Tag Archives: Midwifery

9/11 Grief honors birthing families

Losing Lauren, his pregnant wife, in the crash of flight 93 on 9/11, Jack Grandcola found that giving provided his path through grief. Jack incorporated personal loss into his public and private identity. Grandcola’s family foundation supports a beautiful birth suite in Marin General Hospital where Lauren and Jack expected to greet their first child together.

The following article includes a touching video of the Grandcola family foundation’s contribution to a beautiful birth suite:

Pregnant Flight 93 victim honored by husband’s lasting tribute

I’m not able to embed this video, so please click on the article link above to view an inspiring and humble video of profound loss and generosity – as well as views of a lovely birthing suite and nurses with whom I work in my moonlighting job at Marin General Hospital.

From now on, when I attend births in this suite I will remember the generous spirits of Jack, Lauren and their unborn child who provided a lasting tribute to young families.

Grief transformed to life-affirming generosity.

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“Mamalita: An Adoption Memoir” by Jessica ODwyer


Jessica O’Dwyer, author of “Mamalita” spoke as a voice of valor, compassion, humility and, most importantly, of determined love for her Guatemalan born children at last evening’s author reading at Book Passage in Corte Madera, California.

A few years ago, the petite blond sitting with me in Linda Watanabe McFerrin’s writing class at Book Passage had once surprised me with essays based upon her Guatemala experiences. Unlike many of my upper middle class caucasian peers in Marin County, Jessica O’Dwyer delved into depths of a society that many educated middle class Americans cannot fathom.

Jessica’s writing expresses a personal humility and compassion for a people trapped in poverty. “Mamalita, An Adoption Memoir” by Jessica O’Dwyer brings American and European readers upon her circuitous journey to motherhood. Driven by maternal love, Jessica, her husband, and their daughter had unwittingly become entangled in a corrupt international adoption enterprise.

Jessica uses the skills of a talented mystery writer to lead readers from her comfortable, loving California life to devastating news of her medical condition causing youthful sterility. A desire to adopt led Jessica and her husband to an adoption agency specializing in children from Guatemala.

From my experiences of Guatemala, I felt a rapid kinship to Jessica in our writing group. Her words eloquently describe the beauty and pain that is Guatemala through eyes of a white mother enamored with her brown daughter.

It happens that my cousin Steven, a sarcastic New York attorney, used to joke about his beloved Guatemalan-born daughter, “She’s the best daughter I ever bought!” Knowing how my cousin adores his daughter, and his New Yorker sarcasm, I do not find him offensive. He calls things as he sees them, no offense intended.

Having worked as a health care volunteer in Guatemala and Indonesia, along with my current work on the Berkeley-Oakland border, I have been close to countless stories of motherhood involving violence, starvation, murder, poverty, of corrupt systems resulting in children essentially sold to adoptive parents. Yet no one, to my knowledge, had written these stories with both confusion and compassion for all involved parties.

While aspects of Jessica’s story resemble others I’ve heard. Jessica’s telling of her story is unique. She writes with a compassion for poverty and challenges of those who know only the corrupt world where they must survive, even when that involves placing a price upon a child’s life. Jessica gently describes both the loss and reward inherent in adoption.

For example, when I worked in Guatemala in 1997, one comadrona (birth attendant) was beheaded as a symbolic gesture for my birthday. Banditos had broken into the comadrona’s dirt-floored home in the middle of the night. They chopped off her head in front of her family because she had worked with us, the northern Americano health care team. The American CIA had largely subsidized the recently ended civil war in Guatemala. Banditos feared that comadronas would sell babies to us.

“Mamalita” does not avoid addressing the realities of this challenging but beautiful country; she shares tragic stories enveloped in her focused motherly devotion.

Violence is a fact of life wherever poverty prevails. Yet these stories are rarely told through personal narratives driven by love and compassion. Great tragedies are usually illustrated through tallies summarized by various Public Health associations, the World Health Organization, UNICEF, Save the Children, and the United Nations. Statistics on poverty, human trafficking, rape, embezzlement and corruption are necessary measures. Statistics do not tug heartstrings like personal vignettes.

Through “Mamalita,” Jessica grows through the love for her daughter. She awakens to experiences of racism through the contrast between her daughter’s nutmeg colored skin with thick black hair and Jessica’s fair complexion with blond tresses. She details, costs, paperwork, corruption, bribery and layer upon layer of her painful realization to both the assumed entitlements inherent in her, our, North American life and the realization that another’s life can be purchased.

After falling in love with her daughter, their adoption process dragged for nearly two years, until Jessica (finally) realized that money talks. International adoption is an often corrupt business.

Humble passion shines through the written word in “Mamalita.” She compassionately develops a relationship with her child’s birth mother, while expressing concern for her young daughter’s ability to bond after so much loss. Jessica’s keen writing engages the reader to her discovery and revulsion of how the world turns in third world adoptions. Both Jessica and her readers are changed by her story.

For an inspirational and realistic view of international adoption, now closed in Guatemala but still applicable to other areas of the world, please read Jessica O’Dwyer’s “Mamalita.”

Personal tales of those suffering because of political, economic and historic inequities need to be shared. Through those who have the fortitude to detail their tales, society may hope to address institutionalized abuses wherever they occur.

“Mamalita” stands as a heartfelt story of victory, courage and determination to inspire all concerned about global maternal-child health and family.

Click to purchase “Mamalita” from Book Passage or amazon.

Click to read Jessica’s ongoing blog about her ethnically mixed family and adoption issues :

“That’s Not in Our Birth Plan!”

“Stop that! That’s not in the birth plan!” Jerry nudged aside the nurse focused upon resuscitating his newborn son. Gladys didn’t budge, sweat beaded along her brow line. She resisted Jerry’s pressure while holding the tiny oxygen mask snugly over the infant’s face, gently squeezing the green ambu bag with her other hand … one, two, three.. forcing oxygen into the waxen floppy infant’s lungs.

“I told you, that’s not in the birth plan! The baby needs to be in Donna’s arms!” Jerry continued, standing helplessly at the bedside warmer while watching Gladys work on his son.

Gladys concentrated upon the task before her. She stopped briefly, placing the stethoscope on the baby’s chest to hear the heartbeat, and air movement. The baby was gaining some color, and taking an occasional gasp. She returned to squeezing the oxygen bag with her experienced hands…one, two three… whispering under her breath, “C’mon baby, take a breath now, c’mon, you can do it.”

Only moments before, Donna gave birth this baby. During a long difficult labor, she developed a fever requiring intravenous antibiotics. Her well intentioned, but slightly deranged partner Jerry, had at various times removed the IV tubing from Donna’s arm, and argued with nurses, midwives and physicians about care for Donna’s fever.

Jerry had insisted that antibiotics were delayed until Donna’s fever had lasted for several hours, rather than immediately as medically indicated. He refused to listen when told that such a fever was potentially fatal for Donna and their unborn child. At one worrisome moment when the baby’s heartbeat dropped, he had argued, “I don’t care if the baby dies! This is about my wife’s experience! We have a birth plan!” Susan, the hospital nurse-midwife finally had called in the obstetrician to more forcefully explain the necessity of Donna’s medical treatment during labor.

Susan now listened to commotion surrounding the baby warmer while she focused upon Donna’s perineum. Twelve inches of umbilical cord hung from between Donna’s labia. Blood trickled down. Susan reached her left hand to Donna’s abdomen with a green scrub towel, feeling if the uterus had contracted to release the placenta. She made eye contact with Donna and smiled, “It’ll be OK.” Then looked to see if the intravenous pitocin was running. An infected uterus doesn’t contract well, either to give birth or to prevent excessive blood loss. This uterus needed to contract and release the placenta to control Donna’s bleeding. Intravenous pitocin would help the uterus contract and minimize blood loss.

Birth is a sensory experience. Nursing, midwifery and medical schools teach algorithms of blood pressure, hydration status, medication titration, labor curves. Experienced birth attendants, however, respond viscerally to birth. They know the sounds and scents of a laboring woman, the touch of an effective uterine contraction beneath their palm, the odor of infection, the tone of a healthy postpartum uterus. Even before the first breath, a healthy newborn has a distinct muscle tone and color. The first few breaths may sound a little moist, but they should be effortless. Like a farmer evaluating healthy soil, an experienced birth attendant feels the texture of a healthy placenta and knows if the growing fetus was well-nourished.

Like finely tuned hearing of a blind person, Susan’s senses were heightened at the moment of birth. She’s often thought that birth is her greatest spiritual practice, the Zen of living in the moment. At the moment of birth, she absorbs sensory input and responds accordingly. The analytic brain had integrated didactic information from education, and now responded automatically to surrounding sights, sounds and scents.

Seeing the IV tube empty, Susan asked Fanny, the Registered Nurse, “Please check the IV to be sure it’s running.” With one hand feeling Donna’s abdomen, her other continued gentle traction on the umbilical cord to detect placental detachment. The cord felt hot, even through her latex glove. She thought to herself, “this baby has been baking in a febrile uterus, no wonder it’s too tired to breathe.”

Susan listened to her right, without turning her head, to the baby beneath Gladys’s hands. At last she was relieved to heard the muffled sound of a baby cry beneath the oxygen mask. Donna’s bleeding continued in front of her.

“Fanny, draw a syringe of methergine.” She asked the nurse for an extra medication to manage a hemorrhage. “We’ll also need to culture the placenta and send it to pathology.”

Susan knew that Jerry would object to placental studies to identify the infectious bacteria. Medically, it was important to identify the source and type of pathogen that caused this infection.

Jerry had insisted they bring the placenta home to dry and encapsulate it for deemed natural health benefits. This labor and birth had not gone according to the couple’s carefully designed plan. They would learn soon enough that much of parenting does not go according to plan!

Susan smiled as the IV began to drip its clear fluid into the tubing. Without releasing her hand on the uterus or umbilical cord. Susan then asked Gladys, “How’s it going?” inquiring about the baby.

“He’s beginning to breathe, still retracting though.” The sound of the ambu bag stopped, and Susan knew that the baby must be breathing on his own. She finally relaxed into a full exhale. The baby was breathing, but retractions meant the baby was straining to breathe.

Jerry interjected “Then give the baby to Donna, now!” Susan turned to see the baby still flaccid, with minimal muscle tone. The baby had good color now. Gladys massaged the baby to help it along. “Now!” Jerry demanded, beginning to push Gladys away.

Claiming authority in the delivery room, Susan turned to Jerry, “Jerry, Stop. Let us help Donna and your baby. We support natural childbirth when all is healthy. The hospital provides medical support when necessary. Donna and the baby are sick and need extra help. When things are stable, we will put your precious son into Donna’s arms. We promise!”

Jerry responded, “You’ve gone against everything we wanted in our birth plan!”

Still massaging Donna’s abdomen, and gently holding the umbilical cord, Susan took a deep breath, “Jerry, we explained each variation to you. Complications began before you and Donna arrived here. You’re still together, we’ve kept you informed each step. Donna had an infection. This was not predictable. We don’t want to call security to have you leave. Please, allow to us work for your wife and son. Donna needs your support now.”

Jerry had been pacing the hospital floor for hours, firing a series of nurses, midwives and doctors from his wife’s care. His uncontrolled anxiety manifested by obstructing care for his sick partner and child.

Natural childbirth can be an awe-inspiring experience for a healthy woman and family. As a midwife, that was Susan’s specialty. Susan appreciated this hospital because of their commitment to avoiding unnecessary medical intervention. The high volume and acuity of this setting dictated a careful distribution of resources. Those who need medical intervention or surgery were treated. As a nurse-midwife Susan provided natural support for healthy women, and could likewise assist those with complications

Only patients requiring medical intervention should be treated medically. Healthy women were encouraged to labor naturally without intervention. Susan standardly placed newborn’s directly upon their mother’s belly, delivered in low lighting, delayed cutting the umbilical cord for maximum newborn oxygenation. But when situations demanded otherwise, the high tech skills and experience of this staff could save a woman’s and baby’s life within seconds.

Susan’s thoughts were pulled back as Donna’s vagina gushed more blood, the placenta was beginning to detach. Donna leaned her head back with closed eyes, exhausted and febrile.

Jerry turned to Susan “Let go of that umbilical cord. We don’t want you to pull the placenta out, it needs to come out on its own.”

Fanny picked up the phone, “I’m calling security.” Fanny had patiently worked with this challenging situation for hours. She reached her limit.

Susan sighed thinking that knowledge is a good thing, but too little knowledge can be dangerous.

“The placenta is detaching on its own now. I’m just guiding the placenta out Donna’s vagina, not forcing it.” Susan explained to Jerry. Gently guiding the umbilical cord down and then up, along the angles of Donna’s pelvis, the glistening blue-white of placenta became visible at Donna’s vulva. Jerry stood still and watched..

“The placenta’s coming now. You don’t have to call security.” Susan told Fanny, she removed her hand from Donna’s abdomen to catch the hot organ in her hands. “Please massage her uterus.”

Fanny, exhausted as she was, reached over and massaged Donna’s soft uterus to minimize blood loss. Susan held the abnormally warm placenta in her hands, examining for tears, missing sections, the insertion of the umbilical cord, and presence of the entire amniotic sac.

She held the placenta up with one hand inside, spreading the membranes open, like a wet plastic bag “Here’s your baby’s first house. He was folded up inside this bag. The placenta worked as his liver, lungs and digestion. Now he works for himself. You’ll grow a new placenta for your next pregnancy.”

The excessive heat from the placenta, confirmed the need for special care with this baby. The placenta had good texture she thought, not shredding like that of a chain smoker, or someone with lifelong malnutrition such as placentas of many immigrant women from third world countries. Once the infection is resolved, the baby will be fine, thought Susan to herself.

She wondered if infection could have been avoided if Donna had not waited to come to the hospital until two days after her membranes had been ruptured. Studies show an increased risk of infection to mother and baby if labor does not begin within 24 hours after the amniotic sac ruptures.

In this case, Donna and Jerry stayed home for two days after the water broke, awaiting spontaneous labor. Susan wondered if they had secretly planned to give birth at home, unattended. It was obvious they were well read on the subject of natural childbirth, but unaware of medical complexities.

By the time Donna arrived to the hospital, she was already beginning to develop a fever and had not slept for 2 days. Her body was ill prepared for labor. Donna wasn’t yet infected upon arrival to the hospital, but her risk was high. The obstetric team augmented her labor with pitocin to bring on labor. Even then Jerry had objected to her IV presence interfering with their planned natural birth. Fortunately Donna’s fever spiked close to delivery so was able to continue for a vaginal birth, nearly three days after her membranes had ruptured.

Birth plans for a healthy birth are a good thing, just as are career plans or home remodeling plans. However, all planners must adapt when unanticipated circumstances arise. In this situation, lack of adaption can have fatal consequences.

Susan wondered how can one graciously teach common sense to idealistic young parents in the high emotion climate of labor and birth. Parenthood will be full of many more such unintended surprises and redirections.

“Remember, we will take the placenta home.” said Jerry as he reached for the stainless steel bowl holding the placenta on the delivery table. “We need to encapsulate it to help Donna’s uterus contract and protect from hemorrhage.”

“Jerry, please leave it on the table for now. We’ll discuss it in a moment, let me be sure Donna is stable first.” Jerry pulled his hand back to his side.

Susan felt Donna’s contracted uterus, like a firm grapefruit in her lower abdomen, a good sign. The bleeding slowed to a scant amount. Susan picked up a white gauze pad, holding it up for Donna to see, “This might feel rough, I need to touch you with this gauze to examine for lacerations and see if you need stitches, just warning you.” Donna nodded.

Everyone smiled as the baby finally released a lusty, but crackly, cry. Only five minutes had passed since birth. It seemed like an eternity.

Susan turned her head, briefly making eye contact with Gladys, “Good job, as always! Thank you.” Gladys and Susan quietly chuckled, as they both signed with relief. “We must stop meeting like this.” smiled Susan. This birth came uncomfortably close to a bad outcome.

Returning to her task at hand, Susan said, “Donna, you don’t need any stitches. You pushed well, and your skin stretched perfectly. Your bleeding is under control. I’ll just wash you off, then you can breastfeed your son.”

Gladys brought the baby to Donna’s extended arms. “Your son is beautiful. Congratulations.” smiled Gladys as she gently placed the newborn into his parents’ arms. Jerry and Donna gazed at their new son in their arms, with fatigued amazement and adoration. They had waited months for this moment.

Fanny said “Let’s remove your gown so you can hold your baby skin to skin. That’s the best for both of you.” Susan washed Donna’s bottom, then turned to put away her instruments. Fanny and Gladys made their medical notes.

“Why isn’t he breastfeeding yet?” demanded Jerry.

Susan sighed, “He’ll have a sucking reflex within the next 30 minutes or so. He’s really tired and still learning to breathe. He’ll breastfeed soon.”

Gladys added, “Because the baby and Donna were infected, after he nurses, we’ll have to bring him to the Neonatal Intensive Care nursery for observation and evaluation. We know that’s not in your plan, but infection wasn’t in the plan either. We’ll wait about an hour now before bringing him up. Breastfeeding is important; we do everything we can to support it. Donna will have free access to breastfeed even while the baby is in the NICU.”

Jerry looked to Susan, Susan nodded to confirm Gladys’s words. Susan thought once again how much she appreciated this hospital. Bonding and breastfeeding time is valued here; even a sick baby, if stable, has time with his parents before being brought to the nursery. Not all hospitals make such an effort.

Fanny placed the placenta into a container for the pathology studies. Susan decided to delay informing Jerry of the need to evaluate the placenta. Allow them this quiet time, thought Susan; we can burst this bubble in another hour.

Donna, as the infected laboring woman, had been amenable to changes as her labor proceeded outside of normal. Jerry vehemently resisted his loss of control throughout. Allow them this uninterrupted time to settle with their new babe could calm the unrest.

Outside at the nurses station, Susan documented details in Donna’s chart. Lydia, another nurse, began rubbing Susan’s shoulders. “Oh, thank you!” said Susan as her shoulders relaxed.

“You worked hard for that one!” responded Lydia.

On the postpartum order sheet, Susan scribbled for a social worker evaluation for Donna, knowing that controlling partners can often be abusive. Susan wished she could order a psychologist for Jerry.

When Susan finished writing, Lydia stopped the shoulder massage to ask, “The woman in room 5 is requesting an exam, she wants to know if she’s progressing. Shall I check her or would you prefer to?”

Susan responded, “Thanks for asking, Lydia. As the bedside nurse, you are more aware of her progress than me. Please would you check cervical dilation and let me know your exam. I need to stop for a breather.”

Deanna, another nurse handed the phone to Susan, “It’s for you. Triage asked to speak with you.”

Susan took the phone and heard, “ We have a woman in active labor for you. She’s having her 6th baby, with a history of fast labors. She’s 6 centimeters dilated now, appears to be moving fast.” Susan felt her adrenalin rise as she heard this news. The voice on the phone continued, “She had limited prenatal care and a history of cocaine use during the pregnancy. Her blood pressure is elevated.”

Susan sighed, “I’m coming now.”

The triage nurse continued, “And we also have a Cantonese speaking woman with ruptured membranes in early labor. She’s a normal midwife patient except for history of a previous cesarean section in China.”

Susan walked around the nursing station desk toward the triage area and nearly bumped into Teresa and Sean as they exited the operating suites. “Did you section the triplets?” Susan asked the obstetricians.

“Yes” Sean responded, “all went well.”

“Whew! How much did they weigh?” Susan asked, knowing they were very premature.

“We don’t know yet.” Sean responded, “But they’re breathing well and on their way upstairs to the NICU. The third one was so small I held her in my palm. She looked up and blinked at me. Amazing.”

Teresa interjected, “Did the infected woman in room 8 deliver?”

“Yes, all is well. Her husband has a lot to learn about priorities.”

Teresa raised her right palm for a high-five. “Good job! We really wanted to avoid having them in the O.R.!”

“No kidding! We aim to please” Susan slapped Teresa’s raised hand while walking past. “I’ve got to admit a couple in triage now. I’ve got it handled. Maybe we can catch up for coffee later?”

Sean walked down the hall, “I”m headed to the postpartum unit.”

“Call me if you need me.” Teresa said as Susan walked away.

“You know I will!” Susan called back over her shoulder.

Alisha looked up as Susan entered the triage area, “Sorry to have more for you, I know this has been a rough day.”

“Hey, no worries. Job security is a beautiful thing!”

Hello world!

First post, using WordPress’ welcome title.

Hello world!” I imagine the prelingual thought of this wet lavender-skinned newborn hesitantly taking her first cold breaths, while snuggled upon her mother’s abdomen.

The new mother’s universal first embrace, palms resting on her daughter’s damp body, freshly emerged from the warm constricting womb. This small infant worked as hard as did her mother to traverse her first voyage – birth, the longest six inches of her life!

The mother’s head drops backward upon supporting pillows, glistening with perspiration,. The infant’s father openly weeps as he gingerly cuts the umbilical cord.

“You’re free now!” I smile aloud, after the new father severs the spiral umbilical cord.

After expulsion from the birth canal’s tight compression, the baby’s chest expands, her newborn lungs inspire oxygen directly for the first time.  Her heart automatically pumps fresh blood toward pulmonary (lung) circulation.

In a few brief moments, the newborn’s blood streams through newly opened channels.  The original vascular pathways close forever, tunneling through the small body and the umbilical cord, to her placenta for secondary oxygen-carbon dioxide exchange via her mother’s bloodstream.  The fetal circulation now becomes an abandoned bio-aqueduct.

While now-needless pathways close, blood courses to moist previously unused lungs, until the now-needless umbilical cord ceases its pulsations.  The cord is cut and lungs assume their lifelong role of keeping this body alive.

As the newborn breathes oxygen, her color changes from the lovely fetal lavender to her genetically predetermined color.

While drying the newborn, the nurse whispers, “She’s turning pink now. Congratulations!”

Pink is a medical term, applied equally to all ethnicities of babies, referring to the disappearing fetal blue color, as lungs oxygenate this body.  In a matter of moments, this little girl’s metabolism completely changes.

Lavender fades like a tactile sunrise. Fresh lavender skin is indescribably beautiful for a few fleeting moments.  If the otherworldly color endures only a few seconds longer, we worry the baby is not breathing.

I wonder, “Did newborn skin inspire Hinduism’s blue deities? It this why I painted my bedroom lavender? Do I unconsciously strive for the security of fetal life?”

The new mother wearily lifts her head from the pillows, her energy slowly returning. Tendrils of moist hair cling to her forehead, wet with perspiration from childbirth’s expulsive efforts.  She smiles while nodding toward the blinking, warm babe in her arms.

The baby’s father wipes away tears while leaning down, forehead to forehead with the new mother.

“You did it!” he says,  “I love you!”

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Hello World!

Welcome to “Coming to Life” blog!

We each survived our own amazing odds-against-us conception and birth.

Life continues to challenge and bless us with personal struggles. We may find ourselves suddenly redirected, just as fetal circulation redirects itself for extrauterine life.

My hope is that through stories of others’ births and rebirths, struggles and overcoming, readers will find personal inspiration to help traverse their bridges.

Happy Spring – the season of renewal!