Sunday, November 3, 2013

Waiting for Radiya … kangaroo care and male circumcision in Minnesota

"We are the mothers, after all, the ones who speak the cultural narrative and teach it through ... well, old wives' tales, which is to say, the ancient, subversive, and immediate mother tongue, the language of metaphor and myth." -- Ellen McLaughlin

It took a while, but now we have an awesome arrangement in place with some of the numerous clinics that serve the immigrant-refugee communities here in Minneapolis and St. Paul. (See: “Welcome to the Twin Cities of St. Paul and Mogadishu” story at my blog: callthedoula.blogspot.com)

Thursday night
My bag is packed and sitting by our front door. Two whole outfits are clean and hanging in the closet. There is a sticky note on the door by the lock that I can’t miss reminding me to bring my phone, phone cord, keys, snacks, etc. 

Radiya (not her real name) was due yesterday. She works nights at the St. Paul-Minneapolis Airport assembling the little meals that you can buy on the planes. She stands at an assembly line with hundreds of other immigrant men and women from 3 a.m. until 11 a.m. every night and her swollen ankles can attest to that fact.

Friday morning
We had met at the clinic where I can avail myself of their Amharic translator. After her
appointment they had given her a portable crib, still new in its box and another box with baby clothes, diapers and blankets. Her husband is still in Ethiopia. She can become a citizen and then sponsor him, though she might have to wait up to 5 years for the whole process. As a resident with a green card, she can go back to visit him and still come back into the U.S. So she came here and works and hopes while she fixes up her little apartment for when they can be together again. I knew she shouldn’t lift the crib box and would be taking a taxi home after her appointment. I had taken a bus to the clinic so I offered to go home with her in the taxi and do the lifting.

When we got there the taxi driver unloaded the stuff in the trunk onto the sidewalk and drove off, so I wrestled with the boxes while she held the doors to the building. I unpacked the crib and found the assembly instructions. Not as simple as I thought. While I worked on it in the living room she had gone into the kitchen to fix us some lunch. I finally got the thing together and standing up but when we each took an end and tried to walk it into the bedroom we couldn’t get it through the doorway. I tipped it up on a side and it still wouldn’t fit. I didn’t know that doulas need a certificate in carpentry besides! So I measured the crib after we brought it back out to the living room and then dis-assembled the thing, carried all the pieces into the bedroom and set it up once again from scratch.

It barely fit between the wall and the bed but we got it in. The bed took up more than ¾ of the tiny bedroom. I suggested she leave the crib in the living room so she had a place for baby while she cooked and just keep her baby in bed with her during the night. She had been well drilled at the clinic about the dangers of sleeping with her baby and seemed shocked that I would suggest that. I asked if they had cribs back in Ethiopia and she laughed and said, of course not! So I asked her which her baby would prefer: being with her where he could nurse and see and smell his mama or off in a crib? I went over the basics of safe co-sleeping and told her how we had done it with our 5 children, even with our twins, reminding her that all pillows and blankets should be clear of the baby and he could have his own small blanket or go to bed in a warm bunting or suit. See: Sleeping With Your Baby: A Parents’ Guide to Co-sleeping by James J. McKenna, Washington, D.D., 2007 Platypus Media Press.   

When all the plastic wrap and boxes were cleaned up she invited me to the table to have lunch with her. She made her own bread, a round white loaf fragrant with spices and black pepper. The ever-present banana was by each place and a mug of hot sweet milky cardamom tea.

Saturday
The next evening my husband and I drove to the same housing project to do a postpartum follow up visit with another Ethiopian family. We were surprised when we got there to see Radiya in the kitchen. They were best friends, it turns out and Radiya was coming every day to cook for her friend after she came home from the hospital with her new baby. I had called ahead and explained to the new daddy that we wouldn’t stay long, but that I wanted to drop off some baby clothes and have them fill out the survey for the doula program that I would then turn in. So when we got there and Radiya and another woman were busy cooking, I thought to myself, there is no way we are going to be leaving in the next hour.

It was an interesting visit. I looked at the baby in his crib and asked when he had last nursed. He was tiny at birth, just 5 lbs. She said it had been at least 3 hours. I asked how long he has been sleeping during the night and they both agreed it was 3 or 4 hours or more. It was sweltering in the apartment, though it is fall here, so I suggested they unwrap him a bit and as they did so, I realized he had on two blankets, a fuzzy sleeper, a little dress under that, and a Onesies T-shirt under that. And socks. When he stretched and yawned I noticed his mouth and lips were quite dry. No jaundice though. His mom changed him at this point and I was very surprised to see that he had not been circumcised. I looked at his dad and he explained that the insurance company just cut off (pun not intended) any non-emergency services and they couldn’t have it done in the hospital because of that. They had shopped around and the going price at all of the clinics that did offer that service charged a flat $600.

I explained that it was no longer deemed as a necessary medical procedure by all of the American doctors' and pediatricians' organizations. Half of the people at the apartment were Muslim and the other half Ethiopian Orthodox Christians, all educated, some with graduate degrees. I also explained that there are numerous studies that now disprove that by not having it done increases the child’s chances of getting infections, or HIV or AIDS later in life. I explained that all little boys need to be taught correct washing and that it is even considered by many today as genital mutilation and an offense against boys who have no say in what is happening to them.
None of the people present that night felt that it was part of some tribal rite of initiation. None subscribed to the idea that it was exclusively cultural, either. For both the Christians and Muslims, it was ordained by their religions. The Ethiopian Orthodox Christians sited the Old Testament injunction and the Muslims the Qur’an. And I am Jewish.

So I told them that my own sons, Abraham and Isaac were not circumcised and both had expressed when they had grown up that they were glad it had not been done to them as babies. One of the women said that beyond the religious reasons, that women prefer men that have been circumcised. I asked why. I couldn’t believe we were having such a frank discussion in mixed company. This was a first for me. Either we visited as women only and talked about labor and birth, or I visit a couple and the conversation usually stays on a somewhat formal level. She explained that it is just nicer, cleaner, not as ugly and she could not imagine sex with a man who had not had it done. I laughed and discreetly pointed to my husband who was still enjoying his ingera and dahl and didn’t see my message at all. I get what this symbol represents for them within both religions and in the process realized that I had just wandered into quite a mine field! One of the dads even suggested that they could take their sons back to Ethiopia when they were 5 and see the relatives at the same time. The two mothers present protested saying that it would hurt so much more when their precious sons were older. My worst case scenario would be that some immigrant here in Minnesota who had seen it done back in the old country would start doing it himself, ‘underground’ so to speak. 

So I first called a few clinics and found out that yes, very few insurance companies were still covering the cost of circumcisions. The lowest fee I could find was $377 which would still be quite a lot for an immigrant family. Then I found out that one hospital had their residents doing them all gratis – free -- if you delivered there. Next I called the hospital that most of the Ethiopians use here and asked if they knew that the other hospital is offering circumcisions free and that they are at risk of losing an entire customer base because they were not. They had an idea that this had come up but not the full extent of the problem.

Then I called a reformed or liberal Jewish synagogue. I knew that they have what are called mohels or non-medical people who perform the religious or ritual circumcisions at the temple and in homes. The rabbi agreed to email me a list of mohels in the Twin Cities. She could not tell me if they would be willing to do it for non-Jews. Or if they would even be allowed to by their rabbis.

I called one other name on the list that turned out to be an elderly Orthodox Jewish rabbi who was also trained as a mohel. When he started talking he sounded just like my own zaide (grandfather) who had died at 90 in 1981 and I melted. He suggested that I learn how to do it, being that I am Jewish. He suggested I should find a nice doctor who would let me watch him a dozen times or more and then certify me. Yikes! Not where I want to go. I would be excommunicated from the midwifery community.

I found one mohel who is both a physician and Jewish. She was very intrigued with the idea of doing this for the African communities here. She is employed by one of the big health networks and explained that she would have to look into the legal issues that might prevent her doing this outside of her own community. So I am waiting to hear back from her. In the meantime I am getting calls daily now, asking if I have found anyone to help them. Yes, I respect them enough as a people to give them choices, even if I don’t agree with those choices.
No, I could not arrange an abortion for a woman, any woman, though I have never been asked to. If I have a certain privilege in this country, they must have those same privileges. That is justice. Back in the 1970s when we were helping Southeast Asian refugee communities, I had become involved with several families with infertility issues. Some of the options available in the U.S. were not approved by my own church at the time. Yes, I would have been excommunicated then just for assisting a couple to access those methods. But I was not worried about myself. I could not deny someone else the information that I had free access to. St. Thomas Aquinas, who was one of the greatest doctors of the Catholic Church of all time said at his death, after having spent an entire lifetime writing about divine matters, “In the end…we know nothing of God.” I don't feel any hesitation in helping in this area. So I went ahead and explained all the different options and helped many families in that way. Every single one of them was able to start a family. 

Sunday evening
It is my twins’ 31st birthday* tomorrow and we plan to celebrate with a phÓ buffet, Ruth’s favorite. I make a vegetarian version of it. (See: http://www.inspiredtaste.net/4307/vietnamese-soup-pho/) The phone has been quiet all day. I go shopping and get all the ingredients at our local oriental supermarket called “United Noodles.” It is really called that. It is down the street from Have A Happy Day Jewelry store. I can get all the fresh veggies there even more cheaply than the larger groceries. Fresh Thai basil, cilantro leaves, mint leaves, bean sprouts, scallions, and chili peppers. I clean the apartment and make a note for David to remind him to pick up a carrot cake on the way home from work tomorrow. Everything is ready. We watch a movie later that evening and turn in by 11:00 p.m.

Monday morning
The phone rings at 3 a.m. Radiya thinks her water has broken and is having a few random rushes about 15 minutes apart. I suggest she calls the midwife at the hospital and let me know what they say. This is a first baby. We could easily be looking at a 24 hour labor. It takes time. I go back to bed until the phone rings at 4:00. It is a nurse at the hospital asking if I am on my way. The contractions are now 4 minutes apart. They had told Radiya to come right in so she had called 911 and she and a girlfriend who doesn’t drive either were already at the hospital. I called my friendly Iranian taxi driver and raced to get myself ready in 5 minutes. I am off.

5 a.m.
3 centimeters, 75% effaced and asking for meds. I suggest that we get out of bed – the nurse has at least 20 minutes of monitoring baby on the graph already, and we get the go-ahead. Radiya says it feels so much better to be up rather than lying down with monitors strapped on. Of course it does! We walk the halls and try the rocking chair in the room. I insist that she drink a whole cup of juice and visit the bathroom. The midwife comes in and offers some options for meds which Radiya agrees to, so she is brought back to bed and an IV is started. As her doula I can’t argue with her though I’ve tried to put this part of labor in perspective: she is doing great, the rushes won’t get beyond her strength, and this is the longest part of labor, getting to 10 centimeters. But she insists on the IV, asking the midwife if it will speed up labor. I point out that she will be more relaxed, which might help her dilate or she could be very sleepy and slow it down.

Now that she is on the IV the nurse asks her to switch to juices only, no food, and explains that they need to do a continuous electronic monitoring of the baby to be sure he doesn’t react to the drugs, which he does in the next few minutes. His heart rate drops with each contraction so the nurses and the midwife watch the machine for a while and consider their next options. In the meantime it appears that though the meds affected the baby, they didn’t do much of anything for Radiya. She is still having some big rushes every 4 minutes and not getting much relief from the IV. They add another bag of IV fluids after she begins vomiting all the juice she’s had so far. We deal with each rush together and get into a rhythm. Breathe in through your nose, hold it... slowly blow it out, breathe in, slowly, now breathe out... and rest. She can do this. Her midwife encourages her as do the nurses. They check her again: 4 centimeters. The meds have worn off completely by now and she is asking for an epidural. I try to point out how well she is doing and talk her through more rushes using visualization, riding over each ‘wave’ and then watching it go away. There, you did it. Blow that one away now. You never have to do that one again. It is gone. It has done its work. Let each one open you up… that’s it. You are sooo strong! Think of all of your grandmothers and great grandmothers… all the women all over the world that are birthing their babies tonight. You can do this… breathe... good job, sweetheart!

7 a.m.
The epidural is ordered though they tell her the anesthesiologist is in surgery just now but will come soon. The nurses all leave the room and I suggest we get up to the bathroom before the procedure. She agrees and then is again surprised how much better she feels standing rather than lying on her back in bed. We get through the next rushes while she is on the toilet and then Radiya closes her eyes and leans against the wall and rests. The rushes seem to be gaining strength, to me at least, so when the midwife comes back to check on her I ask if she wants to see what her dilation is before getting the epidural. The midwife says no, she was only a 4 at the last check, and while we are talking, the next contraction starts and with it we both hear Radiya first breathe in and then PUSH with everything she’s got. I am not surprised but the midwife seems completely flustered. It is only 6 hours since her water broke but it is apparent that her body knows exactly what to do and she is following along perfectly.

7:30 a.m.
The midwife runs out to get the nurses to set up the room and I continue to support Radiya who now has both my arms locked in her grip and rests her head on my shoulder. I am sort of half kneeling, half standing. I ask the nurse to get us some pillows and get Radiya to lean back on them before the next rush. She is still on the toilet. The midwife comes back with a flashlight and checks for the baby’s head. She is indeed 10 cm. and bringing baby down beautifully. After the next rush, without opening her eyes she asks if the epidural is ready. The flustered midwife tries to explain that it is too late to give it to her now and she is sorry about that (I'm not) but her baby seems to be ready to be born. Then Radiya says in that case, they can do a C-section. I help her with the next rush, telling her that she is pushing perfectly and will see her baby soon. She leans her head against my shoulder again and rests, almost sleeps for a few minutes before the next one starts. Behind us in the bathroom doorway one of the nurses is arranging a low wooden birthing stool and covering the floor with a clean draw sheet. She and the nurse help Radiya up and we pivot over to the birthing stool and help lower her onto it. 

7:40 a.m. 
We can all see baby crowning at this point. As she grips my arms even harder, her baby’s head slips out. The midwife asks if she can keep pushing, but Radiya is asleep already. The next rush starts and the midwife has her push… longer…. Push… yes! Do it again… good!... PUSH!… but can’t seem to help the shoulders out. I move further back at least a foot, still attached to our mama, hoping that it might help with the shoulder instead of leaning forward like we had been doing. It works. 

7:45
They lift a very pudgy baby girl up and I help hold her there while the midwife is busy assessing what looks like a lot of blood from my vantage point. I help rub baby’s back till the nurses take her over to the warmer where she cries right away. The midwife says we have to get up on the bed and as I help get her up on my side with one of the nurses helping from the other side, I watch a steady stream of blood dripping across the floor. She is at the side of the bed and I automatically lift both legs up while the nurses position her top half on the bed. The midwife is rubbing her stomach at the fundus (the top of the uterus) to get the bleeding to stop. She explains that it looks like she tore when the shoulders come through but that the bleeding is under control now. We can relax. 

8:00 a.m.
The nurses bring baby back but Radiya says she needs a clean nighty before she can hold the baby. The midwife explains that the baby needs to be skin-to-skin but Radiya refuses, saying she will wash up first, so the nurses put the baby back on the warmer where she starts to cry. I ask if I can hold her at this point which the nurse agrees to right away. I put a dry hat on baby and wrap her in warm towels and hug her close.

Last week I attended an all-day summit on skin-to-skin and some of the discoveries being made by a pioneer researcher from South Africa. Dr. Nils Bergman (left with his kangaroola wife Jill) has been studying maternal-infant-maternal attachment (your baby attaches to you too, it is not just you bonding with your baby) and can scientifically prove that Nature had this all figured out before we started messing around with an incredibly intricate, fool-proof system. The bottom line is that babies need to be exclusively within the environment of the mother after birth. Zero separation and nothing less is what babies are born to expect, and what Nature has wisely ordained. He even goes so far as to prove that premies will thrive and do better using kangaroo care alone and not by being placed in isoletts. (See: http://skintoskincontact.com/dr-bergman.aspx)

Dr. Bergman has made it his life’s mission to provide the scientific evidence for the neuroscience of optimal birth, the role of skin-to-skin contact, breastfeeding, parenting for secure attachment and to conduct the research as needed. He further seeks to disseminate this knowledge on mother-infant togetherness by educating all health professionals both here and abroad and by empowering parents. His work promotes practical change in health systems and facilities that enhance mother-infant togetherness. Together with his wife, Jill Bergman who is an educator and doula who also teaches kangaroo care (he calls her his ‘kangaroola’) has written a book for parents, Hold Your Premie, and produced four DVDs: “Kangaroo Mother Care: Restore the Original Paradigm,” “Rediscover the Natural Way,” “Hold Your Premie: the film,” and “Grow Your Baby’s Brain.” There is also a set of talks for parents by Dr. Bergman at: https://www.youtube.com/watch?v=BjgT6FsbqsE&list=PLE899313810FEECB1

So, after this workshop I was even more determined to get this baby onto her mum’s chest, and so were the midwife and nurses but Radiya told us she wasn’t ready, so I wrapped up baby and held her close while talking to her. She started rooting and salivating, both signs that she was telling us it was time to eat, and I believed her, so rather than letting her cry I let her suck on my little finger while she gazed into my eyes. Not the right eyes, or the right body or the right smell or the right nipple or the right voice, or the right finger, but she seemed to be OK with this alternative situation at least for the moment. The midwife had the leading OB come in to assess the tear. He was the only OB on that day, though I had assured Radiya that we’d keep her draped and not have any men in the room. She agreed to have him come in if he had to and promptly covered even her head with a blanket and stayed like that until he left. He did not need to do the actual repair and made some suggestions to the midwife who set up a tray to stitch the tear while he left.

8:50 a.m.
I was still holding baby who was still staring at me and nursing on my pinkie. I tried to get her back with her mama but the repair was still uncomfortable enough that Radiya said I should hold her until it was over. I certainly was not going to put her back on the warmer, so I hung out with baby until Radiya was finally cleaned up and ready. She tied up her new clean nightie and I tried to convince her to untie it because her baby wanted to nurse. She didn’t believe me until I gently unwrapped baby and plopped her down in her arms where she promptly latched on and vigorously nursed! Dr. Bergman had talked about alternative caregivers filling the place of the mother in certain cases like adoption, but stressed the fact that it should be the same caregiver for at least the first 2 years, not numerous people coming and going. I hope that we did the best we could have in this particular situation. 

  
Stay Tuned! This and other stories will be available in my book, Ma Doula coming out in May 2015!*See Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© (pending publication) and the chapter “Twin Birth on The Farm.” Also see Spiritual Midwifery© by Ina May Gaskin, chapter on twins, pg. 129, 2nd ed. 1989 with permission.

1 comment:

  1. should a father do have to have the same concern as a mother to her child.

    Pulau Pramuka

    ReplyDelete