done almost immediately after birth, the Glenn Procedure at 3 to 6 months of age, and the Fontan Procedure at 3 to 5 years of age. Those babies who undergo cardiac transplantation have a 5-year survival of approximately 50-60% as a group. However, it is becoming clear that there are higher risk subsets where 5 year survival is lower including those with lower birth weight, additional congenital anomalies, a genetic syndrome or those with a highly restrictive atrial septum. For patients without these additional risk factors, 5 year survival now approaches 80%. Further, studies show that about 50% of those children who survive surgery in the early development of staged reconstruction have developmental delay or need special education; about 25% of these surgical survivors have severe disabilities. There is growing evidence that while the incidence of developmental and behavioral disabilities continues to be higher than that in the general population, children operated upon in the more current era have shown significantly better neurological outcomes.
            Some parents choose an option referred to as compassionate care, and these infants receive treatment aimed at relieving suffering without extending life. Compassionate care is overseen by a physician, and may be carried out either in the hospital or at home. Studies show that when presented with all options, about half of parents choose life-prolonging interventions and half choose compassionate care, although when I began questioning our hospital’s neonatal cardiologists, they told me that they had actually never had a family choose compassionate care and that over 99% here in Minnesota at least went ahead with the surgeries. A study in 2003 concluded that a selection of physicians who are experts in the care of children with HLHS were evenly split when asked what they would do if their own children were born with HLHS, with 1/3 stating that they would choose surgery, 1/3 stating that they would choose palliative or compassionate treatment without surgery, and 1/3 stating that they are uncertain which choice they would make. The three-stage procedure is a palliative procedure (not a cure), as the child's circulation is made to work with only two of the heart's four chambers.
            While infants successfully treated for HLHS have a good chance of survival, they may experience chronic health problems for the rest of their lives. The 3-stage surgeries were developed in the early 1980s with no survivors prior to that time. Therefore, the earliest survivors are in their early 30s today and the long term prognosis is unknown.  However, the advances in surgical and medical techniques have helped increase the survival rate dramatically since the surgeries were first developed.
            As is true for patients with other types of heart defects involving malformed valves, HLHS patients run a high risk of endocarditis, and must be monitored by a cardiologist for the rest of their lives to check on their heart function. The three stage Norwood Procedure only increases the life span of the heart as HLHS cannot be cured. A heart transplant may be needed at some point in the child's lifetime. By the time the child is 3 or 4 years old, they may become a good candidate for a heart transplant, though of the over 1,000 children a year in the U.S. waiting for a donor heart, only about 70 actually receive one. Of those, there is still the possibility of the body rejecting the new organ, or of developing other side effects from the anti-rejection drugs, cancer being one of them.

©Stephanie Sorensen 2013

Monday, March 18, 2013


 One of my clients was (told she was) overdue and becoming increasingly nervous about the fact. Unless a baby is conceived by artificial or in vitro fertilization, or the couple chart basal body temperatures and see ovulation occur, it is almost impossible to predict the exact date of conception and then calculate the due date. We are actually changing the term at this time from Due Date to Guess Date. In the past, doctors have induced babies rather routinely that were still not showing any intention of being born into their 41st week. They were worried about things that might happen when babies are truly overdue and their placentas are no longer working at 100% speed, but babies who ‘cook’ until 42 weeks are more often than not perfectly healthy and do very well. Babies are mature and viable, as we say, after 37 weeks, though they do better if they arrive closer to their 40th week. So, without knowing a true due date, babies have been induced far too early, due to miscalculations, and sometimes it becomes apparent that they are even premature, and not at all overdue. The medical community is taking a new look at induction at this time, with good reason.
          Jeannie called me the day after she reached her 40 week Guess Date. She had been to the doctor that morning who had insisted that they go ahead with an induction the next day and possibly a scheduled C-section as her doctor sited that the baby “appears rather large”. She had two other children before but the doctor was worried about a host of ‘risk factors’ surrounding post-dates babies. Jeannie’s first baby had been born by C-section, though baby #2 was a successful VBAC or TOLAC (Vaginal Birth After Cesarean or Trial Of Labor After Cesarean) at only 28 weeks. The next baby, a beautiful little girl was born in 2010 but was earlier than that and did not survive.
          So I got her call later that morning. Jeannie was crying and understandably upset. She told me all that the OB had laid out for them the next morning and said she came home and told her husband and asked him what they should do. Lonnie’s answer was, “Call Stephanie, she’ll know what to do.” So she was on the phone waiting for some advice and support.
            It is important here to explain that as a doula I do not make decisions for anyone. I don’t tell them which is the best of all the options they are offered, but I will help them explore the possibilities and give them as much information as I have or call someone else if I don’t know. Even as a retired midwife and lactation consultant, I won’t tell a family what to do. So I added a few possibilities to the OB’s list: they could have sex, for one. Yes, it has worked and the premise is that the male hormones assist with ‘turning on’ labor, or that orgasm simulates contractions and that the uterus follows suit. Some women have tried the notorious castor oil cocktail, which works by stimulating the bowel which in turn, if irritated enough, triggers a response by the uterus, and thus labor. Some practices are not advocating this method. Check with your practitioner first, please, before trying it. Riding a bike or taking a drive on a long dirt road has worked on occasion, too. “Stripping the membranes” is when a midwife or doctor separates the cervix from the bag of water by sweeping a finger around the baby’s head just inside the cervix which also tips off the hormones that labor should soon follow. This can only be done if the cervix is dilated 1 – 2 cm. already. An Amish lady friend of mine told me once when I was ‘overdue’ that you get in your buggy and go visit a friend and that will start labor, rather than sitting at home hoping. (I guess lifting 3 or 4 other little kids up into the buggy, riding along back roads and then lifting the kiddies back out at the friend’s house with all the snacks and coats and all, and hauling myself up and down on the buckboard would have worked for me!) I told Jeannie I knew of another couple who just thanked the doctor and didn’t show up for the decisive next appointment, but instead waited for labor to start on its own, which it did – I’ve never know a baby not to come out – and showed up at a smaller, local hospital once they were well into labor, but I’d advise against the last option if you don’t want to have some very ticked-off staff on your hands.
            Then I said to Jeannie, “You should also take some quiet time and connect with your baby. Tell her it seems to be time, and you don’t need a C-section or any drugs, for that matter, so maybe you two can work out some kind of a deal.” She agreed and thanked me and promised to call the next day. 
            The phone rang at midnight, later that same night. She was delighted! They had spent a quiet day at home together, took a nap, and then went to a barbeque at a friend’s house. Just as they finished eating WHAM! the rushes started, all on their own. She was euphoric, but told me they were going to head right to the hospital because she didn’t think there was time to go home and pick up her baby bag first. When I got to the hospital she was just getting checked by the nurse. 6 cm. already! We gave high fives all around, very pleased with ourselves. It was less than 12 hours short of the O.R. (operating room) according to their doctor.
            Then Jeannie told me one of the strangest stories I have ever heard. While they were home settling down for a nap, she had been talking to the baby as she fell asleep and connecting like I had suggested on the phone. Then she had a dream, describing it as “totally real” and in the dream she was talking to her baby, whom they were planning on calling Camilla. The baby was telling them, “Well, actually, I’m not coming out unless you agree to name me Veronica. No way!” So, in Jeannie’s words she said, “I said, 'OK, anything you want.' You got it!” and the dream ended. They told their other kids about it and all agreed that Veronica it would be though they had never given that name a thought. Then Veronica’s older sister said, “It should be Veronica Jordan. I am sure.” Jeannie and Lonnie looked at each other and said that their kids seemed to know more about this than they did as parents, so Veronica Jordan it would be.
            About half an hour after the nurse checked her, Jeannie said she was feeling a bit ‘pushy’. The nurse checked again and she was 10 cm. The nurse ran out, crashing into another nurse coming in and both raced to get the room set up with a warmer and instrument tray and all the paraphernalia that they bring in now. I helped her focus on breathing and getting into a comfortable squat on the bed while Dad picked up all the coats, the birth ball, and clothes strewn around us. In the rush, someone asked if the doctor had been called. She hadn’t, till just then. Jeannie and I just grinned at each other. Another doctor was on the floor who quickly gowned up and stood at the end of the bed, hands ready to catch. As the little head crowned Jeannie’s doctor rushed into the room, the other doctor stepping aside so she could catch the rest of Veronica Jordan as she slid out. It was all and more than we could have wished for.
            An interesting aside is that another baby girl was born to a family down the block from Veronica’s house about the same time as she was. They named her Camilla, not knowing at all that Jeannie had also picked out that name earlier.               
With permission from Veronica’s family.

Wednesday, March 13, 2013

What would happen if bonding with our babies looked like this?

‘Drink your tea slowly and reverently, as if it is the axis on which the world earth revolves – slowly, evenly, without rushing toward the future. Live the actual moment.’ ~Thich Nhat Hanh

An Amish Birth

While we were living in Wisconsin in the mid 1980s I attended several Amish births. The Amish don’t use modern farm equipment, electricity, or indoor plumbing, and also don’t have telephones, much less computers, email, iPods, or things like that. So, when a baby announces his or her imminent arrival, the mother has to first locate Pa somewhere on the farm, get the children to grandma and grandpa’s doddy haus, (Amish dialect for a grandparents’ apartment, often built onto the main farm house.) find a teenage neighbor to agree to do the morning or evening milking that day, and have Pa go to the nearest friendly ‘English’ (meaning non-Amish) neighbor in order to use the phone to call the midwife or doctor.
Emma and Joel were expecting their 7th child. She had had easy births with the others and remained in good health throughout this pregnancy. She had carried the baby to term; he was growing nicely, she took good care of herself, understood good nutrition, kept her house clean and tidy (one of the things I observe when I consider a family’s suitability for a home birth) and was excited that they had been blessed with yet another baby, though they didn’t know if it was another little ‘dish washer’ or ‘wood chopper’ yet, – the terms they used when announcing a new baby girl or boy to their Amish family and friends.
I carried a primitive kind of pager back then and had the dads call me as early as possible. The Amish settlements stretched for over 50 miles in all directions. There were perhaps half a dozen of us midwives covering this area and would often assist each other at these births.
When the call finally came one sunny day about noon, I quickly called my husband David who helped me pack up our five children (he couldn’t leave them home and keep the car) so he could drive me to the Lehmann’s farm. When we got there Emma had everything all arranged: the farm and kids were all taken care of, she had done up the dirty dishes, the bed was made with a plastic sheet under fresh linens, with another full set under that for after the birth, and she was walking around the house in her homemade nighty and slippers, grinning from ear to ear and blowing little puffs of air along with the contractions while Joel was nervously trying to work on a jigsaw puzzle she had assigned to him (more to keep him busy and occupied, I suspect). She walked around for a while, sipping juice and taking short trips to the outhouse every hour or so. The bedroom had a freshly painted commode by the bed so she wouldn’t have to leave the bedroom after the birth for 10 days. A night stand was set up with everything she would need to care for the baby and herself right there: diapers, a diaper pail, baby clothes, sanitary pads, and an oil lamp.
Things slowed down around 4 in the afternoon. I suggested she use the time to nap, but she was all business and suggested using ‘the combs’. I had never heard of this so she showed me the pressure points along the base of your thumbs which can be stimulated to help with contractions. She made two fists around two small hair combs and, sure enough, she got the contractions going again in no time. 
About an hour later she made a bee-line for the bedroom, had Joel light a kerosene lamp and hold it up for me, propped herself up on the bed, though I could not detect by her breathing that things had picked up that fast, and after a couple more rather sedate, lady-like puffs, started pushing. Before I could dribble some olive oil on my hands to support her perineum, out barreled an 8 pound wood chopper and promptly howled his arrival! Leave it to efficient Emma! I should have been more prepared. They hadn’t really needed me at all. They knew exactly how to do this.
Joel picked up and held his baby while I helped deliver the placenta which they would bury under the eaves of the house, an old Amish tradition. Then Joel spoke for the first time all day: he told me how with their first baby he had been so afraid of poking him with a pin while diapering him that when he finally finished and tried to pick up the baby, found him stuck to the bed – he had pinned the diaper to the sheets!
Then Joel looked down at Emma and said in his slow drawl, “Well, Ma, what should we name him?”
And she said, “Oh, Pa, I dunno. What do you wanna name him?”
And he said, “Well, I dunno.” After 7 kids surely they knew how to do this, I thought to myself. After a minute or so he added, “Maybe we should get the hat.”
So he got his black Sunday hat from its peg in the kitchen by the wood stove and laid it on the bed. Then he cut up little pieces of paper and they both wrote down their favorite boy names and folded them up and dropped them in the hat.  I still didn’t know where this was going. Then he picked up the baby and gently put the baby’s hand into the hat. When he did that, the baby’s hand opened up as his arm was extended and then shut into a fist when it touched the bottom of the hat.  He was supposed to pick his own name!
His father pried the scrap of paper out of the tiny fist, opened it and announced, “His name is Elmer!” They both positively beamed at each other then, a long, loving look into each other’s eyes. So that was how they did it. He could never blame them for some name he didn’t like. He had chosen it himself.
Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!

Call the Doula!

Doula, pronounced DOO-la, originated from the Ancient Greek word meaning servant to women; a non-medical person who assists a woman, her partner and/or family before, during, or after childbirth providing information and physical and emotional support. Continuous support during labor by doulas is associated with improved maternal and fetal outcomes and other benefits. 
It was a circus; hardly a birth. Bah is 14. I put this into context this way: her parents were married at 15; life expectancy in their experience is about 45. They’ve been in the U.S. a couple of years. There are over 50,000 Southeast Asia immigrants in Minneapolis. FOB, as us doulas call him (Father Of the Baby) is too young to drive himself to the hospital. The family sleeps on homemade platforms at home, squatting on the floor to play cards, like in the old country; gold papers stuck to the walls to placate any bad spirits that might be lingering there.
            Bah (not her real name) called me on a Friday at 11 p.m. to tell me that she was having contractions, wondering if it was time to go to the hospital. I offered to go her home and hang out with her until it was time to go. I went.
            The contractions weren’t very strong and by 4 a.m., now Saturday, petered out. They stopped altogether after breakfast: whole fried fish, eggplant soup and steaming piles of rice. I went home after breakfast suggesting they rest and call me when the contractions are 3 – 5 minutes apart for a whole hour or her water breaks -- whichever comes first. Later that day I had supper with my husband. No calls yet. We went to bed at 11 p.m. Then the call came at 11:15 (of course). She wanted me to come.
            Bah’s mom had 9 full term babies; 3 died simply because no one knew how to resuscitate them at birth. Her last baby was born shortly after they arrived in the U.S. She was terrified, labor stalled and she ended up needing interventions she didn’t understand; a very traumatic birth. In the end she jumped off the bed -- IVs and all -- and had the baby squatting in a corner, everyone yelling at her. Now Grandma tells me no one is to touch her daughter, no internal exams, IVs, Pitocin, medications, C-section, no men including doctors. I told her we’ll try to labor at home as long as we can though I can’t promise what she is asking. Whoa!
            Bah speaks English, having been attending a high school for pregnant teens. Her mom speaks none. I had learned a bit of their dialect over the past 30 years which helped a lot.
            Understandably she was projecting her fears onto the girl. I explained to Bah that her labor was going really well and she and her baby were healthy. We were at home until things picked up at about 2 a.m., now the third day. I asked her who was going to take us to the hospital. She said, “My parents don’t drive, just call the ambulance.” I said, “No, we won’t and anyway, how would your mom and I get there?” I called a taxi and I jumped in saying, “You know where St. Joseph’s is?” And he says, “Yeah, but is someone having a heart attack?” I said, “No, a baby actually.” The guy turned white (no, he wasn't my regular Somali taxi driver) and said, “You’re kidding me, right?” I said, “No, I’m not, but I don’t think it’s imminent and I will tell you if we need to pull over.” Literally shaking he says, “Really, you’ll know WHEN?” I said, “Yes, start the car and just drive. I am calling the shots, don’t worry.”
            I settled them in their room and went out to brief the nurses. The head nurse wanted to know why the mother hadn’t been able to resolve some of her issues in counseling. I told her that she is from another world where you don’t talk about these things, much less with strangers. The staff left us pretty much alone. After a while the nurse asked if she could check Bah’s dilation. I told the mom that very simply the doctor won’t come to deliver the baby if she won’t allow a check. She said OK, but only one finger, and very gently. We agreed. (Normally a vaginal bimanual or two finger exam is done to track the progress of the cervix’s dilation from 0 to 10 cm. which is how we measure each stage of labor.)
            8 cm. Great news! Bah surprised me how well she was doing with the pain though pretty worn out having now been up 2 days and 2 nights -- slow but not unusual for a first baby.
            An hour later an aunt showed up with some herbal potion that would speed things up. The doctor didn’t want to speed things up, especially since waiting can allow the baby’s head to mold well and stretches the mother naturally, but they insisted. So she drank the brew and it starts coming back up. I get to hold the bag. Just as she is getting cleaned up another aunt comes and proclaims that the reason her baby isn’t coming is because she ate sweets and made her baby too fat!  I whispered to her between contractions as soon as I could that her baby was just the right size for her and he isn’t 8 or 9 pounds; we still think her labor is going really well and I am very proud of her.
            Great Aunt shows up next and tells her that her baby won’t be born unless she apologizes to her parents for the times she talked back to them. She does. They give her more brew.
            Then -- and I swear this is all true! -- FOB’s clan sends three chubby middle aged tribal pastors to come pray over her. They walked in the door without knocking looking like the Three Stooges in pin striped suits that are too big for them. I asked Bah if I should send them away. She said they could come in for just a minute. They trooped in, laid their hands on her head and prayed -- on and on, through at least 2 contractions with Bah trying to hold still. Finally I said, AMEN and ushered them out thanking them profusely. I got a door sign directing all visitors to check at the desk first and closed the door.
            Finally Bah was 10cm. and could push. It took another hour but then her little boy was born, crying right away. Grandma told us she would hold him first because the placenta wouldn’t come out if Bah held him, so we wrapped him in warm blankets and she held him after she cut the cord. I tried to involve her as much as possible, hoping this birth might help heal some of her memories. She cried when she cut the cord and thanked us. We had her in charge of the cool cloths for sponging her daughter’s face and neck during labor. I kept telling her what a great doula she was, such a good mom.
            So, Grandma was holding the little guy who won’t be officially named for a couple of weeks (the bad spirits might hear his name or someone say how cute he is and ‘they’ could take him away) and Bah starts bleeding a bit too much and promptly faints. They start an IV, massage her uterus and Grandma has a total melt down, throws the baby on the lounge chair, and starts shrieking not to touch her. The doctor has me explain hemorrhage and what they have to do but Grandma is beyond reasoning, calling the clan elders on her cellphone to hold a palaver and take her side. In no uncertain terms I say that there are mothers dying in China after birth everyday because they don’t know how to do this (at this point the doctor and the nurses are all vigorously nodding all together) and finally we get her to stop yelling. Finally I help Bah get baby latched on properly (which helps the uterus clamp down and reduces bleeding) and he starts nursing and things settle down.
            8 P.M. My husband picked me up. Out for supper and then SLEEP! Back to the hospital this afternoon to figure out the next step. In their tradition a mother can’t come back to her family after birth, she is unclean for 30 days. We wouldn’t want to incur the wrath of the bad spirits, but she can’t go to her boyfriend’s family either, because Child Protection is involved and won’t allow that. FOB is going to a hearing this month to be tried for statutory rape: she is under 15, which is the cutoff for a ‘consensual relationship’; she’s a ‘vulnerable minor’ instead. In the past another family in the same predicament built a hut in the backyard for the mom and baby in the middle of a Midwestern winter and of course the courts got involved. The doctor won’t discharge Bah unless she is OK with whatever arrangement we can get the family to agree to. Mother Teresa’s nuns at the Missionaries of Charity Shelter where I volunteer have agreed to take her.
            My next birth is with a family from Liberia, but that is another story.

Monday, March 4, 2013

The best baby video yet!

What a midwife should not do: A lesson in destroying bonding.

I was in midwifery training, doing an internship on the Texas – Mexico border at a clinic in 1989. There were 7 of us in my class. I had been a lay midwife working in Wisconsin among some of the Plain settlements there. The rural Midwest is known for its Amish, Mennonite and Hutterian colonies scattered throughout the countryside. This population in particular was very much under-served medically, for a whole combination of reasons. At the same time it became apparent, to me at least, that what I was doing might be risky and I did not feel at all confident with my skills level, so I wrote a grant for a Bush Leadership Fellowship and got it, going back to school after 5 children. It was very excited – for me at least. My husband David had recently completed his Masters and I was so very eager to go back to school; he even agreed to the whole crazy plan. (He is one of those rare saints).

The clinic saw over 20 women a day, mostly from Ciudad, Juarez which is across the Texas border within walking distance. We were on the El Paso side. For those who had the proper documents, it was easy to cross the border and visit the clinic. For those who didn’t have the paper work, it wasn’t impossible. If you could manage to have a baby in the United States, however, you had an instant IN. We even had to keep the birth certificates in a locked safe because they were such a valuable commodity. On the black market they could sell for $10,000 or more I was told. So if you had a baby on our side, then you could get papers. You could even work in the U.S. legally. But there is the border. On the U.S. side they check everything, often stripping down cars, and even people, it was rumored. On the Mexican side it was a whole different story: one ‘official’ dozing in a chair with his sombrero tipped over his face shielding him from the sun. When he was awake you’d get waved through without even producing I.D. Sometimes he just slept and you walked past.
To get to the U.S. when you don’t yet have papers, you just wait on the bank of the Rio Grande below the bridge where the customs guys are. The guys who run the inner tubes back and forth have lookouts up above signaling when the coast is clear (of border patrol cops). When they say go, you get pulled across, climb under one of the chain link fences and up the opposite bank, hopefully before getting caught. So, many of our clients arrived covered in mud. Usually we just showed them to the shower. Sometimes women came already in labor. Most had enough time to clean up before 2nd stage and pushing, but every so often we’d catch a baby in the shower.
We saw all sorts of mommies-to-be: 14 year olds, 45 year olds, healthy, undernourished, educated, illiterate, even some women doctors chose to deliver their own babies at our clinic because they recognized the superior level of hygiene in comparison to the Mexican hospitals. Between contractions you could see them fingering a Chux pad or a disposable syringe, wondering if this was a first for them.
One sweltering day, when I was “on first”, meaning I could ‘catch’ babies on my shift under the supervision of one of the instructors while less senior students would be assisting me, a first time mom came in active labor. We roomed her and got everything ready. She walked around awhile, rested for a bit, and did pretty well in general. She was very quiet and didn’t have a lot of family there, compared to some of the birth-day parties some families had.
Finally the baby came, an 8 pound boy who cried right away. I plopped him on her tummy and my breath caught. At that moment I noticed his feet: splayed big toe, feet extending upright almost touching the tibia. I froze. I looked up and noticed the low tiny ears, the big tongue, the stubby fingers – it was all there. I tried to smile, but I doubt if I did a very convincing job. Mom was quiet, taking it all in, not overly excited or even happy. Now, 25 years later, I can’t remember a dad in the picture, but he must have been around somewhere.
While she was being cleaned up I asked if we could take baby back to be weighed (which I never do now – we have all night to weigh him, in the room if at all). I wrapped him up, a beautiful, dark, furry little boy. Hair on his head, all over his back, chubby fuzzy arms. I cuddled him and burst into tears when we got to the lab. I looked again: there were the Simian lines on his hands. Damn. Why her? Why now?
I had heard all the horror stories about Mexico. Macho Mexican husbands expect perfect kids. They abandon wives who cannot produce them. And she was only 18. And a first baby. Deformed, not perfect kids go into institutions in these countries. They are an embarrassment. But I had to do something for this little guy. My little guy.
I enlisted the clinic’s translator. I talked with my supervisor and laid out a fool-proof plan. We would inform the mom before she went home that we would line up all the best referrals to all the best services we could find in the city and make sure he got the best start possible. We would tell her that she could advocate for him and would have our full support. We would educate her and make her a real champion for these children. Yeah, right.
She didn’t know what Downs even was. The translator did her best but the fact was that in her eyes he was retarded. I don’t remember her crying. She was just silent. She listened and held him, not particularly close. I assured her we would have more information when she came back for her 3 day follow-up visit. I hugged her goodbye before she left that evening.
She did come back for the next appointment and the one after that. I made a big fuss over him each time, telling her that this was one of my very favorite babies. Between her visits I grilled the staff, trying to find out how we would know if he was going to be placed in an institution. How would we know? I even entertained the thought of adopting him myself should the family decide to do that. 
Finally, I had to let go. They had no reason to return to the clinic and we had no way of knowing where they went once they crossed that bridge for the last time. A week later I ‘caught’ another beautiful baby with Downs. This time I didn’t say anything. I made sure mommy and baby were skin-to-skin and bonding. I kissed her and told her what a beautiful baby she had and what a good job she had done. I told her that her husband should be so very proud of her. He beamed when I said that. I stitched her up, cleaned up the bed and went back to the lab and cried. I knew then I had blown it the first time. Now I knew I should have just let them bond. Nothing else. Let her fall in love with her baby and think he is the smartest baby in the world. When she takes him to kindergarten and someone tells her he isn’t smart, that he actually may be retarded, well, by then she will love him so much (and so will his dad) that they’ll do anything to help him.   
I am older and wiser, but I still cry when I think of my little guy, and I can’t tell him I am sorry. 
© Stephanie Sorensen 2012