Tag Archives: Motherhood

“I Cain’t Go Home”

(The following essay was written several years ago, inspired by a patient affected by another senseless murder. Identifying information was changed. )

“They killed my brother this evening! You cain’t send me home!” Ashana insists. Her right forearm flicks up and down rapidly at her side. “I’m not safe! I might hurt myself!”

19 year old Ashana refuses to leave the triage hospital bed. A few hours ago, an ambulance brought her to our unit. She is due to give birth to her second baby in a month or so. We determined that she and her unborn child are healthy. She’s not in labor and is medically cleared to go home.

“Why would you hurt yourself?” I ask, resting one palm upon her denim covered shoulder.

“I might do something. I don’t trust myself now.” Her fingers click as her right arm absent-mindedly flails, alternately thumping the mattress below and swatting her own ripe abdomen. She turns her head side to side. “No, no, I have to stay here!” She stops moving for a moment. “I don’t know what I’ll do if you send me away. I’m upset. The cops, they don’t do nothing. It ain’t right! He just be walking down the street, someone shot him from a car and drove away. Ain’t nobody seen nothing and my brother be dead. I need to stay here. I’m afraid I might hurt myself or do something to hurt my baby!”

Ashana agrees to wait a few minutes for me, while I negotiate on her behalf.

I find Sean, with furrowed eyebrows, walking down the hall.

“Are you available for a non-urgent consultation?” I ask, approaching my obstetrician partner for the night.

After Sean nods for me to talk, I begin. “I have someone in crisis because her brother was just murdered. She’s medically stable at 36 weeks gestation. I want to admit her overnight for a Psych evaluation in the morning.”

“We can’t keep her.” Sean responds as I expected. “There is no medical indication. We are too crowded already. And no insurance nor medicaid will pay for a psych admission on an OB unit. We have too many non-billable expenses. She’s a Psych case, not an OB case.”

“Sean, you know the Psych unit won’t accept patients this late in pregnancy. She needs to stay overnight and get a hold of herself. Her brother was just murdered, for God’s sake.”

Sean shakes his head, “We practice obstetrics. She doesn’t need us today.”

“Sean” I flirtaciously lock his eyes with mine,“We dedicated our careers to keeping mothers and babies healthy. Ashana is asking for our help. She had nowhere to go. She is here alone. Believe me if I could avoid this, I would. Unfortunately, this hospital’s protocols require me to consult with you for a non-labor situation.”

“I won’t authorize it.” He responds, “We are not a psych unit!”

“That’s news to me!” I smile and tilt my head to the right. We both roll our eyes and chuckle remembering various family dynamics we daily encounter. “Seriously Sean, I refuse to discharge her home. So, it’s your choice. I can transfer her to you right now. Then you can discharge her. Let’s see how you feel when she’s found injured or dead after you sent her home.”

Sean leans his head back, looking toward the ceiling. He doesn’t have time for this. “If we admit her, the chart will be reviewed for a non-billable diagnosis.”

“Fine.” I quip. “I’ll talk with the hospital’s interrogation board the same way I’m talking to you.”

“What do you suggest?” He sighs.

My cheeks broaden to a smile, knowing I’ve won my friend over, “I’ll keep her overnight for fetal observation, per your consultation. She’ll eat dinner, then I’ll order either Ativan for anxiety, or Morphine to knock her out for a night’s sleep. In the morning, Psych can make a plan for her. She’ll be here less than 24 hours so the cost will be minimal.” After a brief pause, I add, “Sean, your heart knows this is the right thing to do.”

Sean’s shoulders relax. He nods assent.

I give him a quick thank-you hug, then turn to walk back to triage.

Sean calls out, “Don’t make a habit of this!”

First and last breath – May holiday murders bring renewal

This week the western world prepares to celebrate the birth of a child born into poverty from an underage teenage mother who was traveling with an older man. After he grew to adulthood, this baby was crucified because he dared preach of a peaceful world.

The recent plight of America’s holiday murders finally opens public discussion about firearm access. America must face ugly realities already familiar to inner cities because an armed madman opened fire on innocent children and teachers at Sandy Hook Elementary School. America is shocked that this happened in the mostly caucasian middle class town of Newtown Connecticut. Only the week before there was a shooting at a shopping mall in a Portland suburb, and today another in small town Pennsylvania.

Sadly, American inner cities are accustomed to the slow slaughter of their youth. This video, less than 8 minutes long, addresses the increasing homicides in Oakland California and grass roots efforts toward solutions. Increasingly, children are collateral damage to the casual violence.

These inner city deaths occur with such frequency, either singularly or with only a few victims at a time to poor people with brown skin, that the press does not celebrate them. Murderers usually escape without investigation. Their annual death toll come to many times that of last week’s innocent deaths in Newtown Connecticut.

As of late November 2012, Oakland’s homicide count alone was already at 115 (link here).

The problem is greater than “gun control”. It’s a multifactorial issue of poverty, lack of opportunity, lack of direction, lack of educational resources, deeply embedded anger in a growing segment of our population, and more.

A nurse co-worker of mine recently posted this photo on facebook:

Oakland photo by Jennifer Carraher, November 2009, printed with permission

Oakland photo by Jennifer Carraher, November 2009, printed with permission

My work gives me the privilege of welcoming new babies in the economically and racially diverse Bay Area. Every week families discuss memories of a recently murdered loved one who will never meet the new baby to be born into my hands. The absent family member who was murdered within the last year is usually a husband, brother, father, cousin, nephew, uncle or son.

Bystanders are also shot but not necessarily killed. One laboring woman incessantly scratched at a tangled scar which had grown over shrapnel embedded in her arm. Several years before she did her best to dig shrapnel out of her arm herself, after she tired of the 10 hour wait to be seen in Highland Hospital’s emergency room. She had been splayed in crossfire because in her words “I was walking down the wrong street at the wrong time.”

Too many of my patients say, “It’s not safe to walk in my neighborhood” when I suggest they take a daily walk as part of an exercise regimen to help their diabetes or blood pressure.

Our nation is complicit in senseless shootings through collective acceptance of easy access to firearms and inadequate educational and work opportunities for the poor. Social inequities, lack of opportunity, mental illness, and poverty have historically been a recipe for small and large revolts. Small constant revolts have been occurring in America’s inner cities for years. The media pays attention now that this violence spills over to white communities.

During this season of rebirth, may we remember the only guarantee when a baby takes his or her first breath — there will be a last breath. Society can minimize the chances of a premature last breath caused by preventable violence.

Hopefully the mourning community of Newtown Connecticut inspires national discussion and some active solutions. For all our sakes.

Maybe therein lies today’s celebrated end of the Mayan calendar – the end of the world as we know it.

Robin Lim, Midwife, CNN 2011 Hero of the Year!

It is fitting that during the Christmas Season, On December 11, 2011, Ibu (Mother) Robin Lim was honored as CNN 2011 Hero of the Year!

Robin’s honor is also a victory for marginalized childbearing women and those who serve them everywhere!

Every December, Christiandom’s most celebrated holiday honors an unwed pregnant teenager traveling with an older man who was refused a room at the Inn because they were of the wrong ethnicity. Thus, Christianity’s deemed son-of-God was born with little notice in a barn. Despite religious honor given the eternal story of childbirth under duress, there has been little public recognition of the real problem of inaccessible maternity care for the world’s marginalized women.

Robin’s public recognition as a CNN hero this recent holiday season marks a media milestone for the importance of women, babies and families.

Like many midwives the world over, Ibu Robin cares for impoverished, abused, hungry, poor marginalized childbearing woman. Robin’s articulate passionate voice unrelentingly brings these issues to public attention with gentility and respect.

Many congratulations to Robin Lim for her well-deserved acknowledgement!

Robin began serving pregnant and birthing women on the island of Bali years ago because needy women came to her. Robin did not intend to become a hero; she simply could not deny the women who came to her. At that time, Robin thought that minimal care was better than none. Beginning on a shoe string, with their own life savings, Robin, her husband Will, and a few close friends and family began a rudimentary service to provide no-cost midwifery care for the needy near Ubud, Bali, Indonesia. She began attending homebirths on Bali’s dirt floors, eventually enough donations came to construct a clinic. For nearly 15 years Robin has worked tirelessly on behalf of the families dependent upon her care, often with little support and meager funds.
CNN “Portrait of Hero, Robin Lim”

Robin’s public writing and speaking on behalf of her passion slowly nourished growth of Bumi Sehat Foundation. By 2011, CNN’s team had narrowed their hero-finalists to a field of 10 heros, each are well-qualified altruistic award finalists,
Robin Lim was awarded the final “CNN 2011 Hero of the Year” $250,000 gift (in addition to $50,000 granted to each of the finalists). Robin’s nonprofit organization, Bumi Sehat Foundation International will use the funds for a much-needed expansion of existing services – clinics, birth centers and youth programs – in both Bali and Aceh Indonesia.

Click onto this line to view Robin’s post-award interview with CNN’s Anderson Cooper.

Bumi Sehat models low-cost health promoting care through education, support services, nutritional guidance, exercise programs, risk screening and transfer for medical intervention when appropriate. Funds and supplies come through donations.

Thanks to gentle consistent childbirth education and health maintenance programs, the majority of Bumi Sehat clients give birth with minimal or no medical intervention at Bumi Sehat’s birth center.

Robin’s nomination for CNN’s awared was supported by Christy Turlington Burns with her organization “Every Mother Counts”. Christy’s own harrowing experience with a retained placenta and life threatening post-partum hemorrhage, after a lovely peaceful birth, made her aware that other women in the world might not be so lucky as she. Christy thus founded her own organization to promote global access to maternal-infant care, “Every mother Counts” :

More information about Robin Lim’s work can be gleaned from the film Guerilla Midwife produced by her daughter, Deja’ Bernhardt :

Everyone in the field of maternity care hopes that increased publicity will expand access to preventative and gentle maternal-infant health programs.

Thank YOU Ibu Robin, dear old friend, for your contributions! You inspire us all, and motivate others to consider their priorities.

Society grows healthier from the micro the macro by beginning at the beginning.

The Twelve Nights of L & D

(Sing to the tune of “The Twelve Days of Christmas”)

On the Twelfth Night of L & D, the shift gave to us :

12 Sets of Twins

11 Triage Patients

10 Drunken Guests

9 Hypertensives

8 4th Degrees

7 Code Storks

6 Vocera Failures

5 …. CAT teams now…..

4 Nicked Bladders

3 Birth Plans

2 G-D-Ms

And a healthy baby in its mother’s arms…

The Strangest Job

“We have the strangest job!” Susan sighed while pulling up a chair at the nurse’s station next to Jenny. Jenny laughed while continuing with her nursing paperwork.

Susan sipped her coffee as she opened a medical chart, “I just got here,” she vented quickly to Jenny, “I walked into the room of a woman I’d never met. In less than ten minutes I’d introduced myself in Spanish and said ‘I need to put my hand into your vagina and remove blood clots because you’re hemorrhaging inside. Don’t worry. This will hurt. I’ll be careful. Oh you’re baby is so cute!’ Then I reached inside her vagina, removed a liter of blood clots, and apologized. I fussed over the baby in her husband’s arms, told her to breastfeed, hugged her, and left. She will never see me again. All the while I could only think about finding this other chart, and needing coffee. It’s not even 8 a.m.” Jenny laughed again, nodding in agreement.

Susan savored the warm brown morning elixir while reviewing a chart. For a nurse-midwife, it’s the most normal thing – another vagina, baby, placenta, blood.

Marta just became a mother for the second time, each interaction was memorable in her intensity of childbirth pain, joy and fear. Marta’s previous baby had been by cesarean section; this was her first successful vaginal birth.

Marta’s uterus filled with blood after recently giving birth on the previous shift. At Susan’s request, Marta’s young new nurse had already used a catheter to empty Marta’s bladder since a full bladder can prevent a post partum uterus from contracting to control blood loss. An empty bladder and anti-hemmorhagic medications pitocin and methergine had not helped.

Susan had just arrived and needed to act quickly. She made eye contact with Marta speaking with calm certainty to keep Marta focused, “Respira produndo y sople – Breathe deep and blow.” Susan’s gaze held Marta’s eyes with exagerated nodding her head to guide Marta with deep breaths, she slid her lubricated gloved right hand between Marta’s swollen labia through her vagina until forearm-deep into Marta’s most intimate area. Susan tried not to traumatize Marta as she felt a large masses of jello-like clots in the lower uterine segment. Susan scooped several handfulls of blood clots into a pile of beet jelly between Marta’s brown thighs. Susan felt the rough texture of the inside of the lower uterus clamp down around her fingers after removal of obstruction. Gently retracting her bloody gloved hand, Susan used her ungloved hand to massage Marta’s abdomen. Marta winced in pain while her uterus tightened to a round cantaloupe inside her soft abdomen. Marta opened her eyes “Ah, me siento mejor. Gracias! – Ah I feel better, Thank you!”

Marta’s husband looked woozy as he stood aside holding their new son. He said he was fine when asked. Susan directed him to sit down on nearby sofa and wondered if seeing a stranger’s arm inside his wife’s bloody vagina would affect their relationship. After washing her hands, Susan checked Marta’s blood pressure then gently placed her hand on Marta’s husband’s upper arm, “Todo está bien ahora. No se preocupe. – Everything is all right now. Don’t worry.” They made eye contact, smiled and nodded with reassurance.

Susan felt like she violated a woman when she had to take aggressive action before having developed personal rapport with a patient. Since she just arrived on duty, Susan and Marta had not met before. Regardless of feelings, Marta was now stable together with her husband and newborn – that is what mattered.

Back at the nursing desk Susan scanned the next patient’s chart for areas of concern. She quickly reviewed prenatal blood test results, blood pressures, diabetes status, weight gain, ultrasound results, uterine growth. The previous shift’s midwife had been too busy to complete the admission process for a recently arrived obese woman in active labor. Obesity carries concurrent high risk issues for pregnancy, labor and birth. Susan learned her new patient’s medical history, and quickly needed to complete a physical exam and admission paperwork to prepare for potential surprises. She was responsible for four other laboring patients – two diabetics, one with oligohydramnios, one with elevated blood pressure whose membranes had ruptured with thick meconium in the amniotic fluid before beginning labor. It was early in the day and Susan was already behind.

Susan smiled to Jenny again, holding up the right hand with coffee cup, “Really, who would believe what we actually do, where our hands go and what we say each day? While the whole time I only thought about needing coffee.”

Jenny laughed, “My husband has no idea. He gets nauseous if I mention even a little about work. Oh, I have a student nurse today, she’s been trained and is doing all my work for me. You’ve met Olivia before.”

“Hi Olivia! Good job! You’re lucky to be trained by Jenny. Thanks for taking care of the woman in room 20. She seems stable now so I’ll be in later; I have to check on some other worries first. Call me for anything.”

Jenny laughed, “You know we will!”

Susan stood up to meet this morning’s laboring women and their families.

“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 :

Mother’s Day for Peace

Mother’s Day began as an anti-war protest. Fifty years before America granted women the right to vote, mothers protested that they did not give birth only to send their children to war. Mourning mothers who lost sons and husbands in war directed their pain by advocating for peaceful methods of conflict resolution.

Hallmark came later.

Following the carnage of the American Civil War and the Franco-Prussian War, the lyricist for the “Battle Hymn of the Republic” wrote her 1870 “Mother’s Day Proclamation” to incite women to demand peace, rather than send offspring to war.

As we honor our devoted mothers with flowers and champagne, may we remember to assume co-responsibility to shape society and unite our voices – to protect all children.

Mothers’ Day Proclamation: Julia Ward Howe, Boston, 1870

Arise, then, women of this day! Arise all women who have hearts,
whether our baptism be that of water or of fears!

Say firmly: “We will not have great questions decided by
irrelevant agencies. Our husbands shall not come to us, reeking
with carnage, for caresses and applause. Our sons shall not be
taken from us to unlearn all that we have been able to teach
them of charity, mercy and patience.

We women of one country will be too tender of those of another
country to allow our sons to be trained to injure theirs. From
the bosom of the devastated earth a voice goes up with our own.
It says “Disarm, Disarm! The sword of murder is not the balance
of justice.”

Blood does not wipe our dishonor nor violence indicate possession.
As men have often forsaken the plow and the anvil at the summons
of war, let women now leave all that may be left of home for a
great and earnest day of counsel. Let them meet first, as women,
to bewail and commemorate the dead.

Let them then solemnly take counsel with each other as to the
means whereby the great human family can live in peace, each
bearing after their own time the sacred impress, not of Caesar,
but of God.

In the name of womanhood and of humanity, I earnestly ask that a
general congress of women without limit of nationality may be
appointed and held at some place deemed most convenient and at
the earliest period consistent with its objects, to promote the
alliance of the different nationalities, the amicable settlement
of international questions, the great and general interests of

Julia Ward Howe