Last summer, midwife Tara Elrod and her husband, OB-GYN Dr. Glen Elrod ’91, spent three weeks working for Midwives for Haiti at St. Therese Hospital in Hinche. This is an edited excerpt of their journal entry from their 16th day in the country.
Glen and I walked onto the maternity ward this morning to find two women in labor. Both had just arrived.
A first-time mom is in the first stall. Just five feet and a plastic shower curtain away, surrounded by a midwife and her five students, is a second-time mom with a prior C-section.
The students are struggling to find heart tones and the midwife is struggling, too—moving, turning, and adjusting the Doppler transducer in search of a heartbeat. I look at Glen and he grabs the portable ultrasound and introduces himself to the mom.
I walk over to tend to the first-time mom. The Haitian midwife assigns two students to me—one a midwife, the other a nurse. They will be assisting me with the birth, she says, and she would like me to guide the student midwife, explaining things as I work, giving the student a chance to get some “hands-on” experience.
I check Mom and she is eight centimeters dilated. I ask her if she would like to walk, but she doesn’t want to. We tell her she is doing great and stay beside her to support her.
Through the tattered plastic shower curtain I hear Glen, in a soft, gentle voice, say, “I’m sorry, but I don’t see a heartbeat.” I have heard these words come from his mouth too many times. It doesn’t matter —at home or in Haiti, someone I know or someone I will never know—those words slice like the dirty razor blade that is sitting, contaminated, on the counter.
The mother says nothing. I can’t see her but I am sure she is stoic, just nods. It is not that she doesn’t care. Not that she does not feel the spiraling panic and loss that you might imagine or even know yourself. It’s something beyond our understanding—she knows it happens. Babies die. Especially here in Haiti.
I stop what I’m doing and go to the bedside to support the mom.
The baby starts to slowly crown and Glen touches the baby’s head. He looks at me and whispers that there are no bones. I do not know what this means.
The baby starts to emerge and the sight causes my translator to recoil and close her eyes, as if her hand had touched an open flame. I want to look away too. I want to leave. But this is real. I can walk away and block my eyes and my heart from what is happening and go on with my life, but this is real and forever part of this mother’s story. She cannot escape. Haiti cannot escape. And so I stand firm, eyes and heart open.
The baby’s head comes out and looks like a half-deflated water balloon. The baby has been dead so long that the brain, all its dreams and thoughts and potential, has liquefied. I cringe, but I won’t turn away.
When the baby is out we see what likely caused him to die: He is wrapped up in his umbilical cord. Glen places him on the bed and covers him with a towel, trying his best to form the towel around the head. The mom glances down at Baby and quickly looks away.
I look at Mom and tell her, “There is nothing you did to cause this, nothing you could have done differently. This just happens sometimes and we just don’t know why.” She looks at me, says nothing, but nods.
The midwives take Baby away and put him in a cardboard box and place it under the delivery table.
A shower curtain away, my laboring mom begins to involuntarily push, preparing to give birth to her living baby, so I go back to her and my two students. I explain to them the importance of frequently listening to heart tones during pushing. The student midwife is in charge of heart tones, and she’s doing a great job.
Mom is pushing and Baby is ever so slowly stretching the perineum. As baby encroaches on a full crown, Mom stops pushing and Baby retreats back. We watch for about 30 minutes as this happens. The students anxiously tell Mom to push harder, and I have to tell them, “No, what she is doing is great. She does not need to push harder.”
They listen to my words and watch.
Mom pushes and slowly the baby’s head begins to fully emerge. I put my hand out to guard the perineum, tell Mom and the student midwife they’re both doing great, tell the student to keep guiding Baby out, nice and slow. My student’s hands are right with mine and Baby slides out into them—a double-handed catch! I quickly show the student how to unwind Baby from the umbilical cord.
Mom smiles.
Five feet away, the baby in the cardboard box remains on the floor.
I am so angry, so sad for the situation here. But I also know that, as bad as things are, they are improving. We are told that six years ago people came to this hospital to die. There were no midwives; the hospital cleaning ladies did the deliveries. Now, just a few years later, midwives have been trained and hired and there are at least some skilled attendants, more in training. There are so many things that could be done better, but we cannot forget that strong and permanent change comes slowly. Care for mothers and babies in Haiti has improved and, thanks to the efforts of Midwives for Haiti and so many others who do this work, day in, day out and year-round, that care will continue to improve as long as we who are able to support it.
Now, even in dire circumstances, there is hope.
A couple of days ago Glen and I walked up the hill behind the house. As the sun began to set, various Haitian men and women joined us on the hilltop, some clutching Bibles, some not. As the sun sank lower, soft but strong voices began singing in Creole, and we were wrapped in words we did not understand but whose purpose was clear: thanking God for another day, praying for what another day might bring.
The Elrods are a physician-midwife team practicing in Wasilla, AK. This story was excerpted from their blog, “A Doctor, a Midwife, & a Partridge in a Pear Tree”: http://taraelrod.blogspot.com Read more about Midwives for Haiti: http://midwivesforhaiti.org
Read about the College’s Global Health Partnership, formalized in September.