Last night, after the kids and I finished watching a movie (they're psyched that I'm here with my laptop; Sarah's laptop's DVD player stopped working a while ago), one of our clients came to Sarah's gate showing signs of labor! We took her next door into the clinic and Sarah got her all checked in (this was at 9:15pm). She was just slightly past her due date, so more or less on schedule, and she was already starting to make some rather vocal sounds in response to the contractions. (As exciting as my shadowing on the Labor and Delivery floor at the hospital by Haverford was, I never actually saw any of the lead-up to a birth, so this was pretty neat to be a part of!) Patricia, our client, did a lot of slow walking around in the clinic, and every now and then would yell gently for a while as a contraction passed.
Ninotte, the Haitian midwife who is on our team, gave her some simple exercises to do, just to keep her moving around, because the baby felt like its head wasn't quite oriented down. Sarah did an exam and Patricia was only at 4cm when she arrived, so it looked like it would be a long night! Melinda arrived, too, and we all planned on staying overnight in the clinic (in the other beds) - the midwives needed to be there, obviously, and they let me stay for the experience. :) After a couple hours, Melinda examined Patricia again - still at 4cm! At this point, they figured they only needed to check her every hour for a while, so Sarah and Melinda went to bed. Oh, and I didn't mention that Sarah was also babysitting a friend's 3 month old baby! I alternated between watching Ninotte work with Patricia, getting Patricia water, helping rock our little baby Mara to sleep so Sarah could get some rest, and sitting with Patricia. Ninotte went to sleep for a 1 hour nap around 11:45pm, and I sat up with Patricia and her sister, partly just to have someone there, and partly to make sure she kept moving around but not "pushing" yet.
Ninotte happened to wake up slightly early, around 12:30, and came to sit with Patricia, so she sent me off to take a nap. Not 5 minutes after I had lay down, I heard a knock on my door, and the sister was there! She took me to the next room, where Patricia was standing - her water had just broken! I went and found Ninotte and Melinda, who got her cleaned up and checked her out. Patricia's contractions got way more intense, and finally she looked like she was about to fall over, so Ninotte and the sister helped her into a crouch on a sterile, absorptive, plastic mat they had put on the floor in her room earlier. Suddenly, we could see the baby's head! It has happening! Right before anyone saw, Patricia said "the baby's coming!" (in Creole) - this is her third child, and she knew exactly what was happening. She gave birth very quickly, at 12:50 or 12:55 (Ninotte had woken up just in time!!), standing more or less in a crouch and supported by her sister.
Melinda explained to me later that midwives are there to protect the birth space, and to keep it all as natural and safe as possible. They don't try to get the mother in any particular position - however it happens, whatever the position, they will support the mother and make sure things go smoothly. I was very surprised to see the delivery happen when Patricia was in a squatting position, but apparently most positions are better than the lying-back position used in hospitals because the baby has to come down the birth canal but then come up over a bump in the pelvic bone. It can make birth a lot harder and take longer. Interesting that the standard birthing position in US hospitals is made to be convenient for the docs, but much less convenient/easy for the mother and baby. Hmm.
Anyway, after the placenta came out and was placed in a plastic dish, Melinda and Ninotte got Patricia and Baby Boy snuggled up together on the bed for the first nursing. Interestingly, they don't bother cutting the cord until a while later (either a few hours later, or even in the morning). It's more important to let the mom and baby bond together for a while, without interrupting that. Also, in order to help educate the people who come to give birth in the clinic, we use a different type of "cord-cutting" method here. Since people often don't understand how important it is to thoroughly boil and sterilize the scissors or knife, cutting the cord can be a major risk for infecting the newborn or exposing it to tetanus. Instead, the midwives here have adopted the practice of using a candle to burn the cord. Since it is wet, it doesn't catch fire, but it creates a safe, clean break that is more likely to heal without infecting the little one. And hopefully, the clients will share this tip with other people who don't come to the clinic. Pretty cool, isn't it?