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
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.
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.
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!
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.
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.
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.
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.
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.
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.
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