Saving Mothers

Here’s the second installment from our amazing Saving Mothers volunteer Jackie Candido, writing to us from Santiago, Guatemala about her experience at the Hospitalito Atitlan.

Aug. 25, 2011

An OB patient arrived at the Hospitalito today for rule-out labor, and it was like Christmas for the Hospitalito gringos.  Anjie, our UVA med student, is dying to do her first delivery.  Isobel, our nurse educator, is dying to pick my brain about all things OB.  And I, our only experienced maternity care provider at the moment, am dying to feel useful here. 

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Here at Saving Mothers, we are always excited to hear about the launch of new programs and initiatives designed to help improve maternal and newborn health in the developing world. It is always inspiring to see the innovative approaches people take in trying to make a difference, which is why I so enjoyed reading about the launch of the Jacaranda Mobile Health Clinic in Nairobi.

Jacaranda Health is an organization devoted to improving maternal and infant health in East Africa, running clinics to provide essential medical services to women in need. A few weeks ago, Jacaranda Health opened their first mobile maternity clinic and Nick Pearson, Jacaranda’s Managing Director, wrote a piece for the Acumen Fund to describe the experience of opening the clinic and his ambitions for the program.

To learn more about Jacaranda Health, check out their website.

Photo by Emily Puckart, courtesy of the Acumen Fund

As part of a special series, I’ll be posting updates from Jackie Candido, RN, BSN, who is spending three weeks volunteering through Saving Mothers at the Hospitalito Atitlan in Santiago, Guatemala. Jackie has worked for the past two years on the Labor and Delivery floor at Mount Sinai hospital in NYC, though just relocated to the west coast this month.  She received her BSN from UPenn in 2009. This is her first time volunteering abroad.

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Here at Saving Mothers, we spend a lot of time talking and thinking and writing about the experience of birth from the mother’s perspective so I thought it would make for a nice change of pace to share a birth story from the male point of view.

Alex Williams is a staff writer for the New York Times and he has written about his experience during the birth of his first child as well as about what it’s like being a new parent. 

Story courtesy of Joanna Goddard at A Cup of Jo

Going into labor

It was a Monday night, more than a week before Toby’s due date.

The day had been so ordinary: We had gone to the accountant, Joanna had done a Trader Joe’s shop, we went to work. We watched a TV show in the evening, and then I made a cup of hot cocoa. It seemed too regular of a day for us have a baby!

So, when Joanna started contracting, I felt, this is odd, surely she’s just having cramps, surely…

Timing the contractions

Joanna began having contractions in the living room, and, when they got stronger, we moved into the bedroom. I timed the contractions using my old dive watch. The clunky watch felt imprecise compared to a digital watch; I remember thinking, I hope I’m getting this right.

The birthing books say that you’re in labor once the contractions are consistently 3 to 5 minutes apart. I could tell that Joanna was being tough and stoic; she would tell me the contraction had started after she already looked like she was in pain; and then she would say, “It’s over,” and I would think, you don’t look like it’s over! She would still be wincing. I started thinking the contractions were actually much longer and closer together than she realized.

Deciding whether to go to the hospital

After a couple hours, her contractions were intense. I thought, OK, it’s 1am, we have to fish or cut bait. Joanna was being courageous and downplaying her pain, and the doctor answering the phone was being wishy-washy—so I felt like it was up to me to make a call…but I didn’t really know, because what my instinct was telling me (this is it!) was different from what Joanna and the doctor were telling me (this probably isn’t).

I had expected it to be like, oh, it’s time, like a fireman going down a pole. Instead we basically had to decide whether to go into the hospital, which was weird. We decided this was probably it. We called the doctor and he said, ok, come in.

The big events in life never feel like you expect them to. When the moment is majestic, you expect that the heavens will open up, and the trumpets will start playing, but really your wife is lying on the bed with a roll of toilet paper and you’re trying to figure out if you should keep making that cup of hot chocolate that you were making. No matter how magical the situation, you’re still thrust back into these mundane life details: how to catch a cab in NYC in the middle of the night, I’ll carry the bag, should we take some snacks. It’s funny how you normalize it.

The cab ride

Once we got into the cab, the adventure kicked in. It was Joanna and me together, it was a dark quiet night, and the emotions started flowing. And I started thinking, holy shit!

It was the middle of the night—Tuesday at 2:30am—the deadest possible time to be driving through Manhattan. Like a zombie movie when everyone has disappeared.

We were also both trying to take pictures, which was a joke because it was dark in the cab, and Joanna really wasn’t in the mood to have her picture taken! I was crazy excited.

Feeling protective of Joanna

Once we arrived at the hospital, there was this long beaurocratic hospital check-in—Joanna was in pain and anxious, and, honestly, the triage doctor was being a jerk. I remember jumping up, thinking, I have to make sure she gets seen fast, but I was beating my head against a wall dealing with hospital paperwork.

You kind of want to grab the doctors by the shoulders and think, don’t you understand, my wife is in pain? Look at her—she was sitting on a plastic chair in the waiting room gripping the arm of the chair with her eyes closed, really in pain.

It was a big relief when they told us the labor was real. The nurse said, “You’re going to deliver your baby today.” What a thrill! I wanted to make sure Joanna got all the support and food and drink that she needed.

Trying to be useful

Once we got to our delivery room, my first impression was that it was really comforting and mellow: big with cream and dark green walls. I knew Joanna would feel more comfortable here. A giant Lay-Z-Boy recliner was in the corner, and I was like, that’s got my name on it.

At that point, there wasn’t much I could do, but I really wanted to do something. It’s like that old joke, where the midwives would tell the husband, “Quick, go boil some water!” just so he’d feel useful and stay out of the way. Joanna was obviously in great medical hands. I was there for her, but she was concentrating on the contractions in the hospital bed. She was really cool, calm and tough.

The weeks leading up to the due date, you have the sense of preparing to go to war; you have to prepare your kit, your tools, get everything in order. I had packed Joanna’s nightgown, two cameras, nuts in case I got hungry. I even had music and DVDs, like we needed any of that.

Around 7am, Joanna decided to opt for an epidural. Right afterward, Joanna was totally painfree. We talked for a while and then lay together; I even fell asleep for a while. We both felt calm. I thought, ahhhh, it’ll be easy going from here.

Back labor

We were surprised when, in relatively short order, Joanna started feeling lots of back pain. I kept going out and saying to the nurses, I know she’s not supposed to be feeling anything, but she really is. I had that conversation with them like three times. They were giving me that we’re-really-nice-but-we’re-getting-annoyed-at-you kind of vibe!

Finally the doctor came in and realized that it was back labor. I fed Joanna ice chips and put a cold washcloth on her forehead during each contraction. She would say, “Now, now!” and I was fast as lightning with that washcloth.

Pushing

A couple hours later—although it felt like five minutes—Joanna said she felt the urge to push. We thought that maybe we should call for the doctor again. So a new doctor came in to check everything out; she was super competent and amazing. She reminded me of an NCAA women’s basketball coach.

Then, all of a sudden, she announced it was time—and it was ON!

The doctor put on this crazy moon suit. It really did look like a deep sea diver’s outfit, bizarre. Everything happened so quickly. I was holding up one of Joanna’s legs, and a nurse was holding the other. Joanna was pushing hard every minute or so, and it was amazing.

Then I was seeing the crown of Toby’s head. The doctor and I were like, Go! Go! Push, Joanna! And it felt like such a rah, rah, sports event all of a sudden. Usually a doctor’s bedside manner is really calm and soothing, but she kept booming, “You do it, Joanna! You’re a strong girl!” She was really yelling in this coach-like way.

The most surreal moment I’ve ever had was when I saw the crown of Toby’s head. That’s when it REALLY became real. All the way up until that it seemed a little theoretical that we were going to have a child. But then you’re like, whoa, this is for real. And then you’re really having a sense of anticipation, you’re like, in two seconds, I’m going to meet this child that I’m going to know the rest of my life. Two seconds!

So, Joanna was pushing, and I saw the top of his head, and I’m like, oh, crazy, he has more hair than I expected and dark hair… At first it was taking forever…it was a magical moment…I was about to see the face of this person…Joanna was like, I can’t do it…and the doctor kept saying, push, Joanna, push…

It was more suspenseful than anything I’ve ever done. I was dying to see his face.

Joanna said again, I can’t do it…and the doctor was like, Do it, Joanna, push, push!!! And her rah rah spirit was crucial to the moment…And finally, Joanna pushed as hard as she could and Toby slipped right out!

Honestly, watching the birth looked like a Georgia O’Keeffe flower; now I understand those paintings. It’s like a flower opening up. It was amazing. I was so glad I got to be part of it. You really feel the awesome power of life and a women’s strength, your wife’s strength; it’s thrilling.

Also, to be honest, it was kind of like Alien.

After the birth

The nurses are rushing around; they’re holding up the wet purple baby and saying, “Dad, cut the cord!” At the moment, I was like, oh, no, I can’t do that, but they basically insisted. So I cut through—it was basically like cutting calamari!

The second I saw Toby’s face, I was struck by how unbelievably sweet he looked. I was under the impression that babies would come out really misshapen and funny looking, but I was bowled over by how beautiful he was. My first thought was that he looked like Lucy (Joanna’s sister), and my second thought was, hey, he has my jaw!

The nurses handed him to Joanna first, of course, and she was glowing; and then nurses cleaned him, and then I got to hold him. He was tiny and purple. It was unbelievable—after all those years, wondering if I would ever have a child, thinking it wouldn’t happen, thinking it wasn’t meant to be…and then here I was holding Toby. It was a profound moment, beyond description.

I had the camera set on rapid fire, and doctor made a joke that it sounded like an AK-47. I probably took 300 pictures in the span of fifteen minutes.

Then I handed Toby back to Joanna. She looked so beautiful, with this blissful, serene expression on her face. Relief, exhaustion and accomplishment all together. It must be what it’s like to be on top of Everest. She looked beautiful. I was in awe of her.

In most cases, women go to hospitals to receive the care they need to give birth to healthy babies, but many find the experience unpleasant. Giving birth in a hospital setting may provide a certain amount of security, especially if there are complications during labor. That said, many women feel pressured to accept pain medication they don’t want or cesarean sections they don’t need.

On one hand, it’s easy to understand why hospitals do this: it’s in their interest to take extra precautions to avoid lawsuits. However, according to a source quoted in the New York Times this month, the outcomes of planned hospital births for low-risk women and planned home births for low-risk women are essentially the same in terms of infant survival. As women become better educated about their birthing options, home birth has become increasingly appealing to women who wish to avoid the hospital experience.

There are some obvious benefits to home birth. The mother has the ability to relax in the comfort of her own home under the care of a licensed midwife and/or a doula. Many women feel that they have more control over their birthing experience when it takes place in their home, where they won’t be pressured or forced into decisions. After the birth, the mother and her infant can rest and recuperate at home with their family around them, rather than in a loud, impersonal hospital.

Despite all these advantages, women who have had complications during pregnancy or are expecting twins or other multiple births are usually advised to give birth at a medical facility. Even under the best circumstances, there can be complications during delivery that require advanced medical intervention. Women who decide on home birth should have a plan in place to transfer them to a nearby hospital in case of emergency.

What are your thoughts on home versus hospital births? Is this something you would consider if you were expecting?

The March of Dimes has launched a new campaign called “Healthy babies are worth the wait.” The goal: To reduce the number of babies born pre-term due to the trend of inducing labor early and elective Cesarean sections.

According to medical guidelines, fetal development is complete at 39 weeks. But the number of deliveries taking place earlier is on the rise. In a New York Times article, Dr. Uma Reddy of the National Institute of Child Health and Human Development says this is especially true among older, well-educated white women.

“Well-educated women may be more inclined to want to schedule birth at a convenient time for themselves and their family members,” the article states. “Doctors, too, may suggest an elective delivery so that birth occurs at a time that best suits their schedules, including office hours and vacation times.”

Today, an estimated 36% of elective deliveries take place before the 39-week mark.

But does early elective delivery truly pose a threat? According to medical facts, absolutely. Contrary to popular belief, the final weeks a baby spends in utero are not just about weight gain — development of the internal organs is still taking place.

A baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 39 to 40 weeks. Depriving a baby of a few weeks of development in the womb can have very serious medical consequences, including lung problems, jaundice, anemia, and susceptibility to infection.

In the absence of medical complications, the healthiest option for both mother and child is to let the pregnancy proceed to its full and natural length. It’s a departure from the current mode of thinking — that medical procedures should, when possible, be scheduled to allow for maximum convenience on the part of the patient. But it’s critical that patients are aware of possible consequences before making decisions.

For further information on the new program, visit the March of Dimes website.

Today is the first day of World Breastfeeding Week. As a social and political issue, breastfeeding has been a hot button topic in recent years. For years, women have been trying to balance the recommendations of doctors and health organizations with their own routines, abilities and expectations. Why is breastfeeding so important, and how can women learn to breastfeed in a way that is best for both themselves and their babies?

It’s common knowledge that there are important health benefits associated with breastfeeding, not only for babies but mothers as well. Early breast milk (also known as colostrum) is extremely rich in nutrients and antibodies. The hormones and antibodies passed to a baby through breastfeeding can help ward off illness, and babies who are breast fed tend to be healthier than babies fed exclusively on formula.

As a baby grows, its mother’s body begins to produce mature milk comprised of fat, sugar, water and essential proteins; this milk is easier for babies to digest than formula. For mothers, the feeling of physical closeness can help strengthen the bond with their newborns. Breastfeeding also aids postpartum weight loss and can alleviate postpartum depression.

Many leading health organizations (the WHO, CDC, U.S. Department of Health & Human Services, for example) have recommended feeding babies exclusively on breast milk for the first six months of life and continuing to breast feed until the child’s first birthday.

That said, breast feeding can be difficult. Apart from certain physical challenges (breast tenderness, difficulty producing a sufficient quantity of milk, etc.) there are also lifestyle-related obstacles. In the U.S., women make up almost half of the total workforce, and many are not able to take more than a few weeks of maternity leave. Many low-income women can’t afford to take time off, and many women in high-powered careers are pressured to go back to work immediately. Either way, figuring out a regular schedule for breastfeeding in the first six months, let alone year, can be a real hardship for working women.

Finding time to breastfeed can create an enormous amount of stress and guilt for women who find themselves pulled in different directions by responsibilities. Of course, there is no one-size-fits-all answer to this problem. But having the facts and understanding the benefits associated with regular breastfeeding are good first steps.

For more information on breastfeeding:

World Breastfeeding Week via WomensHealth.gov

WHO Resources on Breastfeeding

Breastfeeding stats and studies from the CDC

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