Monday, March 4, 2013

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

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