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Thursday, 28 November 2013

Royalty



I’m just back from assisting at a first-time mama’s birth – she had worked hard all night and I joined them just after sunrise as she was nearing full dilatation. The room was peaceful, the woman resting on the bed with her husband at her side giving backrubs during contractions. Her mother came and went from the room – she seemed to be finding it hard to watch her daughter in pain, but wanted to help as much as she could as well.

As the labour progressed, the woman found it hard to get comfortable – on and off the birth stool, up and down from the floor, using lunging and rocking to help her baby move into the best position to traverse his way to birth. It seems rare to see intimate moments between husband and wife during labour – but this couple were swaying together in a labour dance of love and support. It was a classic ‘transition time’ – working hard for that last centimetre or so of dilation.

After a time the woman showed signs of being fully dilated, and she began pushing. First-time mums often take a while to zone in on the right pushing muscles, and this mum was no different. It’s hard, physical work needing lots of reassurance and comfort, and we did our best to show her where to push to bring her baby down. In an effort to help her relax a bit I asked her if she planned to have more babies after this one – “2 babies? 3 babies? (pause for comic effect) Ten babies?” They both laughed and sweat dripping from her head mama looked me straight in the eye and said “Just. One. Baby!”.  Some humour is universal... ;-)

On the little baby came; after a slow and gentle descent he made a run for home and came out all of a rush – head, shoulders, body all in one fluid motion. He was a little stunned at first, but soon enough filled his lungs with air and the room with sound. Mama looked amazed; she radiated the proud “I did it!” glow that always makes my heart fill with emotion. She tucked into bed with her baby on her chest, we sat opposite her filling out the paperwork.

The highlight of this birth? Not the beautiful baby, the radiant mother or even the resounding “thank you Lord” that we all uttered after the baby made his speedy final rush to the light. Following a birth here the fathers always provide some simple food for their wife – usually it’s instant cup-noodles or perhaps some sweet bread. But this daddy slips away and spends his hard-won peso not only on 2-minute noodles, but also on a simple plastic tray – the kind of bright-coloured shallow container we might keep in the bathroom cupboard. Onto this tray he arranges the pot-noodles, water glass, and plain paper napkin like a five-star meal. And then he presents it to her as if she were a queen holding the heir to the throne, accompanying it with the most beautiful look of love and respect. 

A simple meal, a simple gift, for a most extraordinary moment in their lives.

Tuesday, 26 November 2013

Outside my window



Outside my window, it’s hot. 31degrees and high, high humidity following a short blast of rain. I’m lying on my bed with the window open, and the electric fan on full-bore to try to shift some of the glutenous air around the room. I don’t think I’ve felt any natural breeze here at all, only those generated by hard-working oscillating fans. Even in the poorest of homes, you will find an electric fan – without one the humid heat smothers you like a blanket.

A couple of dogs flit past. With my angle on the bed I only see only a flurry of legs but I know these guys nonetheless. There’s a gang of strays that roam the streets around the birthing home; probably all related given the colourings and size. There’s a pregnant mama amongst them, she’s slower than the rest and can often be seen tongue-lolling, sitting at the door of the birthing home. Perhaps she is waiting for a check up?

Outside my window I hear distinct ‘chirp-chirp’ that is becoming a familiar sound. I glance up and see a small yellow gecko creeping across the window mesh. The windows here are not just glass like at home, they have an exterior metal grill with mesh inside to prevent mosquitoes and provide security in a country where open windows are a necessity except during rain showers. The gecko stops wiggling for a minute and I try to sneak up for a closer look – I’ve yet to capture one in a photo – but he runs away before we get eye to eye. Shame, I’ve come to love these little guys; they are often seen inside the birthing home snaking across the labour room ceilings.

I roll over and try to concentrate on my book. I’ve read this paragraph at least three times now but only seem to realise it once I’m well into the second sentence. Not that it isn’t a great book – but the heat is slowing my brain and my concentration. I feel sleepy, so drop the book on the floor and close my eyes. I’m just drifting off when I hear children singing “Happy Birthday To You, Happy Birthday To You...”. How sweet!

But hang on- my birthday was days ago now... 

My brain catches up again. We hear this song often drifting out of the orphanage – it works like a wake-up alarm many mornings. The law of averages tells me there is little chance there are actually that many birthdays close together at the orphanage, so I’ve decided it’s just an English song the kids know the words to. The little voices are so cute as they sing with all that toddler exuberance, then with a crash, someone has thrown something and the voices die down as the culprit is chided and the victim’s tears are shushed by one of the caregivers. 

Outside my window I see one of the neighbourhood cats slowly skulking down the stairs - perhaps it was startled by all that noise circling above? Every cat I've seen so far has been skin and bone - SPCA material back home. They even move differently. It’s like each step is a labour, a carefully weighed up cost-benefit analysis of energy expended for food gathered.  And I have yet to see one with a full length tail – they are twisted, knotted, stumpy things surely no cat could be proud of. In fairness, I am impressed that these guys are even surviving – they belong to no-one and get by on scraps chanced from the rubbish. We put out our food scraps behind the apartment each evening, and it is all gone by morning. Last night we saw a mama-cat hungrily gobble our chicken bones, and then carry a piece to the corner of the garden and leave it there... sure enough a tiny kitten popped her head through the fence and slowly savoured that little morsel. How these cats survive, never mind carry kittens and raise them is beyond me. 

I close the windows – shutting out the busyness.  I’m tired after a long night assisting at a birth so I’m going to use the heat as a sleeping pill. 

The noises blur. 

Outside my window.

Monday, 25 November 2013

Skin to skin



I celebrated my first ‘hands on’ birth here in the Philippines last Thursday.  A long labour by Philippine standards, but one where I could really ‘mother the mother’ and enjoy giving care only midwives can give. We didn’t share a lot of words, but communicated more through our eyes and hands. Gina was attended by her husband Paulo and also her 3 year old pocket-rocket of a daughter. That wee girl lightened the mood with her running in and out, and made me laugh as she copied the ‘breathe-in-through-your-nose-and-out through-your-mouth’ routine with her tummy pushed out and her hands on her swaying hips mimicking her mother...

Gina’s waters had broken early and as she lay down on the bed for me to assess her baby’s position, my hands tracked easily over her baby’s body. I could clearly feel all of the limbs, the knobbly knees and a little hand sitting up close to the baby’s face. After Gina got up from the bed I stayed close, hands lightly resting on her belly to feel when a contraction started. Filipino women for the large part labour almost silently – it’s hard to tell when they are even having a contraction, so with my hand I was waiting to feel the gradual spread of power radiating from the top of her tummy and down to the base. It was an amazing feeling as I adjusted my hands – with the combination of her intense contractions, her slim, slim frame and the lack of fluid around the baby I felt like I was cradling that wee babe in my hands before he had even made it earth-side.

In time, Gina moved to the birth stool as she began pushing. A traditional birthing aid, these stools comprise four short legs with a curved seat that sits around 20cm off the floor. They are made of carved wood and allow the mum to maintain a deep squatting position to assist a quick passage for baby into the world. Gina looked a bit uncomfortable - I adjusted the stool’s position under her and could feel that the seat was worn smooth from countless uses and post-birth bleach scrubdowns. Paulo slips into place behind her, providing physical support for her back and whispering encouragement into her ear. It’s not long before a slippery, squealing little boy eases into my hands and a wee tear escapes from my eye.

Welcome special baby! I didn't know you, but I came a long way to meet you...  

Wednesday, 20 November 2013

Home is where the heart is.



Ah, home. It’s far away for me at the moment, but there’s nothing like leaving your home to remind you of all the things you value about it. I’m experiencing a new normal, these hot humid days which mean normal is a constant shiny layer of sweat on my skin. It’s normal now to drink lukewarm water, because refrigerator space is tight and our clean water comes in big blue drums that sit on the kitchen bench, not in the fridge.

The midwives here work with a different kind of normal too. For them, it’s normal to work day on-day off. They arrive with their husbands and children at the birthing home at the start of their shift, and then they live and breathe midwifery together as families joined by the midwifery calling. By day, it’s normal for the midwives children to peek around the handle-less doors to check in with midwife-mum in the middle of a labour. Children sit around the dining table doing homework projects while a 4-day old baby is brought in for a checkup. The midwives put down their knitting during a quiet moment to share in the fresh doughy sugarbuns one of the husbands has brought up fresh from the bakery at the bottom of the hill.

At the end of the day, the well-worn lounge furniture is moved around and the husbands bring out the mattresses and mosquito nets to set up the communal sleeping area for the night. Women come into the home in labour and are ushered past this mass slumber by the on-call midwife into a birthing room. So this really is a home, these families live this week-by-week life together in this special place. It’s a home, where women birth. It’s a home, where new families emerge after the hard work of bringing life into the world. It’s a home, where friends and co-workers sit a share a meal, laugh about life and enjoy each others knowledge and stories. And the huge heart of this place has made me feel at home too.

Monday, 18 November 2013

Hello Philippines!



So, hello Philippines. You’re dusty, hot, noisy, busy, crowded and always trying to interest me in a bargain.
And yet right now I’m sitting in a clean, cool room at the Birthing Home trying to collect my thoughts after two days since landing. It’s been a whirlwind already, so much contrast between our quiet little life in New Zealand and the hustle and bustle of metro Philippines.

* * * * *

The women here are so beautiful, humble and reserved. They birth quietly, trusting in their bodies and have wonderful physical support from their partners. They arrive for antenatal checkups in twos and threes, some with their partners, some without; walking or perched on the back of a motorbike. It’s hot and humid from early morning here, and everyone looks for a place beside the fan that is central in the lounge room.
I attended my first birth this morning, in an observational role – before we can be ‘hands on’ we must witness several births conducted by either the midwives or the more experienced interns. This birth is not as easy as the others of the past few days – two women arrived fully dilated and only just made it the birthing room before their babies slipped out easily. This mother spends several hours almost fully dilated, trying different positions to help the last piece of cervix dilate past the baby’s head. This swollen cervix just won’t budge but eventually the women can’t resist pushing and her new baby boy is born. After the birth, while baby is tucked up in bed with mum, the father quietly clears the stained newspapers that cover the floor under the birthing stool, and mops the floor with bleach. I’m busy writing up the birth notes when a quiet “please... excuse me” prompts me to lift me feet up from the floor as the father swishes the last bit of water in my corner of the room. He tucks back up beside his wife and new baby – his bright white smile cutting cherry path through his dark skin. He is clearly tired but proud of his wife as she latches baby on to suckle for the first time...

* * * * *

Sleeping has been a struggle for me – its pretty hot over night and there is constant noise with stray dogs, chickens, cats making their way up and down the staircase that is just outside the window of our basement rooms. Beyond the staircase is TLC – The Little Children’s home. Every now and then little faces peer out towards us, occasionally calling out for attention. The noise from TLC starts early morning as the babies wake for the day, and it’s hard to sleep through their occasional early morning tears. We visited there for the first time tonight, it was heartbreaking to be in an orphanage and see all these little faces waiting for a ‘forever home’, but at the same time, wonderful to see the amazing work the founders and staff do for these unwanted children. Even this morning, a wee, unnamed boy was left at the home – a tiny, malnourished little soul, probably only a few weeks old at best. We stayed and cuddled little people for half an hour and felt such sorrow when we left...