Thursday, February 26, 2015

Wisdom of the Midwives

There was a knock on our apartment door....“Hay consulta!”  (There’s consult here!) one of the midwives said.  Essence (my student) and I were called into the prenatal room, as we normally are when a woman comes in for a prenatal check-up.  

Maria (not her real name) was in her last month of pregnancy.  Santos, the midwife on duty had already been checking the baby and when we came in the room, she asked Essence to go ahead and check.  Essence checked the position and then looked for the heartbeat but could not find it.  The baby was clearly moving so there had to be a heartbeat somewhere.  I stepped in to find the heartbeat and also could not find it.  I searched and searched while Santos stood by watching, patiently.  She waited for me to give up and then said,  “Donde esta la cabeza?”  (Where is the head?)  Only then, I checked for the baby’s position (duh) and the head was near the woman’s ribs.  The baby was clearly breech.  She must have found me humorous. “Allow me,” Santos suggested.  I stepped out of the way and she started her work.  She lathered up the woman’s belly with lubricant and explained what she was about to do--move the baby to a head-down position, which is much more conducive to a safe birth.  


She lubed up the woman’s belly with an herbal salve (Azucena makes all the herbal preparations) and began talking to the baby in Mam.  She translated for us, saying, “I’m telling the baby that the the doorway is not here, it’s over here, and he’s not going to be able to get out over there.  He has to move down here so he can get out.  I am explaining to him that he needs to move.”  All the while she massaged, and shook and jiggled the baby, with one hand on the baby’s head and the other on his bum, with sweeping massage motions in between.  She talked the baby through the whole thing and the woman lay completely relaxed.  For my own comfort I checked the heart rate before and after the procedure and the baby seemed to tolerate it quite well.



Within a few minutes she had a head-down baby, whom she instructed to stay there.  Maria was asked to come back in a week to make sure the baby stayed and that was that.  What we witnessed is something that Maya midwives have become known for, first through the work of Bridgette Jordan, who wrote about Maya midwives in Mexico in her book, Birth in Four Cultures, and then through the work of anthropologist Robbie Davis-Floyd, who has written articles and given many lectures, also about Maya midwifery in Mexico.  Here, they call it “componer el bebe,” or getting the baby in the right position.  In western obstetrics it has a fancy name--External Cephalic Version.  If it sounds intimidating, it’s with good reason.  In the U.S. it’s normally done under ultrasound and often with relaxant drugs and a lot of warnings about possibly needing to go into surgery if it doesn’t work or anything bad happens.  And only some obstetricians will do it.  Most will simply order a c-section for breech.  Some midwives in the U.S. do it but it is frowned upon, in my experience, because of all the fear and liability in the obstetrical world.  


Here in Guatemala, it is common to see a lot of babies that are lying sideways or in breech position.  I have my own theory about it that it has to do with the way the women wear their skirts, with a belt around the top that sometimes doesn’t leave a lot of room for the baby to get into the best position.  Whether or not my theory is accurate, when there is a midwife who knows how to get the baby back where it belongs with so little fuss, it becomes a non-issue.

In another prenatal visit, Essence and I had done our usual listening, measuring, and connecting with the mom and baby and as I was helping the woman sit up, it was clear she was in some pain.  Then Antonina, the midwife, said, “Hold on... i have to do her massage.  You don’t do this, do you?”  “No, “ I said, “go ahead.”   She put her hands on the woman’s big round belly and began to knead, and massage, and jiggle, and push and pull, all so gently and kindly.  “Suave,” she said.  Gently.  Chaba (In Mam)  In Mexico, they call it “sobada.”  Here they call it “masaje,” which just means massage.  She spent about 5 minutes on this massage, and as she did she explained, “This is one reason why the women like to come to the midwives.  The doctors don’t do this.  Often the woman will have a lot of aches and pains and when the midwife does her massage, she feels better.  That’s why they ask for it.”


Another thing we have have seen is the binding of the uterus after the birth.  Azucena took a wide belt and wrapped it tightly the morning after the birth around the woman’s hips.  She wrapped several times around and pulled hard and tight, like she was cinching it.  She explained that she was pulling tight to squeeze the hips because that in turn squeezes the uterus and helps the woman so she will not bleed so much after birth.  This is done for all women here with the idea that it aids in overall postpartum recovery.  I learned from Essence today that her great-grandmother, a granny midwife from southern Florida, did the same thing with her ladies, only she used a strip of an old sheet instead of a handwoven belt.  And that tradition was passed down to her daughters and granddaughters.



For me, there is much to be learned from working alongside these midwives.  And it’s not even so much about “technique.”  Techniques can easily be learned and transferred to other settings. It has more to do with their way of being.  Santos, for example, exudes a quiet confidence that puts women at ease and makes it easy to just follow her and do what she says.  I watched her in a life-threatening situation stay cool as a cucumber and do what was necessary to get the woman to the hospital.  I was totally shaken up after the event and it was her groundedness that helped me get back to equilibrium.  

And Antonina, for example, spends most of her time in the prenatal visits asking questions, telling stories, and making the women laugh.  I do way more laughing than midwifery skills in my visits with her. Unless you want to count humor among those skills. It’s about the way in which the midwives are so much like their clients, and that creates a certain integrity and continuity with the women they serve.  An ease and comfort and familiarity.  They dress the same, speak the same local language, struggle with the same issues of poverty, ethnic discrimination, and male chauvinism.  Antonina joked with one woman who’s husband had gotten her pregnant and then left as a wetback (or “mojado” as they are referred to here) for the states, “Well, at least you won’t have to deal with him for another 10 years.”  They all found that extremely funny.  

And then there’s Azucena (Lily)--keeper of the herbal wisdom.  The herb garden is her baby here at the clinic.  She gave us a tour and named every single plant and how it is used.  She even knows some of them in English because she has given talks to groups of American students and has learned them that way.  Various medicinal herbs are usually found drying in the special greenhouse on the roof of the birth center and huge bags of dried herbs are found in glass cabinets in the waiting room, along with special mixtures for urinary tract infections and other common issues in childbearing.  All of the midwives know how to use the plants but Azucena leads the way in these matters.

These midwives know how to keep a woman healthy with food, herbs, massage, loving and competent care, and good advice-- the things that are most accessible, and they know how to attend a birth in a way that makes sense to the woman and her family and makes the woman feel well-cared for on all levels--physical, emotional, intellectual, and spiritual.  These are the wise-women of the community.  It’s really clear.

When the midwives are in the clinic and not attending to women, they are cooking, cleaning the birth center, attending to the herb garden or working on weaving and handwork projects.  They may also be involved in meetings on any given day of the week.  There seem to be an endless stream of meetings.  Meetings with each other, meetings with other women’s groups, meetings with representatives from various groups to address issues of women’s rights, poverty, education, environmental contamination, and the encroachment of transnational enterprise.  I find myself deeply impressed with both the day to day talents I witness and the commitment to a larger vision of collaboration for change in this country.  I have much to learn here.




1 comment:

  1. How beautiful! And how much more gentle for the baby and mother to have a breech situation dealt with in this way. It's wonderful to be reading this and have photos too.
    Thanks Sarah!

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