Title photo: The Carrie Wortham Birth Center, by Kate Noon
In Cabestor, you may wake to the sound of the church bell ringing- it may or may not be at the top of the hour- to remind community members that there is service today. You may wake to the squeals of a pig being tied to the back of a moto against her will, struggling to be free, who eventually quiets down and is carried away. Or you might be awake still from the tireless crowing of the roosters or the all-night chatter of family members who stayed on the birth center porch while their loved one was nestled in a postpartum bed or in early labor. Hopefully you will wake to the beautiful singing of a Haitian woman in labor. She will moan, ask God for help, and then often break into song.
The volunteer room where I sleep is above the birth center space- a labor and delivery room equipped for two patients, a postpartum room for three moms and babes, and an extra room with an exam table for overflow patients, a small pharmacy, the autoclave, and storage. The Haitian midwives sleep in a room next to mine, and Bengie, my interpreter, the next door down. When there are no patients in labor, we all sleep upstairs and see what the night brings. Junior, the security guard, will call upstairs when a patient arrives, but often this is unnecessary. Most patients arrive by moto and the sound of the engine awakens us. Those who arrive by foot are often in a significant amount of pain and their labor song stirs us from our slumber.
At the Carrie Wortham Birth Center, women are free to labor and birth in the position that they chose. They walk freely outside in the yard, stand and sway with support, rest on their side with a peanut ball, sit on the birthing stool, among other things. They can push on all fours, on the birthing stool, on their side, or propped up on pillows. The three Haitian midwives who attend the births- Nelta, Michele and Anise- are compassionate and competent providers who truly understand the community. They spend three weeks at the birth center followed by one week off each month. The week that I volunteered I had the pleasure of working with all three of them.
Mornings start with clinic between 9 and 10 AM on the front porch. Prenatal and postpartum care is facilitated by the midwives in a group setting. New material is presented and the review information (nutrition, warning signs, breastfeeding education, among other topics) is offered by the patients themselves in a round-robin fashion. Vital signs, fundal heights and heart tones or newborn checks are performed in a private space with a midwife. In this manner, patients are empowered to share information among themselves, rather than sit and listen to information in a lecture format. (For those of you familiar with Centering Pregnancy, this is the same idea.)
While clinic is happening, there are more-often-than-not labor patients in the birthing center. Also, extensive discharge teaching is performed for postpartum moms prior to sending them home in the morning. Additionally, they allow those in early labor a chance to progress rather than sending them home, due to the financial and time commitment on the patient’s part in arriving. In other words, the midwives are busy and are experts at multitasking and triaging.
When clinic is finished, often around lunchtime, there is a brief pause before afternoon home visits. Patients are seen at home three days after birth to check on their bleeding, blood pressure, incision, breastfeeding, infant weight and emotional well-being of the mother. Women are offered a home visit by the midwife if they live within a reasonable distance from the birth center. I had the pleasure of attending home visits with Ms. Nelta and Junior. We take motorcycles for transport to patient homes, but some are inaccessible from the road and an additional trek through the mud on foot ensues. Patients are always welcoming to the Haitian midwives who are trusted and highly respected in the area.
Most women who give birth in Cabestor are candidates for a birth center birth. If problems arise during labor or a patient is in preterm labor, the patient is transferred to Mirabelis Hospital, which is the closest regional hospital about an hour and a half away. There is a well-used Mitsubishi 4×4 vehicle which navigates the difficult, rocky road. I rode in with two transfers during my week in Cabestor, although we did have three total- all within 24 hours.
The first transfer patient was a woman in preterm labor who ended up delivering in the back of the Mitsubishi. Both mom and babe fared well and the vehicle turned around after reaching Las Cajobas, a market town about 45 minutes away. The second was a critical patient who presented at 23 weeks gestation with significant vaginal bleeding, contractions, and severe range blood pressures. She was stabilized and transported to Mirabelis where an emergency cesarean section was performed. Unfortunately the fetus was pre-viable and did not survive. If this system of triage and transfer did not exist, the mother would have likely died of a severe hemorrhage or an eclamptic seizure. The third patient was simply a postdates patient approaching 42 weeks who needed an induction of labor, something that the birth center does not perform.
On the rare quiet afternoon, the midwives stay busy tallying logs of prenatal and postpartum visits, home visits, births, and updating charts. I pitched in cleaning beds, sweeping and mopping the floor, reorganizing the birthing space and home visit bag. On the rare quiet evening, we enjoyed a card game and soda under the mango trees, wondering if we would sleep later or if another patient’s labor song would keep the night going.