The midwives of LaGonave

The Midwives of Lagonave

A matrone, the traditional birth attendants of LaGonave, offers me a chair to sit on as we visit.  99.9% of all babies are born at home without any prenatal care.  The matrones are supported with clean birth kits and monthly trainings. They are paid a monthly stipend for their work.

The two midwives, I am here to support, are from the island of LaGonave.  Before going to school in Henche, last year, they were community health agents.  Last year, they left their homes and families to learn how to serve their small, rural villages, as midwives.   

They attended the midwifery school, Midwives for Haiti; an intensive program that trains two year nursing graduates in the skills of prenatal care, normal labor and delivery and post partum care including family planning.   The midwives I worked with at MamaBaby Haiti were graduates as are the two new midwives here in LaGonave. 

These two midwives did not go to nursing school first but were rather agent santé or health workers.   I was not a nurse before becoming a midwife either.   There is a great international debate about this situation.  In Canada and most of Europe you do not become a nurse before becoming a midwife.  It is largely a product of the United States health care system and thus adopted, like many things, by Haiti’s institutions.  The two midwives here, who I will call Rose and Anie, are not part of the elite and could never have gone to nursing school.  There are no nursing schools on this island and they could not afford to live and go to school on the “mainland.” 

They are intelligent, kind and eager to do well.   They had already, as health agents, given shots, done vital signs and helped with malnutrition.  They were public health workers.  What they had not done was worked in Haiti’s large, crowded public hospitals. They had walked the time worn paths that connect the many villages that make up their island.    They have come “home” to a place where 99.9% of the women give birth at home and 99.9% have never had prenatal care.   Their challenge, and the one I am here to help them with is getting basic prenatal care to the many women living in remote villages and offering them a place to give birth should they choose. 

The challenges are many.  The villages are about a one -hour walk apart with some being hours from the clinic.   The women have never had prenatal care and do not necessarily connect maternal and newborn deaths and disabilities to preventative healthcare.  The pregnant women do not often have money to spend on healthcare.   The women have 7-8 children. These are all significant enough barriers but there is one more.

There is one  that I was not expecting.   The clinic is a well funded,  institution where roles are defined and things are done as they always have been done.  It is overseen by a pastor in town, funded by churches in the SE United States and run by a director who has good intentions but is not often present.  In the absence of the pastor, the churches in the US and even the director, the midwives are left to the informal systems of governance.  In this system, there was no need for midwives.   There was an absolute resolve that pregnant women did not need care, were not having any problems in childbirth or wanted family planning.  A line was drawn and so if we were to reach the thousands of women at risk during pregnancy and childbirth, the new midwives had to be accepted as people and in be seen as a much needed resource.   

Having just been in Cambodia, I saw how they effectively trained one -year midwives and got them out into rural communities as fast as they could.   They trained women from the communities, as the partnership here did.  I could see that training women in the city and then expecting them to go to rural centers is difficult.  In my own state, they have difficulty getting doctors to work in very rural communities.  Here, there and everywhere there is a call for skilled birth attendants who can quickly get prenatal care, education and life saving measures to women and babies.  There is not time or money to send rural women to years of nursing and midwifery school.  These communities cannot even commit to sending young people to high school.   

And so one of the greatest obstacles they face, in getting care to the thousands of women who need it, is the age-old barrier of discrimination, class, privilege, access and acceptance.   Is the education system intended to create, diverse democratic communities in which all people have a right to healthy, sustainable lives or is it here as it is my own village, a ticket for some to maintain wealth and privilege?

These two midwives, from modest backgrounds, have worked hard but the medical hierarchy, so devoted over thousands of years to undermine midwives, looms large even in this small, isolated and resource starved island.  I like to think that when the World Health Organization called for more skilled birth attendants to solve the problems of maternal health, they understood this barrier and so defined it to welcome the Rose and Ani’s of the world, as vital links in their village health care system. Although I knew this, I had not fully grasped it.   The reason why so many women and babes, are dying worldwide is this very barrier.   If Haiti wants to reach its rural women, they will need to applause this model and in this model change the lives of families in Haiti, one village at a time.

Mentoring two new midwives in LaGonave

LoGanave

 With this, I begin a story of the mothers, babies, midwives and communities in the mountains of LaGonave, Haiti.   As in all my writings about maternal health, I try to bring a historical and geographic perspective to health care.    I try to come as a citizen of one world community but know I am forever “American” and with that comes the burden of commiting to know and understand the colonial and imperial impact on the women and young children of this community.

There exists, the lingering questions of how I can try to care for people, regardless of borders, knowing my country’s collective wealth was and is at the expense of others.  If we grew up, as I did, with John Lennon’s Imagine or Michael Jackson’s Heal the World is it possible to sing those songs with all our hearts; our hands and feet in motion with acts that cause no harm?   I was raised a Quaker where it was suggested that the happiest task of life was heading out into the world “cheerfully looking for that of God in everyone.”  As a midwife I have enjoyed seeing that light in the newly born.  I have also been committed to understanding the how it might be that all babies can be born into healthy, sustainable communities that assure them an equal opportunity for a meaningful life.     

My blog, thanks to Kayla, is divided into chapters.  The last one was SE Asia and there are other trips to Haiti where I also tried to write about history and culture. These stories reflect the people of LaGonave;  Haiti’s largest off shore island.  It is not large; about 30 miles by 5 miles but it is covered in rocky mountains with very few roads, electricity or water.   The island is rich in stories of Haiti’s last Taino queen, heroic Africans who escaped French slavery, pirates, and an ever-important mermaid. There were women led agricultural societies known as Congo Societies, a white marine who was made king and then the deforestation and long term effects of US occupation, dictatorships and natural disasters. 

Within these stories, are the women whose families have lived here for many generations and who know every winding path and all the people along the way.  I am tucked in a cluster of support structures, paid for by people of my country; a school, a church, a clinic, solar power, a well, an orphanage and a dairy goat program.  This hub branches out into smaller villages with more small schools and churches and wells and a cadre of community health workers live.  There are visiting medical teams who stay in the harbor town but I am up here in the clinic, living with the nurses and midwives who make this their home. 

When I agreed to come, it was because I had met two new midwifery students, at the school in Henche, run by Midwives for Haiti.  I have come to offer them support and help get the structures in place that might make their work easier.   When I talked to the NGO, they said again and again “There is nothing there.  There is no maternal health program.  There is nothing but mothers and babies dying.”  

Haiti, as most people know, has the highest rate of maternal and under 5 death in the western hemisphere while being a 45-minute plane ride from Florida.  I come wondering how to use what I have learned from other maternal health programs in Haiti to help grow this one. Is there a simple path that can be easily duplicated and repeated?  Despite the mountains, dirt roads and lack of infrastructure can all the maternal health programs create a network of support and shared resources? Can communities of mothers and midwives throughout North America find effective and meaningful ways to help mothers and babies thrive in this one small island at the tip of our very own wealthy continent?   How do we as parents deal with such disparity?   Do we allow our fear of failure to discourage and numb us? Do we say we cannot take one more painful story or photo or begin to conceive a sustainable way of building communities that begins with the long-term well being of each baby born? 

As a midwife, I fully believe that there exists within the midwifery model of care the essential elements of education, support and care that are nested into each village and each family.  Midwifery is an ancient tradition that flourishes in the mountain village around me.  This is their story as well as the story of the newly graduated midwives. 

Writing has been a good and dependable friend to me. I am thankful for the teacher, who in 8^th grade first who encouraged me to write and all the writers who have offered me their stories.   At night here, they sit under the warm stars and share stories long after the last baby has stopped crying and even the roosters have grown quiet.  In this time, you along with them, become my zanmi under the tree; my friends to share a story with.

Being Born Is Important - A Poem by Carl Sandburg

This is the last post, for now, on Birth in the United States so I wanted to close with this poem that seems to capture so much of birth with bedposts.  On Monday morning, I am leaving for LaGonave, Haiti and will begin to write about my experiences there.  I have loved visiting places in my country and trying to see it throughout the perspective of birth.

Carl Sandburg

Being Born Is Important

Being born is important.

You who have stood at the bedposts

and seen a mother on her high harvest day,

the day of the most golden of harvest moons for her.

You who have seen the new wet child dried behind the ears,

swaddled in soft fresh garments,

pursing its lips and sending a groping mouth

toward the nipples where white milk is ready

You who have seen this love's payday of wild toil and sweet agonizing

You know being born is important.  

You know nothing else was ever so important to you.

You understand the payday of love is so old,

So involved, so traced with the circles of the moon,

So cunning with the secrets of the salts of the blood

It must be older than the moon, older than the salt.

The Birth of Rosa Parks ( historical fiction )

The Birth of Rosa Parks

February 4, 1913

Tuskegee, Alabama

A painting of a young Rosa Parks with her parents.
Here mother was a school teacher and her father was a carpenter.

Leona came from her sleep with a dreamy uncertainty common in the last days of pregnancy. The kind of dream that causes a mother to wonder about her basic instincts and abilities and to stir doubt while knowing all along it is way past time for doubting.

She had dreamt about a girl who must have been her baby grown some and out in the rain with all these people trying to get them all in out of the cold and rain. It didn’t make any sense. All those colored people walking like that and her baby girl all wet and laughing.

A drop of rain landed on her face right above her right eyebrow. She opened the left eye.

“James, The roof is leaking again.”  Leona shook her young husband’s strong, stubborn shoulders. She felt like pulling the covers off him and kicking him out of bed.  It was February and their small plywood house let in the cold Alabama morning as well as the rain. But instead she tenderly wrapped her arms around him and moved her round belly up against his back whispering,  “Okay, little one. Wake up your Daddy so he can fix that roof before you come out in this Tuskegee rain.”  She had learned early in her young marriage that sugar worked better than vinegar when she needed something done.

She rubbed James strong neck and shoulders as the baby moved against his back.  He was the best carpenter in the area but his own family had to wait. He had promised her the finest house in all Alabama when they courted.  She missed her old unmarried life more than she dared admit. She missed her family and her students and right now she missed her parent’s house that never leaked. Her lonely longings quickly turned to determination. She had not been raised to rest too long in a place of regrets.

“James, I’m heading out to church and when I get back please let there be a roof for me and this baby.” With a gentle kiss and a pull of the covers she was up.  The rain beat against the tiny house filling up bucket after bucket of water from the leaking roof.

Still, Sunday was her favorite day and no rain was going to spoil it. Some didn’t think a lady in her condition should go to church but the minister at the African Methodist was modern. When she had started to show and the other ladies had expected her to stay home he had said, “Why this baby will come out singing and doing God’s work. Your never too young to hear God’s word.”  And so Leona at nine months pregnant wrapped herself in James long coat, did her hair up pretty and walked the mile to church singing as she went the words to a favorite gospel “Woke up this morning with my mind set on Jesus.”

She had a beautiful voice and didn’t mind singing to all of God’s creation including the cows that needed milking and the chickens laying eggs.  The rain had stopped and the morning felt like spring instead of winter.

At home, James determined not to disappoint Leona pulled on his overalls and examined the leaking roof.  He had meant to build her a new house. The best there was. Not just patch this sorry one. He told her she’d have a porch to rock that baby on and visit with neighbors. A picket fence with roses and dogwoods that bloomed at Easter.  He rinsed his mouth with the rainwater. Water made sweet by its journey from heaven, his Daddy had always told him.

He pulled the pieces of plywood from the barn. They weren’t new. He had saved them from a job he had done but it was still good cedar and would cover. The only problem was that it said “Smith’s Lumber Yard” on it and he couldn’t have a house with another man’s name written on it. This was the real reason he hadn’t fixed the house. He couldn’t figure what to do with that man Smith’s name. They couldn’t afford shingles or paint. Besides this was temporary till the new house could be built.  He ought to ride over and get some help but he wanted it done before church let out.  He used some ropes and pulleys to get the boards up. The morning had turned warm and the sun was coming out. He found himself whistling Leona’s hymns.

When the sun was high and the roof was about patched, a peddler came by. “Might I share a meal with you?” he called up to James. “I’ve come a long way without anything warm and it being the Lord’ Day I wanted to share it with a fellow Christian.”  James, always enjoying company and a good story, jumped off the roof and shook the strangers hand.  He washed up and looked for something to heat. There was some stew and biscuits, which they ate on the front porch under the now bare branches of the Tupelo.

“Why ain’t you at church,” the stranger inquired.

“Fixin the roof to keep out the rain. My wife’s expecting a new one anytime and the roof was leakin.’  James was uncomfortable with all the questions and wanted to get back to work.

“ I wish it was something better for them. Shingles or paint. Something to make Leona proud.”

The stranger thought for a moment and then said, “ I know I’ll carve a star right above your door; That’s what I saw the Amish do in Pennsylvania. It’ll be like the Star of Bethlehem.”

He took a stick and drew the star in the dirt.

“That ain’t like any star I ever saw in the heavens.”  James said with skeptic scorn but still the idea was taking hold in him. The only house in all of Tuskegee with a star over the door. It would show the world his son was special.

“Could be a girl.” Leona would always say.  “ A smart, sassy girl born to keep her Daddy movin”

In the end James agreed to let the man stay in the barn with room and board in exchange for the star. After lunch he climbed up and started right in carving away the Smiths name forever. The sun was warm so James brought the wet things out to dry and opened up the windows.  Everywhere the people were saying what a warm day it was for February.

A bird was fussing in the trees when he heard the wagon come up with people all excited and calling for him to help. He stood there staring and unable to move at all. Then he saw his wife pulling her self up and moaning.

“Oh James. The baby is coming. My waters came and now there are the pains.”

The women wanted to get her into bed but she insisted on walking around the yard holding onto James’s arm and looking at all the trees and bushes as if they could somehow help her to make sense of the pain she was in.

“This is where the roses will be.” She whispered between contractions. “ We’ll sit out here and read lessons right here amongst the roses. And put a swing in the tupelo. This baby is going to learn everything about God’s world and it’s going to start right here in our very own yard.”

Inside the women were cleaning up after the rain, boiling water and getting the baby things ready. No one noticed the stranger on the roof who was now carving with a renewed sense of purpose.  James looked up at him and waved as if a woman having a baby under the roof he was working on was the most natural thing of all.

It began hurting Leona in her back so the midwife told James to walk up and down the porch steps and to thank God for something each time they got to the porch. So up and down they went.

“Thank you for the blue sky.”

“Thank you for the birds in the tree.”

“Thank you for friends and family.”

James thought to himself. This woman is going to run out of things to be thankful for but she never did. Up and down. Leaning on James or on the midwife. Her hair wet with perspiration. Her eyes mostly shut. Moaning. The prayers and thank you’s quieter and quieter. The midwife showed him how to press on her lower back as she leaned on the porch railing. Up and down.

James had heard of other men going out to the barn or even  for a drink during the birthings. They came in and there was a baby but Leona just wouldn’t let go of him and the midwife wasn’t going to either. She soaked his handkerchief in wild ginger water and put the cool cloth on the back of her neck.

Only when the sun began to set and the air got cool did she agree to go in. One foot in the door and she fell to the floor with a scream that made the stranger on the roof smile knowingly and work harder. James carried Leona to the bed while the women scattered like chickens to bring the birthing things from the kitchen. James landed right beneath her and there he was when not a son but a little baby girl danced into the world and was held up for everyone to see.

The midwives worked quickly to tie and cut the cord with catgut. Fussing and oohing and ahhing as if this was the first baby they’d ever seen born. and the most special. They sent James out to get water while Leona passed the afterbirth. He’d seen many an animal do just the same thing but this was his wife and he felt a wave of sickness pass over him. The midwife told him to go get some air and eat.

It was then, out by the pump, that he remembered the stranger on the roof only now he was sitting proud as he could be on his porch!

“Can I see the baby? Can you bring her on out?

“I can’t bring the baby out here. Are you more of a fool than I thought?”

“Lets show her the stars. That’s what my Mama always did. She always showed the new babies the stars.”

So James went in and brought out a baby girl named Rosa Louise and showed her the stars. The night was clear and the stranger knew the names and stories of them all.

“Reach for those stars, Rosa, You can be anything and everything you set your dreams on.”

“James, what are you doing outside with my baby?” James heard Leona call from the house.  She was so small and the night so vast. Her eyes wide open in wonder holding his finger.

The midwives put the baby back in bed with Leona who was clean and ready to nurse. Rosa. Some more women came over with food and gifts. Too many women, thought James and then he remembered the stranger and the roof. He brought him a plate piled with all kinds of good food.

“Tell me some more of your star stories,” James asked but the stranger was already asleep under the trees where they’d been eating. James went in the house and got a blanket. It was late and everyone but one woman was leaving. She ordered him to bed where he slept to the sounds of Rosa’s quiet little sucking noises.

He was woken by her morning cry and the sound of a neighbor woman with breakfast knocking on the door.

“James, Leona. What’s that over your door?”

Leona looked at James suspiciously. What had he done?

James remembering the stranger  and wondered what he had agreed to. Barely pulling on his overalls he ran out and stood back. There above the door was a star just like the one he had drawn in the dirt. A big, beautiful star. There was no sign of the stranger anywhere so James just shrugged and smiled and went back in the house to take a good look at his new daughter. The one born under a star.

On my trip to through the south, I visited the area where Rosa Parks was born but there is nothing to see.  There were some brief accounts of her life and that the house had a star carved into the roof.  I built this fictional story around the star.  I have found, the world over, that birth was a way that neighbors helped one another.  They were not always skilled ad they did not have all the medicines they might have needed but they care for one another. This legacy of a rural United States, in which people walked, struggled and shared their joys with each other, is our collective story.   Rosa parks might never have been able to help organize her famous boycott of segregated buses without this culture of cooperation and love.