It has been a less-than-awesome week. I have repeatedly thought that the best part of this week, is the fact that it is (Thank God) almost over.
But then, it hasn’t all been bad.
For instance, I may have mentioned that I will be traveling to South America this year on a health expedition of sorts, and just going to warn you here, I will (most likely) be ‘mentioning’ it a lot in the coming months until I go, while I am there, and (probably) for many months after I get back. Because it I am very much looking forward to it, and in stark opposition to all the less-than-awesomeness of this week, it is Super Awesome.
As a part of this expedition, I have been attending a regular lecture series on Global Health, and the required reading for the most recent lecture was an excerpt from the book The Spirit Catches You and You Fall Down by Anne Fadiman. The excerpt was from the first chapter of the book and entitled “Birth.”
Naturally, the title of this excerpt grabbed my especially OB/GYN-obsessed attention. But then I read it, and parts of it seemed to literally reach out, poke me in the brain, and then sweetly, almost painfully, squeeze my heart.
Before I explain, here are a few of the passages that particularly poked and squeezed:
[General Disclaimer: For those of you who are less especially obsessed with all things OB/GYN and The Miracle of Birth, this stuff may sound, for lack of a better term, kind of gross. #1 – Just saying, consider yourself warned, and #2 – Your Loss. Now, where were we, Ah yes…….]
“Even if Foua had been a less fastidious housekeeper, her newborn babies wouldn’t have gotten dirty, since she never let them actually touch the floor. She remains proud to this day that she delivered each of them into her own hands, reaching between her legs to ease out the head and then letting the rest of the body slip out onto her bent forearms. No birth attendant was present, though if her throat became dry during labor, her husband, Nao Kao, was permitted to bring her a cup of hot water, as long as he averted his eyes from her body. Because Foua believed that moaning or screaming would thwart the birth, she labored in silence, with the exception of an occasional prayer to her ancestors. She was so quiet that although most of her babies were born at night, her older children slept undisturbed on a communal bamboo pallet a few feet away, and woke only when they heard the cry of their new brother or sister. After each birth, Nao Kao cut the umbilical cord with heated scissors and tied it with string. The Foua washed the baby with water she had carried from the stream, usually in the early phases of labor, in a wooden and bamboo pack-barred strapped to her back.”
“When Lia was born, at 7:09 p.m. on July 19, 1982 Foua was lying on her back on a steel table, her body covered with sterile drapes, her genital area painted with a brown Betadine solution, with a high-wattage lamp trained on her perineum. There were no family members in the room. Gary Thueson, a family practice resident who did the delivery, noted in the chart that in order to speed the labor, he had artificially ruptured Foua’s amniotic sac by poking it with a foot-long plastic “amni-hook”; that no anesthesia was used; that no episiotomy, an incision to enlarge the vaginal opening, was necessary; and that after the birth, Foua received a standard intravenous dose of Pitocin to constrict her uterus. Dr. Thueson also noted that Lia was a “healthy infant” whose weight, 8 pounds 7 ounces, and condition were “appropriate for gestational age” (an estimate he based on observation alone, since Foua had received no prenatal care, was not certain how long she had been pregnant, and could not have told Dr. Thueson even if she had known). Foua thinks that Lia was her largest baby, although she isn’t sure, since none of her thirteen elder children were weighted at birth……When she was six minutes old, her color was described as “pink” and her activity as “crying.” Lia was shown briefly to her mother. Then she was placed in a steel and Plexiglas warmer, where a nurse fastened a plastic identification band around her wrist and recorded her footprints by inking the soles of her feet with a stamp pad and pressing them against a Newborn Identification form. After that, Lia was removed to the central nursery, where she received an injection of Vitamin K in one of her thighs to prevent hemorrhagic disease; was treated with two drops of silver nitrate solution in each eye, to prevent an infection from gonococcal bacteria; and was bathed with Safeguard soap.”
“It is a credit to Foua’s general equanimity, as well as characteristic desire not to think ill of anyone, that although she found Lia’s birth a peculiar experience, she has few criticisms of the way the hospital handled it. Her doubts about MCMC in particular, and American medicine in general, would not begin to gather force until Lia had visited the hospital many times. On this occasion, she thought the doctor was gentle and kind, she was impressed that so many people were there to help her, and although she felt that the nurses who bathed Lia with Safeguard did not get her quite as clean as she had gotten her newborns with Laotian stream water, her only major complaint concerned the hospital food. She was surprised to be offered ice water after the birth, since many Hmong believe that cold foods during the postpartum period make the blood congeal in the womb instead of cleansing it by flowing freely, and that a woman who does not observe the taboo against them will develop itchy skin or diarrhea in her old age.”
Now I will tell you why these passages, and really most of the excerpt (you can find the whole of it Here, if you are so inclined), struck me so deeply. Practicing in an infinitely larger, and more ethnically diverse city than I have ever worked in before, part of the reason I wanted to come here (i.e. from a place where the greatest diversity is the difference between a Northern or Southern Norwegian ancestry. With the occasional Dane thrown in to really shake things up), I have had the opportunity in the last many months to do a number of deliveries with just me, an attending hovering somewhere in the general vicinity, a woman completely dilated and crowning, and an interpreter phone on speaker on the bedside table. And/or a selected family member hidden behind the privacy curtain translating things like “Try and hold your breath when you push!,” or “Don’t push!,” or “It’s a Girl!” in a wide variety of languages.
My heart aches for, rejoices with, and is captivated by every woman whose baby I get to bring in to the world, but it in particular, it goes out to these women. With every one of them, I can’t help but wonder what it must be like to deliver your baby in place where you can’t even speak to the person who is doing one of the most personal things one person can do for another. I know I that feel frustrated by the wall that is essentially, metaphorically, linguistically thrown up between us. But I think, I know, that it must be that much harder for them.
And then, even besides being robbed of the ability to speak for themselves in such a situation, I wonder, and I worry about any number of their taboos, customs, or traditions I might be breaking or clumsily, unwittingly stomping all over. I wonder how different, maybe frightening, and maybe offensive it must be to deliver a baby in the rather sterile, authoritative, Western way that we are accustomed to, as opposed to whatever way they may have experienced, envisioned, or understood.
I can’t help but wonder and worry, and these passages in particular gave me some insight into how it must feel, and as to what sorts of beliefs and customs I might be clumsily trompling all over.
As with any soon-to-be new mothers, I do try to show them in ways that, I hope, transcend any walls, that I care. In whatever ways seem to be necessary at the time, encouraging nods and smiles, or a 5 second you-can-do-this-and-I’m-not-going-anywhere-until-you-do look, or with gentle hands that lay a baby on their belly with the sincerest saying of “You did it. And your baby is so beautiful.”
That last of which, I wish I could say in every language, because every last one of them, even if they don’t speak any other words of English, always looks at me and says “Thank you Doctor.”
Just slays me. Every time.
Therefore, I will get up, very early, and go back to work again tomorrow. Because those moments mean more than any amount of less-than-awesomeness.
And I suppose at least, in preparation for my South American health expedition of sorts, I am attempting to learn Spanish. Very quickly. So far I can say things like “The cat has water,” or “The horse drives a bicycle.” Don’t know exactly how helpful those phrases will prove to be on a health expedition, but I still really enjoy saying them as often as possible, to as many people as I can.
And, on that yes-I-am-obviously-over-tired-and-should-go-directly-to-bed note, Buenas noches amigos!