Friday, December 20, 2013

Warming the mother after the birth

Warming the Mother and Baby

We gather on the porch, in the dark, and watch the rainfall.  They have lit an oil lamp and made tea but it is still  a deep, damp,cold.  It is only five in the afternoon but a storm is coming and it gets dark early. Nhan has invited four women, from the surrounding houses, to visit.   They have known each other their whole lives. They too were born and  raised there amongst the rice fields; marrying someone they knew in childhood.  The men sat outside the circle  but listened attentively, jumping up to add a story or comment with considerable enthusiasm.

I have told Nhan that I want to meet with some older midwives and with women who gave birth during the war.  They were all good friends with my son’s mother and watched him grow up, before his family was forced to go to Saigon.  He was born only a few hundred yards from where we sat in a house that was never rebuilt after it was bombed. We are in the heart of what they called the “DMV” on the nightly news.  It was the place between north and south where most of the fighting took place.  

They had no access to birth control and so babies came every year or two.  They gave birth as part of a normal course of the day.  None of them had any problems with their births and all their babies lived at the time of the birth.  They all lost several children in the years after they were born.  They died of starvation, they supposed, or because there were no doctors.  They were not sure.  

“Having a baby did not hurt back then, “ they explain to me.  “We could feel some hard feelings but it didn’t hurt.”

Another woman, sitting straight in her chair, smiles at her friends and explains that most often she was outside and the baby just came.  They all nod.

“We liked to go out in the rice field as it was peaceful.”

I ask.  “Were you working out there?”
“No, its just peaceful.”

“Then we call for someone and go inside.  Then the midwife comes.”

The midwives main job, they explain, was to cut the cord.  She used a chopstick as a guide for where to cut the cord and tied it with string or bamboo cordage from a sewing basket. 

The mother then laid down on a raised bed and coals from the kitchen fire were placed beneath or near her.  I am very cold, shivering in a light dress, so I can see how this would be needed.

There is no source of heat in the house at all.  The only fire is in the outside kitchen and so they do what people the world over have done for centuries.  They take colas from the kitchen fire and put them near the person who needs to be warmed.  

I ask if they are trying to “roast” the mother and they laugh.

“No, just keep her warm.”   They show me a pot for this purpose and it is about a one -quart size pot.   

When I go to Italy to see my son, I am helping him clean the old grandmothers house and find a brass pot.  I ask what it is for and they say, “to put in under the bed to keep you warm.   You put coals in it.”

Ah, I think to myself so the practice of placing coals under the bed was done in Europe as well.  Perhaps it was even brought to Asia from Europe or vice versa. Perhaps it is so sensible that many people without heat devised such a method all over the world.

“Was it smokey?”  

They are patient with my questions that must seem to lack all intelligence.

“It is only a few coals.”

I can see the house is lovely and well made but also has much natural ventilation.  It is only a few warm coals.

In Asian culture things are seen as cold or hot; foods, events, seasons.  Labor and birth are seen as a cooling event so the mother must be warmed up and given “warm” foods.   They wear warm, woolen hats after birth; even when it is hot outside and are warmed by coals under the bed.  

They are fed a simple rice soup. Fruit is seen as too cooling and avoided.  Meat is also taboo.   There are  warm, traditional teas.

The practice of “mother roasting” is being discouraged at hospitals and they are given an assortment of prescriptions instead.   They include a pain killer and an iron pill.   These are helpful but will not warm the mother in the absence of electric heat. 

We laugh and they tell me story after story about birth and children and being a mother in Vietnam.  The paths between the rice paddies is flooded and so they say they should hurry home.  

It is cold so they warm water for my bucket shower on the kitchen fire.  I go outside and pour the warm water over me as the rain falls in hard, steady stream.  The bed is a bamboo mat on a board but I fall asleep quickly.

In the morning, the aunt, has made a fire in the cook house where we all sit to keep warm.   I am shown a small stool that nursing mothers used to keep warm in the kitchen.  Nhan and the aunt show me how you can take leaves and warm them and rub them on the mother and baby.  They do it for me and it feels wonderful.  

As I sit there by the fire, I consider how something so practical and simple can be turned into something strange and exotic in the western world.   A young woman comes by to say hello and she shares that she always had warm coals by her bed and always let the grandmothers care for her.   She has gone to college and has a good job but she will not give up this tradition.

I think of the grandmothers; how many  will watch, with  bewilderment, as her granddaughter arrives home with a scar from surgery and is put to bed with strict orders not to put coals under the bed.  Perhaps the grandmother’s pot will be rebuked as old fashioned or perhaps this is where they silently  draw the line and accept it as wisdom beyond medical understanding.   

The warmth drifts up into the bed and the smell of a simple rice soup fills the house.   The grand daughter smiles up at her grandmother who does these things for her as she did them for her mother.  She lies there and wonders how her grandmother gave birth so easily and she had to be cut open.  She had not wanted to be cut but the doctor said she had to be.  

She thinks these things until the warmth of the coals and the soup and her baby nursing relax her and she drifts into sleep.   Her grandmother is old and has lived through wars, famine and the birth of many children, grandchildren and now this new great grandchild.  She is happy that she has lived to be here for her after the birth; happy to hear her feet padding across the floorboards as they have her whole life.   

In my experiences in childbirth, I have seen many women shake after the birth and feel cold.   The mother may shiver a great deal.  Many midwives, warm a flannel sheet or a light blanket in the dryer and wrap it tightly around her.  We make a warm tea with sugar or honey and offer her a few sips.  In these ways she is able to warm herself and the shaking soon stops.  Of course, a midwife is attentive to the mother’s vital signs, bleeding and sign of shock.  She understands that breastfeeding soon after birth and an empty bladder prevent many problems.    She understands that after the birth is a time for her to stay with the mother and baby for several hours, even if everything appears normal.   In our homes and hospitals, the beds are far too thick with box springs and mattresses to ever allow heat to penetrate them from below but we, like our SE Asian sister midwives, assure the warmth of mother and baby after the birth.   I am struck with the many wise ways midwives have accomplished this the world over.   In hospitals all over the world, babies are put in very expensive warmers rather than on the mothers own warm body.   Now science teaches us that there are many benefits to putting a baby on the mother and not in a warmer; things that midwives and grandmothers have always known.  

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