Crossing Borders with Andrea
These articles were first published in Midwifery Today.
Crossing Borders with Andrea
by Sister MorningStar
Andrea lives in Nicaragua and was pregnant in 2014 with her first baby. The hospital cesarean section rate in her area is 80%. All first-time mothers either schedule a cesarean or receive an episiotomy. Induction is recommended and standard at 39 weeks and required by 40 weeks. Andrea was healthy but confused by the standard of care in her country.
Andrea has a friend in the US who had recently birthed easily at home. Andrea found a doctor who was considered open-minded—she promised to help Andrea achieve a natural birth in the hospital. But as Andrea neared her expected time in late November, the doctor explained the necessity and importance of induction. She said the placenta was dying, the fluid was gone and the baby, too, would die. As they spoke about the details surrounding an induction, Andrea asked if she could use the one private room for delivery. The doctor said all first-time mothers deliver in the operating room because they will need stitches. Andrea then asked for delayed cord clamping; the doctor said she would agree to wait only two minutes before clamping the cord. Andrea asked for the placenta to come on its own; the doctor explained that it cannot be left because it starts to die. The doctor then did a brief ultrasound and found fluid and a head-down baby. After an internal exam, the doctor found Andrea’s cervix 2 cm dilated. Later Andrea told me, “Oh Sister, the exam hurt so badly!” The doctor pleaded for Andrea to stay for an induction. Andrea spoke of her fears of an eventual surgical delivery. The doctor spoke of the risks of waiting. Andrea insisted, “But there must be some risk to cutting me wide open! I am going with the other risk.” She then restated her desires for a natural birth and went home. Andrea wanted something different.
Andrea called me at my home in the US, and we discussed her experiences, her past, her feelings, the doctor’s actions and statements, Andrea’s desires, needs, people resources and her instinctual knowing. Andrea’s expected due date was November 24 and it was November 29 when she called me again. She spoke of her confusion with the medical way with birth and her own instinct that it should be a natural straightforward event. Fear dominated the birth stories that circled around her. “Every time I interact with the medical people, I become filled with fear. Otherwise, I feel calm.” Andrea decided to keep waiting.
Andrea and I stayed in contact by email every day. The days became a week and we entered December. Each day she reported that the baby was active more at night, that she enjoyed her morning walks to the beach with her dog and that she was planning to stay home as long as possible and then go into the clinic at the end. “However, I can’t imagine moving through a busy Nicaraguan clinic and into a surgical room without being tense.” I asked about her postpartum plans and what help she would have after the baby arrived. I suggested she hire a local older woman with experience with new mothers. “But what would they do?” she asked. And so began the talk about physical, emotional and spiritual recovery after the birth of a baby.
Andrea continued to wait. Despite the urgings of well-meaning friends and medical folk, Andrea waited. And so I waited with her.
“MorningStar? This is Colin. I am calling for Andrea. She wants to talk with you.” It was December 5, 2014, at 12:50 am deep in the night where I live. I was still awake in front of my fire in Rose Cottage, deep in the woods of Missouri, making prayers for Andrea.
Over the phone I could hear the sounds of a woman in labor. She was breathing heavy and pausing between words. She told me about her busy day and how when she lay down, she couldn’t get comfortable. “I felt gassy and went to the toilet. I think my water broke. There was a gush and clear fluid.” She thought that was around 12:30. We discussed what it might be. The contractions were getting stronger. The pressure in her back hurt. She felt less tense in the shower and that is where she was talking to me with headphones on. Then more big breath sounds.
“Oh Andrea, we have a labor! I am so happy for you!” Her baby was moving a lot. Andrea was lying with her head on a ball, warm water on her back and sipping water in between.
“Oh, oh, umm, oh goodness,” she murmured. “Oh man! Oh! ahhhhh…I feel so gassy…I am having contractions and pooping,” Andrea commented.
“Nature is so nice to make room,” I whispered in between.
“I don’t think I can move. I don’t know how I could get in a car….” She trailed off, then added, “I can’t tell if they are near or far apart.”
“Just rest,” I repeated like a mantra as she drifted off and was quiet for a bit.
“Oh-oooooh, my legs are shaking. I’m nauseous. Ohhhh, ouch, ummmmf!”
“It’s a big one—we can do it,” I encouraged. “Now rest. Rest, my dear, between them.”
For an hour we breathed together with more than 1000 miles between us. I asked if the room was dark and warm. I suggested some towels for her hurting knees and to have Colin create a landing pad in the bathroom for when she wanted to get out of the shower.
“Colin, can you bring in some candles and turn off the lights?” she asked some moments later. “MorningStar, are you there?” she asked into the phone.
“Yes, right with you! You are doing great. So beautiful,” I assured her.
“Colin, can you get some towels for my knees? Too hard. Too hard,” she whispered.
Andrea threw up at 1:50 a.m. “Oh I feel better!”
“Making more room,” I whispered back as we continued our breathing together.
“Oh I want to lie down. Honey, can you make a pallet on the floor with a blanket? All of them,” she requested.
“Any plastic or chux pads?” I asked.
“Huh?”
“Have Colin put a towel under your bottom, so you can change it out when it gets soiled,” I suggested.
Andrea lay down on her side and rested. “They are slowing down a little,” she observed.
“To let you get some sleep,” I assured her, and I explained how they would increase in strength and length and then let her adjust before they do that again and eventually work her baby out. Andrea rested.
But not for long. “Oh! That came up through my back and belly! I need to get this shirt off! Okay. Oh! Umph. Okay. Oooooh”
“Do you want me to help you move over?” asked Colin.
I heard big breathing. She told me her thighs were shaking. “Oh, God! MorningStar, something just burst! A lot more water! Pop!” Andrea described with words and sounds from 1000 miles away. I asked a few questions and she told me the baby was moving. Colin used a flashlight to see that the water was clear. I could hear that the contractions were changing. “Oh! Ouch! Oh!”
“Slow and steady, Andrea. Calm mind. Breathe with me,” I said, getting into the river of birth with her.
“Colin, can you rub my back? Push on my back,” Andrea directed. “I feel it down my legs.”
“Peace to you, Andrea. Peace of mind to you. Rest. Rest now,” I fed into her mind and body.
Then another contraction and another. “Ooo, ouch, ahhhh, ohhhh, ahhh, the bottom of my belly is so sore,” she willingly shared with me. Belching out “Oh my God,” Andrea left behind the world of being polite. It was 2:40 am when Andrea threw up again. Hearing her fluids coming from all openings, I noticed the sounds of a gentle rain starting in Missouri.
“I put my butt in the air, but I don’t know if it helped,” she told me and I knew she was referring to getting the pain off her back. “Colin, push harder. Oh, my back!”
“Breathe with me Andrea,” I invited her as we worked through a series of unrelenting waves of contractions. And then a pause. She rested for six minutes. It was so quiet.
Up came the wild creature out of her slumber, breathing like a panting tiger. We got through the surprise and I taught her the use of low sounds and of slow and steady breathing. “Oh my God!” she answered me.
“Now rest. You never have to do that one again.”
“She’s really moving. I need to get in the shower again. Colin, turn the water back on. Warm. Warm. WARM!”
Our call dropped. I waited. For nearly an hour I waited, making my prayers. “Perfect timing I ask from the Great Mother. Hail, Andrea, full of grace,” I prayed and waited.
Colin called. “She’s in the shower on her knees leaning against a ball. She’s having another strong contraction. Hold on just a second.”
“I feel like I need to push-poop!” I heard her blurt out while I was still talking with Colin.
“Poop can come out in the shower,” I said.