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themidfuture-blog · 10 years ago

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A human home birth in Cochabamba

It was almost two a.m. For the last couple of hours, a thunderstorm had been building up beyond the mountains rising close by our house. Blue flashes illuminated the sky, silhouetting the undulating ridge. The rain was falling hard and the contractions were intense. Bri was in such pain, having foregone drugs, that the only relief came in taking hot showers. But with the storm closing in, that would have to stop. We determined that after this last shower, she’d go upstairs. Then as soon as the next contraction had passed, I’d ask our doctor Julio to come check her dilation. Thunder crashed. He noted nine centimeters, then donned a gown and began arranging all of his gear, cleaned his hands again and put on gloves. Any minute now.

In the last few days leading up to Lucky’s birth, we were a little nervous because, after weeks of counting on it, our midwife Vivian Camacho couldn’t be with us for the birth. She is working on a Master’s in social entrepreneurship and as summer wore one she’d gotten busier and busier. However, she put us in touch with Dr. Mireya Zapata, whose clinic in Quillacollo serves poor women who might otherwise have unsupervised home births, or, if attended by anyone, then perhaps an aunt, a neighbor woman with some experience birthin’ babies, or some kind of traditional healer – a k’allawaya or curandera/o who may specialize more in magic and faith healing than in delivering a healthy baby. Thus is the reality of far too many pregnant women in Bolivia: poverty conspires with superstitions and fear of doctors, leaving her to face birth in dirty conditions, with inadequate help, the umbilical cord cut with a piece of broken glass…

We had done everything a college-educated couple (unimaginably privileged by comparison to the average Bolivian) could do to prepare for a natural homebirth. We had started in the US – in Portland – where our midwife had given us the kindest and gentlest, non-invasive attention we could have asked for. As the pregnancy seemed to be totally without complication, we did our best to envision finding a midwife in Bolivia and having our baby as we’d planned. Vivi encouraged us with her kindness and solidarity, helping us through the last two months of our pregnancy and introducing us to María René, a natural birth enthusiast and now good friend who helped us throughout the day Bri after began labor. Three days before labor started, we went for an ecografía (sonogram). A 3D ultrasound only cost about $35, but at Bs/240, would have been perhaps a weeks’ wages for the roughly %60 of people living in poverty here. The ecografía showed Lucky was in good shape, decently heavy and in position to begin labor at any moment. We knew we could count on Mireya and her team to help us deliver him safely.

Earlier in the afternoon, we tried some oral nipple stimulation and other touching techniques we’d practiced as we explored tantra, but they helped only a little. Eventually, intense, painful contractions led us to believe the labor was moving along more quickly than, in fact, it was. Bri’s reaction was to engage with the pain. She let her breathing get away from her, and the uterus responded with less productive contractions. We were doing our best, but overlooked this dynamic. Luckily, once Mireya was able to determine her dilation had slowed dramatically, she assessed the breathing pattern needed to change and I translated her instructions. Bri was disappointed the labor didn’t seem to be going anywhere. Mireya and her team left, promising to come back in the evening, allowing time for Bri to move along. There wasn’t anything else we could do but try to change the mood. María René soothed her and the two of them went for a walk. With some years of experience, María René had attended a lot of births and had her two kids at home. She began concocting a mate – an herbal infusion – to mildly stimulate the labor physiology. Around the world folk medicine for labor and birth varies from dangerous to very effective. Just as the medical approach discourages using oxytocin to induce dilation until the cervix is already open 5-6 centimeters, we waited to administer strong teas of oregano (which may stimulate oxytocin production) until later in the evening. Walking helped a lot, so Bri took space from me and paced upstairs, occasionally coming downstairs to take a hot shower. She breathed calmly and as deeply as possible, showing the utmost self-control and deepest inner strength.

Mireya came back at about nine, with her two male doctor comrades - and in true Bolivian fashion, her husband and two sons. Dilation was proceeding, so she left Julio and Gherry behind to supervise the process. As Bri wisely asked, we only let one other person into the bedroom at a time. We had a thin twin mattress on the floor, and a strap hung from the door, so she could labor any number of ways, squatting, standing, hanging. María René had left late at night to get home and take care of her own children. Aurora, our six year old who was also born at home, had come back from the neighbors’ house and did her best to stay out of the way, perhaps to sleep. The guys sat downstairs and talked quietly while I attended Bri as best I could. When her cervix had reached 6 centimeters, I brewed stiff cups of mate de oregano, which Bri sipped between contractions. We kissed and she held onto me tightly, standing as the contractions came, leaning her head on my chest. We exchanged caresses and “I love you’s” and I kept encouraging her, telling her how beautiful she looked and how well she was doing.

Eventually, there came that last moment when we knew birth was imminent. In Spanish, the colloquial expression for giving birth is dar a luz – literally to give to light. I love this expression, as it really maintains the spiritual dimensions of what’s happening. In labor, both mama and baby are in a liminal space. The ability of a woman to push an eight or nine pound baby through her pelvic bones and her pussy is a thing inconceivable to most men or even most women. You’re doing something that is ordinarily impossible. The baby is between worlds: the dark, safe, nurturing haven of the womb, and crossing the difficult, rather dangerous threshold into a world of light, of air, contact with germs and bacteria and the violence of everyday life. But it’s also a glorious, unimaginable awakening – a breakthrough, a passage, the inverse of death. That last hot shower, then back upstairs... Julio came in and checked – nine centimeters plus – and readied himself hurriedly. The thunder was loud. Aurora awoke, sniveling audibly in the hall. I put her back to bed.

Bri was now squatting on the pallet, knees wide, leaning against me – I can’t really remember just how we were holding each other. Julio was in front of her, kneeling, waiting encouraging: “Ahora ¡empuja!” I could tell she was ready to deliver. The candle on our dresser-top altar flickered. Everything about her breath and her actions had shifted. Thunder, lightning. Aurora awoke and stood at the door. “Come on in here – Lucky’s about to come out!” I said. She stood next to me, surprisingly calm, watching with eyes wide, waiting. Bri made animal grunts and gasped quick breaths, pushing, trying, feeling. After maybe three minutes of pushing, out popped a head. Julio held it and pulled gently as Bri pushed, and Lucien Henri sprang into the world, the blue lightning flickering on his wet body in the dark room. Julio deftly cleared his airway. “What’s that?” asked Aurora, staring at the umbilical cord. An adorable smile spread across her face. Bri tilted her head up to kiss me. Julio smiled as he handed the little creature to us. “Felicidades,” he said.

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