Manos Abiertas

I arrived here at Manos Abiertas in ciudad Vieja, Guatemala on Friday to spend the next two months apprenticing with Hannah Freiwald. I finished my formal Midwifery training at Maternidad La Luz spring of 2010 and wrote and passed the NARM exam this past February in order to become a Certified Professional Midwife (CPM).

I have been excited to start bridging the gap between the role of a student in a school environment to taking a lead role in births, learning to trust my skills and intuition and testing the boundaries of my comfort level.

On Monday night I had my first opportunity to do a birth as the primary licensed midwife. Yarlin was a first time mom and started contractions on Friday. We saw her for a labor check on Sunday afternoon but things didn’t really get going until the following afternoon at which point she hadn’t slept in a few days. She had such a sense of determination about her and it seemed to me labor was as much a process of giving birth as a process of emotional letting go.

It felt like forever since I had attended a birth and I felt nervous that somehow it would feel unfamiliar, like the eyes of my knowledge would have closed and slipped into a deep sleep but as I soon discovered the sensations of birth, the feeling, smells and sounds all came flooding back to me in a few flutters of the eyelids.

I feel so honored by the trust that Hannah has put in me and feel as though I have already made leaps and bounds in the short time that I have been here, even if it is just in my own way of thinking.

Ups and downs

At last I have found some inspiration to write here. The last few days have been hard not knowing how I am going to survive financially and feeling overwhelmed and burned out by the program. Exploring my options for getting licensed in Canada can be somewhat scary as I see a long road stretching ahead of me. Today I woke up clear of that turmoil and fear with a new fight to make it through and reach my goal. A new sense of drive and clarity.

I'm now in my second quarter. On March 1st a new group of students will arrive and shortly after that we will write our 2nd quarter exam and become interns. We then will be in the teaching role and be taking on more responsibilitys. I'm really excited for this new challenge and look forward to sharing and consolidating my knowledge with the new students.....

The clinic has become so much easier and I'm signed off on pretty much all of the skills we are required to have and be supervised for the first ten such as pap smears, blood draws, physical exams and new born screens (we have to poke the babies feet and make them bleed, its horrible). I don't have much to measure my Spanish up against. I can ask the same questions over and over again but lack the flow of easy conversation that I wish I had.

I've now been to over 30 births and caught 9 babies. Each one has been such a big lesson and such a blessing. The clinic is really slow right now and its been 9 days since I caught a baby and I'm already starting to miss it.

I've been in the program for four and half months now and already my hands are learning what to do. I won't be leaving here until March 2010 as I need to graduate an 18th month program to be eligible to write the PLEA exam which if I pass will enable me to register as a licenced Midwife in Canada. Leaving here seems like a million years away, I can only imagine how much I will know by then of that time. All of my knowledge is starting to come together and feel like something that I can really feel and touch.....I feel so blessed by the support systems that I have near and far.

Tears to ecstasy

This program is like falling in love and then out of love everyday. It seems like each time a woman arrives in labor and it is my turn to be her Midwife I open my arms wide, my heart jumping and I fall in love in moments wanting to share every little thing about her with the people around me, wanting them to see how amazing she is feeling blessed that I got one of the “special” ones. I marvel at how she walks, breaths and moves. And then I watch as she gives birth, as life emerges from her body, as she pours her physical strength into the task at hand. Seeing her face as she holds her baby for the first time, a look of dazed shock and then an over joy as she knowingly takes this small being into her arms and begins the processes of nurturing her child for life.

Other times the world seems to be crashing down on my head and I doubt myself and wonder if I can actually do this program, actually complete it. I feel as though I am drowning in it all, my essence slowly seeping from my body, my creativity dead and sleep becoming a fantasy. Some days my actions are robotic, the same questions asked over and over again. Get file, run through questions and vitals, put file away and move onto the next and then the next and then next.

Some days I step outside and look up and around me. Hear church bells in the background, laugh at the kittens outside or breath in the air and marvel how the sunlight reflects on objects around me and I remember.

Tears to ecstasy, tears to ecstasy.

My first catch

September, 23, 2008. 7:21am

Evolution

Change has occurred in the air. Tonight is cold and blustery, I am wrapped in scarves and sweaters against the cold and they feel oh so good. Today is a big day for my class as we begin catching. We have been shadowing the primary care giver the last few weeks learning the ropes of the clinic and getting comfortable with the flow of birth at MLL. Now we are the ones that will be shadowed by our interns and they will be assisting US. In another three weeks we will be flying solo. Many of my class mates are nervous but I’m mostly just excited. So far almost everything has come to me really naturally and feels really right on many different levels. Thats not to say this program stretches and test each and everyone of us to our own limits...

I now actually enjoy drawing blood and am comfortable giving breast exams. We are also able to do pap smears and physical exams. It seems that whenever I begin to find my footing in the clinic another skill is added on. It certainly keeps me on my toes and straining my eyes forward to whatever comes next.

This afternoon Juana , a woman who’s birth I was in the other day came in for her postpartum appointment. She was a walk in client so we had to do her initial which usually takes a few hours while she was in labor. At one point her and her husband asked what kind of pain medication we had. I will never forget the look of shock on her face when I told her we had none. She was 35 but it had been sometime since she had her two others kids who she had birthed in the hospital. I told her that it was very possible and that many women give birth here without pain medication but with lots of assistance and support. When she asked me if I myself had ever given birth I had to say no and felt rather silly about it. Seeing her positively glowing face of joy today was an amazing feeling and her reaction when she saw me was even more heart touching.....

Fall birth

I was in my second birth this morning. It was beautiful and surreal, dappled fall light coming in through the open door and church bells chiming in the background. My body helped support the mama's and when the baby came out I was christened with vernix. She scooped him up into her arms and studied him with wonderment and astonishment covering her face in vernix and laughing as she met her little boy.

Nacimiento

I drifted off to sleep after writing that last post, joking with the other girls that a woman would come in complete and pushing. As I am still in orientation in the clinic we are "shadowing" the interns and watching the roles that each of them play in the birth. I had shadowed Olympia as primary a few nights before and we spent the whole night with a young girl having her first baby. At around five in the morning she and her mom decided to go to the hospital, I suspect there was some strong persuasion going on from grandma as she had difficult obstetrical history. It had been a long night with a bit of a sad ending so I was hoping that perhaps on this shift Olympia and I could complete the circle in a sense.

We both thought it was a joke when we got woken up an hour or so later being told we had a complete and pushing mama! I took the role on as documenter recording each new progression of the labor. For example: head born @ 11:57 am. Baby born at 11:59am, September 25th and so on. In retrospect I was a little shaken by the power I had simply as a documenter, especially in this birth. I made the call that it was 11:59pm when I could have seen the clock as 12:00am which would have made her birthday September 26, a date that she will be used to identify for the rest of her life. Part of being a student at MLL requires that we write a birth report after each birth with our reflections on that birth. Here is mine.


First and thousandth birth....
Allisson’s birth was the first and the thousandth for me. It simply was, as I am, and seemed less of a mystery then I had anticipated. Birth. Beautiful and complete, yes I know this, yes this is familiar. More familiar then anything has ever has been. I am struggling to find the words to describe it. My emotions and thought process seem slow and glitchy. Attempting to find the end of my thoughts to be picked up and examined seems fruitless. It is complete, a full circle with no ending and no beginning to it. I don’t think anything else in life has ever felt so whole and so completely satisfying.

After Allisson was born I lay on the on the bed beside her while her mama was taken care of.
As I listened to to her breath, the thump of her heart and the gurgles of her tummy I was struck with how defined and perfect she was, this creation of woman’s womb. Her skin was so soft, vernix tucked into the roles of her neck, her eyes closed tight against the bright light and her tongue and mouth rooting. She represented to me the beginning and as I looked at her I also saw the end and I found bliss in both.