As a midwife, there is the moment the baby is born; the relief and gratitude I feel when the baby cries or lifts their head, eyes wide open to find their mother's face. There are the small. clenched fists and mouths that quickly suckle, a sneeze or cough to clear their lungs.
And while these things, sweet and miraculous are taking place, the uterus, former home of the baby must quickly empty itself of the placenta and return to its almost pre-pregnant size. The uterus, stretched to capacity must shrink down to the size of a grapefruit. It must clamp off the blood vessels that nourished the baby and in this feet of anatomical engineering, it must be careful not to loose too much blood. To do this, it must be empty; nothing can remain.
Mostly this happens. We wait and watch. Here in Haiti, we draw up pitocin before the birth and give it to the mom seconds after the baby is born. As a home birth midwife for all those years, I trusted that this would all work well but here with transport difficult and the women dehydrated and malnourished, we do not. This shot of pitocin, now known as active management of third stage, works well and we all feel pretty confident. "There is so little blood" we comment as we clean up and help the mom to a bucket shower and a clean pad.
And then there is the baby. After so many resusitations, always a happy sigh of relief and then on Friday afternoon, a woman bleeds an hour after birth and no amount of IV"s or medicine stops it. I put my hand inside and pull out hand fulls of blood clots and then in again and again; emptying the utereus and then for a long time holding it in place; rubbing and holding it beneath my hand forcing it to stay hard and small. We offer more medications, the power of a nursing baby and finally hours later it stays hard and the bleeding stops. Piles of laundry, used gloves and blood stained clothes.
We stand and go out into the hall to drink water and feel the fresh air of the approaching night. Another Mom is pushing; she is moving quickly and then there it is ; a perfect baby boy who cries and rests slippery and wet on his mama's breast and then the shot and the quiet wait for the placenta. I am drying the baby, changing blankets, offering the mom water and then the student midwife looks up and says, " the cord broke". I quickly change places and when I pick up the cord it comes off in my hands and there is no other end to be found. I try to reason that the other end must be right there and I can find it but can not. I reason the placenta can come out without the cord. Calm and reason.
We get her up. We give meds, oreintal herbs, Oregon herbs, more meds. We have her stretch and stand and squat but the placenta does not come out and she begins to bleed. For the second time in the day, I reach in to take the placenta out and it falls apart in my hands. I can not imagine what is going on. I feel for the familiar and it is not there. I can not feel what should feel like a placenta.
The Dad carries her to the car and our little team , along with Dad and baby, make our way to the hospital in Cap. And all the way I am holding the mom's head in my lap and holding her uterus in my hand; not allowing it to go soft. Sharon, the nurse, holds the IV bag. The always present holes in the road, seem worst than ever. I am afraid beyond afraid.. Why are there so many cows in the middle of the road. Why is it taking so long? Where did all these dogs come from? Which way to turn? Its so dark. Surely this alley is not the way to the hospital.
And then we are there. People everywhere waiting to get in; people sleeping outside. The Dad carries her in and then I am faced with a Hatien labor ward. Screams, rats, dirt, blood, one doctor for everyone. Rows of women drapped in stirrups withe no support or privacy. Babies waiting on the counters. We tell the Dad to put her on a bed and the very young Hatien doctor removes a small, deterioriated placenta that is more like a broken and deflated balloon.
We can not believe the baby survived and determine that the cord broke off at the base, leaving a large gaping hole in the placenta. There was not enough surface to nourish a baby and yet it did.
The mother should have bled more and yet she did not.
The father says to me, "we are use to angels and to miracles here in Haiti."
While we wait to make sure she won't bleed, Sharon covers babies and we try to help the other women. We get the doctors number and promise to call her. And there are women everywhere screaming. No one listens to heart tones. It is beyond my reason. Another mouse; no running water, no sheets.
And yet a woman, takes me to a washing station and pours clorox water on my arms and washes off the blood that is caked on my arms. I think she is a nurse's aide perhaps. The clorox burns and I am moved by this small kindness in the midst of so much.
I move from anger at the cows in the road, anger at the state of the hospital, anger at the situation in Haiti and then to tears and relief and then gratitude that the mother and baby were alive with virtually no working placenta.
We gather her up and head back to the birth center. This time, she sits with her husband; Sharon and I in the back with the baby. She walks into the center, bathes and gets into bed to bed to nurse and snuggle at long last. I am taken back by her strength and her resiliancy.
In the morning, Jason is sweeping the walks and the air is clear and cool with a soft Hatien sunrise over the mountains. I go downstairs to check on them and the other moms and then the fear and relief and exhaustion overcome me and I cry and cry with gratitude.
Each year hundreds of thousands of women die the world over because there is no trained midwife at their births, because there is no way to transport them to a hospital and no medicine to stop the bleeding.
The women of Haiti understand this risk and travel far to come here.
I feel inadequate and tired but there is team of us here now and others will come and go and when I look out two more women have come in the gate and are walking towards the door in labor. It is Saturday and Delha makes pancakes for everyone and the kids come in to show me their new drawings and the women must be checked in and a minster brings me bags of cocanuts and bananas and a new day begins.