Tuesday, December 31, 2013

Returning home - How do I Tell You?

Returning home
How do I tell you?

How do I tell you that in the last year I have heard five stories of people pulling babies heads from their bodies during the birth.  I am trying to get into the spirit of the holidays and I am trying to listen.  No one wants to hear about this.  This is not the kind of thing one ever talks about. I did not ever hear of such a thing in all my years as a midwife.  I am not sure I thought it possible.  

You are talking.   I watch your mouth move and the doors open and shut behind you.  It is warm inside.  I cannot say what is on my mind. It is too terrible and too lost.  I can tell no one wants to know this.  What could they possibly do about it even if they knew? I do not even want to know this but it is too late, I do.

In Vietnam and Cambodia, the midwives and the women along the road at the small market,  seem to want to tell me this.   They want to tell me about the baby’s head being pulled from the body and what I might suggest.  

I try to recover quickly from my horror.  A small child is sitting at a pedal sewing machine while her grandmother tells me this story.   In the schools and clinics they say “and then the baby’s head came off.’   I am trying to enjoy a warm cup of tea but I am still sitting by the road listening to the story.   In the back of the house there are pens for baby pigs the family is raising. I stop and visit with them when I go to find a bathroom. 

I include shoulder dystocia in my workshops. I wear pants and get down on the floor and show them a few things to try like getting the woman up and on her hands and knees or pulling the legs as far back towards the womans head as you can.  I show them super pubic pressure.  I say never pull on the head.  It won’t work.  I say lying on a too small table flat on your back with feet in stirups is not the best to prevent this kind of thing. 

I am thinking about this while you are discussing your home remodel and your problems at work. I cannot say. “Yes, I like that color for a bathroom and by the way can you believe they actually pulled the baby’s head off.’

I need to dance, to sing and pray out loud; to fall on my knees and sleep in a den made by the coyotes in the forest last summer when it was warm.  I need to let the rawness of my heart find its way.

 I am told that the trick is to wear a nice black coat and good shoes and no one will pay attention to what you are wearing underneath. 

I think about the medial table making its way into the birth rooms of low resource countries.  They are flat with stirrups and sometimes very old.  They look like someone cleaned out a warehouse and sent them to poor countries.   The medical directors, place them in small rooms and, like the black coat, think that now all is well.   No one dares to give birth off the flat, too small table or to get her up or change positions.   It is the sign of civilization.   I am thinking about this while you are explaining the problems at your job and with your boss.   It deverts my attention for awhile but I am going to Haiti in a month.  Do I bring a birth chair or get a design and have one made.  Is that possible?  Of course its possible.  

I am not a good friend.  I think about how to prevent baby’s heads from being pulled from their bodies as you talk.  I am afraid to go to sleep for fear that the babies will come to me there.   I wonder if anyone has a birth chair they are not using anymore.
I remind myself that people are sick of Haiti.  It was suppose to get better by now.  Its Christmas and then New Years. 

The head of the midwifery school thanks me and says she will teach everyone about these positions. That she herself, did not know this.   I cannot remember not knowing this.   I can feel the birthing  women in my arms; breathing and moaning and turning all by themselves to get in the right position to birth.  

 I do not want to spoil the party. When you ask me how I am I will say fine and then at dawn, I will make a fire and write, even if no one ever reads it.   I will burn it in the fire and take out the ashes and put them in my garden and I promise I will never tell you the dire consequences of the birth practices imposed on women.

A mother is talking about a doll hospital where they will fix your doll. For example a doll’s head came off and they put it back perfectly.    I nod my head and agree it sounds like a magical place.

Coming home- Happily ever after

Returning home
Happily ever after

My once up on a time husband brings over boxes of ornaments for the tree.  They are flower fairy ornaments mixed in with Disney Princesses.  He got them on ebay.  They begin with “Once upon a time” and end with “Happily ever after.”    I once tried to tell a granddaughter the deeper meanings of fairy tales; how Sleeping Beauty is really us waking our own self up to our true potential and that only we can do that and not a prince.  I could see she was carefully considering this.

She loves the new ornaments.  They are magical and beautiful with wings that shine in the lights.   When my once upon a time husband said he did not want to be married anymore, he use to try to offer me reasons.   Number one.  I had too many children and now I had too many grandchildren. It was never going to stop.  Number two.  I was a midwife.  Number three. I started a public school and with it, came far too many problems. 

This Christmas, freshly back from Vietnam and Cambodia, he tells me that his new wife does not celebrate Christmas which is good because he could not stand my endless cookie parties, caroling parties, block parties and progressive dinners. 
He tells me that I have destroyed my health by “trying to save the world.”    He does not say this unkindly but only as a matter of fact. 

Once a reputable mental health agency offered to do family counseling for our large, unusual family.  After meeting us, they said they did not think they could help with all the teenagers, but they would be willing to explore with us, why we would have ever considered adding so many children from Vietnam and Cambodia to our family.   We never went back.   I kept working, against all odds, on the happily ever after.  If I could not end war, I could make cookies.  If I could not work as a midwife to the world’s poorest people, I could have a free clinic in Portland.   If global enemies could not talk to one another, I could host block parties.  I had to start somewhere. 

It is time, I can see to take down the tree, wrap the fairies in tissue paper and save them for another year.   The flower fairies will welcome spring and we will sing Disney Princess songs as loud as we can in the car.  

In the stories of old, the main character often wanders the world trying to overcome obstacles and looking for the magic that is ultimately within themselves.   The Buddhist teacher, Tach Nich Hahn suggests that we live our life in the present moment and that within each moment is our Once Upon A Time and Happily Ever After.  It is only when we look too far back or too far forward that we suffer so much and are afraid and overcome by greed.

In fairy tales, there is always the crone.  The old women who grants wishes and wanders; the ones who look after the young.   She does not come in the box of fairies and princesses but I know she is there calling to me to follow that ancient path that has no beginning or end. Each step leading to the next and each one perfect.   

The traditional midwife in Cambodia tells me that she was sleeping and she was woken by a dream that told her to go to a neighbors house and help her with her birth.  In the dream she was told just what to do to save the baby.    And so along with the fairies and princesses I hang stars, for all the midwives all over the world who were woken from their dreams and followed the still, small, voice within. 

Monday, December 30, 2013

Coming home - Veterans of the Vietnam War

Veterans of the Vietnam War

I Love You Grandpa

On a warm end of May morning, I get up and go to my community’s Vietnam Memorial.   It is nestled into the side of the mountains near the zoo and arboretum and Rose Gardens.  It tells the history of those days, in Oregon, along with the names of the boys who died.  We can see that while life was going along here, young boys were dying in Southeast Asia.   We can read where they came from and how old they were.  I walk slowly.  It is early, but the walkway and stairs are filled with veterans and family and friends.  I do not know these boys who died, but they were my generation.  It was the war of my youth and so I go to say hello and to say, I am so, so sorry.

In front of me a woman walks with three lively children who carry hand written notes and flowers.  They stop midway up the steps and place their notes in front of a name.  The man they came to honor was only 18 when he died. He may have died before he ever even knew the baby who would one day be the mother of these grandchildren who leave him a note that reads,  “We Love You Grandpa.” 

He is forever 18.  It is the Rose Festival or there is a winning sports team or a natural disaster but he is always 18 and lost in the small villages of a country he never wanted to visit. 

‘We Love You Grandpa.”  


I am at a birth that has, as most births do, gone well. The Mom has brought a sweet, baby girl into the world.  Her husband sits behind her and holds his wife as she pushes.  He gives her sips of water and whispers encouragement into her sweet smelling hair.   Even after the birth, they stay there like that watching the baby.   We quietly, as is our way, say our prayers of thanks and begin to clean small things.  The placenta arrives and the baby makes her way to the breast.   The mother is offered some sweet tea and grandparents tip toe in for a peak.   In time the cord is cut and the Dad wiggles out from behind his wife, stands and stretches. The medical equipment is put in the other room and the pads are changed and clean beneath her.  We tend to small details,  smile and write in the chart.   It is a time of rest and visiting.  

The mother hands her baby to me and indicates she wants to get up and wash; to let us change the sheets and maybe go sit in the living room with the family.   She asks if we would weigh the baby so everyone can know and I begin to get out the scale.   My assistant helps her up.  She is full of energy.  

The father who is walking beside her falls to the floor and begins to scream.  He is hyper ventilating and sobbing and screaming, “No, no.”    His wife sits back on the bed and we go to him.

He is pointing to the floor where they is a few tablespoons of blood that he had walked in and left a footprint.  He had looked back and seeing that was reminded of the Vietnam War. 

We had talked about the war, sometimes at prenatal visits and about how he had struggled to recover after coming home.   He was involved in Veterans issues and healthcare.  He was hoping this baby would begin a new chapter. 

In time the sobs grow quieter.  “I did not want to kill him.”   We say “We know” but we do not know.   We have just helped this baby to be born.   He is scaring us.  He points to the footprint in the blood and cries again.  Quickly we wipe it up and try to get him to look at his daughter; to watch as I weigh and measure her and check her reflexes.  

I can see that his wife and parents have been through this many times before.   We stay a long time and wait for things to settle back into the peaceful rhythm of the postpartum.  We make sure everyone eats and clean the sheets and tuck everyone back into a cozy bed.  

He leaves his wife and baby to sleep and goes outside to smoke.   We watch him from the window as he paces back and forth.  We can never know.  

Sign by the freeway

I pull of the freeway and wait for the light to change.  There is a man, about my age, who is holding a sign.   “Vietnam Vet needs money for a room and food.”   


When I am a school principal, I ask the middle school students to find a veteran and ask them to share some stories with them.  I invite grandparents, if they wish, to come speak.   A mother cries as she listens to her own father tell about fighting in a war.   “He never told us anything.  I never understood.” 

Everyone hates me

A man’s dog has a fight with another dog and he comes to ask for my advice about the vet and doctor bills.  “Everyone hates me because I went to Vietnam.”  I tell him no one knows this; that the people involved were not even born then.  “I did not want to go.”   I say I am sure that is true and that there was a draft and no one blames him and that it is not connected to the dog fight.   ‘It was a long time ago.”   I say but I can see it is still just yesterday. 


Sometimes I see a poster of the sign advertising Woodstock.  It says Peace, Love and Music.  It was the Summer of 1979 and the peace movement was increasingly asking itself how to eliminate, as the Quakers would say, “the cause of war.”  We were  increasingly asking ourselves how we would not just change the war but change the very fiber of a society that made the war possible.   In addition to music, we were to learn skills needed for this new peaceful revolution.  That is what I read when I headed that way.

The boys who attended Woodstock had escaped  the draft.   They went to college or bought deferments   That was August of 1979 and they would not create the lottery until December. 

 In the days that followed, I could see our peaceful revolution; our new society lost in a cloud of drugs, fashion and the same desire to get rich with as little work as possible, regardless of its impact on other countries.   Woodstock and my generation never rebuilt society.  Small steps were taken by small groups of people while others profited from the exploitation of the environment and other global communities.   The Woodstock generation would go on to fund wars in Iraq, Pakistan and Afganistan.   There was a great deal of boasting about how Woodstock proved our generation would end war and change everything. 

Of the 2,709,918 soldiers involved in the SE Asian war, 61% were under 21.  11, 465 were under 20.   They could have been at Woodstock, taking drugs and listening to music but they were not.  


They say that 20 veterans kill themselves each day and most are my age and fought in Vietnam. 


On NPR they have a story about the veterans hospital in Los Angeles.  The reporter is saying they were suppose to provide housing for veterans but they rented the land out instead to private schools and businesses and never fixed up the housing.  He is saying that someone made billions of dollars and no one knows where it went.  

It is Christmas and the long ago John Lennon sings,  “All we are saying is give peace a chance.”

Thursday, December 26, 2013

Birth in the Time of Jesus

Birth in the Time of Jesus

Since becoming a midwife, I have on Christmas Eve, watched my thoughts slip into a wondering place about Mary and the birth of Jesus.  In the crèche that has been passed down from generation to generation, in our family, Mary and Joseph are sitting alone with some animals and an angel.   There is no sign of family, friends or neighbors.  There is no midwife.  My nativity scene has grown, over the years, to include many babies and many mothers, fathers, angels and animals.  There are crèches made in Haiti, Guatemala, Ecuador and the tribes of our first people.  There is a play mobile crèche and animals made from clay and wood.    It is now a whole village of people gathered to celebrate the birth of Jesus.   Small dolls, smurfs and action figures have found a place there as well. All are welcome.

They face one direction; moving towards a common light, no matter their background or nationality.   If there should be a problem, there are many people to go for help or offer assistance.   The baby has been born, however, and all seems to have gone well.  There are gifts of food, clean water and a community that cares about its children.  This is the crèche I create on these cold, winter days. It is the only crèche my children and grandchildren have ever known. 

I have learned a great deal about birth from the women and midwives of Haiti, Vietnam and Cambodia as well as from the archaeologists and scholars who have studied life in the time Mary would have given birth to Jesus.   I also know that no two people ever tell a birth story in the same way; that the midwife, the father, the mother and friends and family all have different perspectives on one common event.  This is the way of stories. 

The women, who gave birth in the area of Judea, were part of small Jewish communities who were under the rule of the Roman Empire.  The Roman Empire was vast and each part of the Empire was governed by a local administrator.  The Jewish community was guided by rabbis and the temple in Jerusalem.  They were warm, costal communities nested into the dry, rocky shores of the Mediterranean Sea.  The women were born, grew up, and celebrated the coming of adulthood, marriage and birth within the laws of their faith.  A young woman, giving birth, would be part of a strong community made up of family, friends and neighbors.  She would have known since early childhood, the activities surrounding birth and the care of the newborn.   Her own first menarche would have been celebrated and a husband carefully selected by her family and the community.  Perhaps she had helped with the birth of a sister, a mother or a cousin; the way women naturally gather to support a woman and family having a baby. 

Much of what we know about birth, at this time, is from archaeology and also from two authors; Pliny the Elder and Soranus.  Soranus wrote a book about midwives in the 2nd century AD.  From his book, Gynaecolgy, we read his description of a good midwife:

(3) ... A suitable person ... must be literate in order to be able to comprehend the art through theory too: she must have her wits about her so that she may easily follow what is said and what is happening: she must have a good memory to retain the imparted instructions (for knowledge arises from memory of what has been grasped). She must love work in order to persevere through all vicissitudes (for a woman who wishes to acquire such vast knowledge needs manly patience). She must be respectable since people will have to trust their household and the secrets of their lives to her and because to women of bad character the semblance of medical instruction is a cover for evil scheming. She must not be handicapped as regards her senses since there are things which she must see, answers which she must hear when questioning, and objects which she must grasp by her sense of touch. She needs sound limbs so as not to be handicapped in the performances of her work and she must be robust, for she takes a double task upon herself during the hardship of her professional visits. Long and slim fingers and short nails are necessary to touch a deep lying inflammation without causing too much pain. This skill, however, can also be acquired through zealous endeavour and practice in her work ...
(4) ... We call a person the best midwife if she is trained in all branches of therapy (for some cases must be treated by diet, others by surgery, while still others must be cured by drugs); if she is moreover able to prescribe hygienic regulations for her patients, to observe the general and the individual features of the case, and from this to find out what is expedient, not from the causes or from the repeated observations of what usually occurs or something of the kind. Now to go into detail: she will not change her methods when the symptoms change, but will give her advice in accordance with the course of the disease: she will be unperturbed, unafraid in danger, able to state clearly the reasons for her measures, she will bring reassurance to her patients, and be sympathetic. And it is not absolutely essential for her to have borne children, as some people contend, in order that she may sympathise with the mother, because of her experience with pain; for [to have sympathy] is not more characteristic of a person who has given birth to a child. She must be robust on account of her duties but not necessarily young as some people maintain, for sometimes young persons are weak whereas on the contrary older persons may be robust. She will be well disciplined and always sober, since it is uncertain when she may be summoned to those in danger. She will have a quiet disposition, for she will have to share many secrets of life. She must not be greedy for money, lest she give an abortive wickedly for payment; she will be free from superstition so as not to overlook salutary measures on account of a dream or omen or some customary rite or vulgar superstition. She must also keep her hands soft, abstaining from such wool-working as may make them hard, and she must acquire softness by means of ointments if it is not present naturally. Such persons will be the best midwives.

 In Soranus’s book he describes the supplies a midwife should bring to a birth.   They include the following:

olive oil [clean, not previously used in cooking], warm water, warm fomentations [ointments applied to the body], soft sea sponges, pieces of wool, bandages [to swaddle the infant], a pillow [on which to which to place the infant], things to smell [pennyroral, dirt, barley groats, apples, quinces, lemons, melons, cucumbers; these were used as we use spirits of ammonia to revive someone who has fainted], a midwife's stool or chair [this was the property of the midwife; she brought it with her to the home where the delivery was to take place], two beds [a hard one for use during labor and a soft one for rest after delivery], and a proper room [of medium size and moderate temperature]. (38)

If possible a midwife should also, he writes, bring a birthing chair but if this was not available a woman should sit on the laps of two women and be supported in this way. They did not give birth on their back.  There is also an indication that sometimes a hole was dug for a woman to squat over with brightly painted birth bricks for her feet.  In all situations, the laboring woman was held up, encouraged and supported by other women with the midwife sitting in front of her to catch the baby.   Soranus recommends that the midwife cover her hands with cloth, as the baby is quite slippery. 

A woman, giving birth in the time of Jesus, would have lived in a small stone house with perhaps one or two rooms.   Most families had a room upstairs for living and a room below for the animals.  This is how it was in Cambodia and Vietnam.  Animals were kept close to the family so they could be easily watched and cared for.   I remember, this Christmas season, the women who rested, after birth, on platforms, next to cows and so now the image of a mother and baby in a place of animals comes with it, an image of mothers laughing and smiling as the cows lazily chew their cud on a warm afternoon.   In the place where Mary gave birth, the animals might have been in a cave with the house on top.

Each community would have had a mikveh; a pool for women to wash themselves in after they give birth or during their monthly bleeding.  After the birth, a woman would have gone and submerged herself in fresh rainwater.  For those of who have given birth, having a pool deep enough to completely submerge ourselves in after birth, sounds peaceful and soothing, after the hard work of birth.  A wealthy family might own their won pool but we might imagine that in a middle class family this would have been shared by extended family and would have been sued by the mother before when she bathed there with her menarche. 

When she returned to her house, the baby would have been washed in salt water or wine and rubbed with olive oil.  The baby would have been wrapped in pieces of linen with the arms and legs straight.  The baby was swaddled as we all swaddle babies but this was also thought to help the baby develop strong, straight arms and legs. Room was left free for the baby to go the bathroom. There were no diapers. The baby was kept close to the mother at all times and she caught droppings in a small clay pot. 

Her house most likely would have opened onto a shared courtyard that was shared by other small houses.   Sisters, aunts, cousins and grandmothers would have ben close by to help with the recommended 40 days of rest for mother and baby.   At 40 days, a family would travel to the temple in Jeruselum to present the baby to the community. This is sometimes known as “Churching”the baby. The baby would have been circumcised, according to Jewish custom, at eight days of age. 

A baby was typically breastfed for 3 years and a special celebration was planned for the weaning of a baby.  Other than the natural spacing offered by early, exclusive breastfeeding, a woman of this time would give birth to many babies following the customs of her community.

When I reflect on the most familiar forms of the nativity scene I think of many things. 

I consider the image of a woman isolated from her community and from midwives; isolated from the unique religious and cultural customs of her life.  A woman who had no one to support her.  Her visitors are all men; shepherds and wise men and not women bringing food and wise council.  I think about hospitals all over the world in which women are forced to choose between their cultural traditions and safe birth; how the two often fail to come together.  I see the women in Haiti and Vietnam in a hospital bed, laboring all alone, flat on their back.    And so I build a new nativity in which women are always in the presence of caring friends and family; supported on either side by women, with a skilled midwife there beside her.

The other image is the image of “no room at the inn. “ These words are spoken at Christmas all over the world.   These words bring to mind the fact that hundreds of thousands of women each day, give birth without adequate prenatal care, clean water, a skilled midwife and emergency referral services.

I draw, in my mind, a crèche in which all these things are provided for all women; loving culturally appropriate practices, skilled midwives, emergency resources and the care of an extended community that provides a peaceful, equitable world for her child to be raised in. 

I can never know, this Christmas morning, what Mary’s birth was like. But based on what we know about Jewish law and the customs of her day, I build a crèche that includes midwives and the support of women in her community. I can see that animals within the home were a normal part of life both now and then.  

I also think of what it means to  follow not just the Star of Bethlehem but to follow the deep inner light that exists within all humanity.  I consider the simple message, offered by a then grown up Jesus; the one that asked us to love one another as he loved us.    

This message inspired and gave strength to many who strove make the world a better place for each baby born.   The church, named in this one baby’s honor, would struggle to understand these words as they saw the church as a place of exclusive membership that a brown skinned Mary, living as an oppressed religious minority, would have had difficulty recognizing.

And so on Christmas Eve, with my granddaughter beside me, I raise a candle and say a prayer for all the mothers and babies of the world. I pray for the healing and compassion and generosity that will make each child’s life safe and celebrated.