Here I am once again for a little update... I've been blogging less and less frequently, that I am wondering if I will eventually give it up altogether. But probably I won't.
We are still in Weslaco with Niko and Jackson (the pugs), and Wilbur (the pig). Kian is almost 2.5 years old, and he's starting to talk a lot. He's very adventurous, and in love with all animals and farm/ construction vehicles. His favorite books revolve around these large machines, until Aunt Mariah sent him Just Because which is his current favorite.
Kennet still works from home and stays busy caring for Kian and doing business in the US and Honduras.
I am still at the birth center. After 2.5 years, I have officially decided that I don't like taking overnight call. I like working in the birth center clinic and at the Humanitarian Respite Center clinic where I get to see pregnant and postpartum clients who have just immigrated to the US. I have decided that birth work is fine and I am so happy to help people try to have the birth experience that they want and to have a good experience in general, but I do feel like it's not something that I will do forever. I'm so grateful to the people who do it for the long-haul. They are underappreciated.
I am now doing the ARDMS ultrasound certification. I often think about how the one good thing that came out of my time of living in Guatemala was the training I received from the MFM doctor and physician assistant from New York in OB ultrasound. It came in handy for countless 2nd and 3rd trimester scans, and some 1st trimester ones. Most of our clients where very late to care, so there weren't many early ultrasounds. From the mostly traumatic experience of living there, I look back and appreciate that skill I was able to learn, being able to offer people a service they could otherwise never afford.
Fast forward from 2018 when I left there until 2021 when I graduated and got my first CNM job. I hadn't done ultrasounds during that whole time. As with any skill, if you don't use it, you lose it, though mostly it's like riding a bike where the muscle memory kicks back in. I'm now able to do the comprehensive training which I hope will be used to help many clients for years to come.
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*Trigger warning: infant loss/ stillbirth*
Other than remembering the many days I spent doing ultrasound, moreso now that I'm in the training again, I often remember the traumatic experiences I witnessed during my time as an RN there. As a CNM now, I often cannot believed the things I witnessed as a new RN who was entirely clueless about rural OOHB (out-of-hospital birth). When the thoughts come to me at the most inopportune times, usually when I'm trying to fall asleep at night, I try to console myself by reminding myself that none of it was my fault, I was not the primary provider, but the observer and learner of the Guatemalan comadrona (midwife). Still, I am hardly consoled with the memories of the cold, deceased babies in my arms. If only I knew then what I know now. The memories often haunt me, those babies remind me of my baby brother Daniel when he came home from the hospital, stillborn. He was my mom's last biological child, number 10 of her 12 kids. I remember the unimaginable grief. I not only felt it in myself, but all around me. I remembering thinking that if I felt this sad, how much more devastating must it be for the mother. And I remember those mothers in Guatemala.
If you want to read the stories of the death of two babies that affected me the most, they are below.
When I first went to San Juan to learn about home births with the comadrona and opening a birth center, I would go with her to the tiny dirt-floor homes of her clients. She normally attended the births alone, so I think she appreciated a second set of hands. This particular patient was giving birth for the first time. A young couple, late teens/early twenties, as mostly all of our clients there were. It was a long night, I don't remember much other than Christian worship music playing, and her asking the comadrona over and over and over again, "is the baby almost here?" She finally got the patient up on in a squatting position. As a side note, ALL of the patients I saw give birth with her were supine, flat on their backs (even after the birth center was open and I tried to teach about optimal positioning in labor). If you don't know how bad it is to be flat on your back for the duration of labor, it's very bad. Anyhow, the baby's head was finally born with her squatting on the floor, but the body never came. It was suddenly a complete panic and the comadrona was screaming for them to get the pickup truck to go to the centro de salud Family members laid her on something that looked a makeshift cot and carried her to the truck. Somewhere during that time the baby was born, all the jostling of the mother got the baby's shoulders' loose. I remember because as we were in the back of the pickup, I gave her the shot of Pitocin in her leg as the comadrona had given it to me prior and I was still holding onto it. By the time we arrived to the nearby centro de salud, I watched the doctor try to resuscitate the baby, but it was far too late. I remember the comadrona blaming the death on the fact that the centro didn't have oxygen available. I helped the nurse wrap the baby as the comadrona delivered the terrible news to the waiting family. Looking back, I have no idea what, if any, resuscitation measures were attempted after the baby was born. If only I knew back then what I know now. Whenever the topic of should dystocia comes up now, that story always haunts me.
The other one happened after the birth center was opened. They called me in after a baby was born (it was a very confusing time, when I as the "assistant to the director" [located in the US] was supposed to be on call 24/7 for births, but I wasn't always called in). Upon my arrival, one of the attendants was doing very poor PPV. The comadrona asked me to call the ambulance across the lake so we could meet it there by boat, cutting the normal 2 hour travel time in half. Being the middle of the night, it was hard to find a willing lancha (boat) driver. Finally we did, and I held that cold, blue baby in my arms as another person tried to continue doing PPV with the oxygen tank that was much too large. It was freezing, wind blowing as we sped across the lake. It was impossible to do adequate PPV. Why do we not have proper transport equipment? The emergency team took over in the ambulance. I tried not to vomit from motion sickness as we spend up the winding mounting to the hospital. Upon arrival they announced what we all already knew. It was too late to save the baby.
This week happens to be National Midwifery Week. I was asked "what drew you to midwifery?" I suppose it actually started from when my mom birthed me, which was a homebirth (her second one) attended by her friend and my dad. From there my mom continued to have "freebirths." As I grew up I tried to find the balance between no medical care and too much medical care in the world of obstetrics. During my RN training, I didn't know where I would land in the world of nursing. I guess it was my time in Guatemala that brought me back to midwifery. While I wish none of those experiences happened, I want to honor them, and I hope by being a CNM I can do that.
