Labor Repose

Labor Repose
LaborPayne during her 6th homebirth (9th baby) at age 44

Wednesday, May 12, 2010

Some Things Never Change

As I gave my Haiti presentation to the local doula group on Monday, I tried to explain the beauty of birth as I saw it manifested in the Haitian women as they birthed their babies. What struck me was a story I have not yet shared about my experience in Haiti on this blog. The story of how 'some things never change.' I was at the hospital on day 4 with one of the American midwives. She was quite a lively animated person, and I enjoyed both talking with her and watching her work. I could tell she loved being a midwife- she was really into birth. She really showed me what was possible and under her tutelage I saw the most remarkable things. Well we were in the thick of laboring a woman. She was dilated to 9, and we had her in the small delivery room along with her aunt and cousin to help her (her cousin spoke English so we used her as our interpreter). She was all over the floor laboring in the most amazing positions, really working hard and effectively bringing her baby down. I was utterly amazed by this labor and how well this woman was working. Then he came. The Haitian obstetrician chose this time to make his rounds. He spoke English and was young and handsome (looked a hellava lot like Taye Diggs). He swooped down on the unit we had been running all day and started to take over. The midwife was miffed to say the least. Prior to his arrival she had given me this sweet little speech about how we were guests here in Haiti and should not behave like colonialists and take over everything. However when that Haitian OB came in and told the family members to leave and our patient to get off the floor and up on the delivery table, I could see the mama bear come out of this tiny little woman. She got right up in the doctors face and said, "Is this my patient or your patient?" She wanted to know who was going to do the delivery. They toussled for a while, there was some give and take. My midwife shook her finger in his face, 'don't you cut her' (referring to the routine episiotomy she thought her patient might get from him.) We slowly allowed the aunt and cousin back in. However we also got the patient on the table and put in an IV at the doctor's request. The doctor had brought along a little patient he intended to do a cesarean on, and I prepped her for surgery as well. While he was over in the main hospital building preparing his OR, our patient delivered, with her female relatives at her bedside coaxing her on. It was a fantastic birth, that almost didn't happen that way. It was because the midwife did the very thing she said she would not (get all colonialist on his ass) in an effort to protect her patient. How many times do we as midwives, doulas, nurses have to put our bodies between the patient and the physician to protect birth and keep it sacrosanct? I could feel the burden of this midwife. I too wanted him to get the hell out of our little delivery cocoon and leave us be. Technically these were his patients. Technically his western-infused ideas about how to conduct safe childbirth came from his American-influenced education. He was puzzled by why and how we were allowing sacred space for this woman to birth in her own body in her own way. He only knew his way, the way he had been taught, the way that didn't allow for individualities of person or cultures. (By the way, this application of western medical values into third world realities leads to some pretty brutal births- think pit induction without epidurals, or cesarean births without post op pain meds.) I understand that a lot of physicians Haitian, American, and otherwise think this mechanization of birth is the key to good outcomes. I understand it, I just don't happen to agree. Watching my little midwife go toe to toe with that physician reminded me that some things just never change- without a revolution. And in the midst of revolution you may find yourself saying and doing things you thought you never would.

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