Lately I’ve been going for walks up the mountain in the mornings. The trail winds steeply up through lush green forest. It’s a good way to clear my head and start my day with gratitude and peace in nature. Being in the woods allows me to step back from the work I’m doing, breathe, and reflect on whatever is swirling around in my head that day.
Today’s head swirls were about pathways and healing. My path has somehow led me to where I am now, in Concepción Chiquirichapa, Guatemala, walking up the side of a mountain. I’m breathing in the wisdom of this place and I’ve been embraced with love into a sisterhood of Maya midwives. I’m strong but delicate here, delving deeply into the work, yet still on my pathway to healing myself from the pain and losses of the last few years. The metaphorical path to here has been similar to the one I walked on this morning. Steep, rocky, winding, muddy, slippery, lonely, and beautiful.
July 26th marked the two-year anniversary of my younger brother Collin’s death. His death was not only painful in and of itself, but it also opened up old wounds from my older brother Brian’s death, 15 years ago. For the past two years I have worked relentlessly on my own healing, mostly around the losses of my brothers. It’s been awful at times, but necessary to find peace. Most of that “work” has been accomplished by diving into the pain. By sitting in silence with a candle lit and feeling whatever comes up. It’s occurred by embracing the darkness, which I have come to know so intimately. I’ve spent many hours alone in contemplation, done grief ceremonies, regular therapy, EMDR therapy, lots of writing, countless hours of crying, and lots of spiritual exploration.
Initially I wanted relief from the pain from external sources. I wanted comfort from my partner, from getting drunk, from anything easy. But these temporary comforts are not there all the time and once they would leave the pain would come back with a vengeance. I’ve discovered over time that most of the comfort has had to come from within myself, with some support and guidance from people I love or from new people who crossed my path along the way. Many have shown up to offer their lessons at just the right moments. I have also lost people in my life, both a significant partner and a few friends, who were not comfortable walking beside me in my grief and were not capable of holding space for the pain and having patience for the process.
Being in a relationship with someone who didn’t honor and respect the way that I needed to grieve created anxiety and panic in me because I attempted to alter the way I was dealing with my loss in order to keep my partner around, which was a human response on my part to avoid being lonely or abandoned during a time that felt impossible to navigate on my own. When someone that we love can’t show up for us in the time we need it most, it’s really fucking disappointing. It’s infuriating too. But it’s not about us- it’s that those people who squirm away from just sitting with the pain haven’t yet become intimate with that darkness in themselves. They haven’t yet realized that it’s that sweet tender painful core that makes us all human and that being willing to feel that sadness of another as if it were your own is the root of compassion. And so I dig deep (very deep in this case) to have compassion for them and to forgive. I’m grateful that the loss of my relationship catalyzed the decision for me to pursue this opportunity to work in Guatemala. International midwifery work has been a dream of mine for years and every day that I’m here I can genuinely say that I am making a dream come true.
As a midwife, I witness a lot of physical pain. It’s a good practice in holding space. When a woman is in labor there is often little I can do to ease her pain or make it go faster (just like grief). If I am tense, uncomfortable, or restless, she can feel it. All I can do is sit with her and be fully present with her process. She could be screaming, writhing, crying, and saying she can’t do this anymore, and as midwives we just remind her to keep breathing and hold her hand or rub her back until she gets through it.
On Monday night, the full moon, we had a delivery at ACAM of a 29-year-old first time Mother. She arrived with her Mother and Mother-in-law around 2pm. She reported that she’d been having contractions since the early morning hours. She asked for an IV so I started one, thankful that she was concerned about being well-hydrated.
It was a long and painful labor. She came in at 4cm dilated and progressed fairly quickly to 9cm, but then got stuck there. All her pain was in her back. Her baby was in the posterior position, meaning it was sunny side up, which can often make for a much harder and longer labor. Often times, these labors will reach 8 or 9 cm dilation and then stall out because the baby’s head is not coming down in the optimal way. They are usually characterized by excruciating back pain. She had been stuck at 9cm for about 4 hours and I was contemplating recommending that we transfer her to the hospital. The baby was doing well with a strong and normal heart rate. I attempted to rotate the baby’s head in hopes of helping it come down in a better position.
I knew that if we transferred her she would have an automatic c-section upon arrival, so we decided to wait a little longer and see if the baby would rotate and descend. She was incredibly strong and collaborative. Whatever positions we asked her try, she got into them. If we asked her to walk, she walked. If I asked her to put a leg up on the bed and bend and squat, she did it without hesitation. She was determined to get that baby out and her family members were unusually calm and accepting of the long labor. Many families become anxious and ask us to give medications to “make things go faster” or even start pushing on the Mother’s belly before she is fully dilated to make the baby come out (I just about lost it the first time I saw a Mother in law doing this).
Finally, around 10pm I checked her cervix again, dreading the possibility that she would be unchanged at 9cm, with an increasingly swollen cervix. To my delight, she was almost completely dilated and the baby had rotated and come down significantly. I pushed back the last bit of cervix easily and she began pushing. She pushed beautifully for about 45 minutes and delivered a healthy, vigorous, 7.5lb baby boy. Her Mother and Mother in law exclaimed their thanks to god over and over that the baby came out vaginally and that we didn’t end up transferring her to the hospital. Celebration and relief were palpable in the room, despite the usually tendency for Maya families to be extremely reserved in their emotional displays.
My excitement was dampened, however, when I looked down at her vaginal tearing and saw that she was EXTREMELY swollen and had torn deeply, starting high up in the vagina and extending down through the perineum and seemingly off to all sides in a star pattern. It was a mess.
I examined the tear and dreaded repairing it. We have suture material and lidocaine at ACAM, but there are no stirrups to rest the patient’s feet, the light source is not great, and I would have liked a second pair of eyes to assess the tear as I felt it was a partial third degree, meaning it involved the anal capsule (not as a bad as a true 3rd or 4th degree, which can tear all the way through the anus). I told her that given the complexity and the depth of the tear, I recommended that we transfer her to a hospital so it could be done there with better conditions by a OB/Gyn doctor (though I doubted how good the conditions would be and how skillfully the resident would do the repair). The patient REALLY didn’t want to go. The midwives told me that she would wait hours once she arrived there, since she wasn’t in labor. The patient asked if we could call some other doctor to come to ACAM. The midwives didn’t think that was possible. I told her that I could repair it, but that it would likely be done better at the hospital (maybe) and that she would need to come back in a week so I could look at the healing.
Most women here in rural Guatemala don’t have vaginal and perineal tears repaired. Most community midwives don’t have training in suturing or they don’t have the materials. The tradition here is for postpartum women to go into the temescal or “chuj” which is a traditional Maya sauna. There, they sit in the heat and steam and blood flow is stimulated, which promotes healing. They use medicinal plants to make medicated steam which is directed into the vagina. Their wound healing is excellent using these traditional methods, from what I have observed and heard. I hoped that between my repair and regular visits into the temescal, that this particularly nasty wound would heal and not create any problems with incontinence or poor healing later on.
I put on my head lamp, rolled up my sleeves, drew up multiple syringes full of lidocaine, numbed the patient as much as possible, and told the midwives to keep the sterile gauze coming as I dabbed and stitched for the next 1.5 hours. My back was starting to spasm and it was around midnight by the time I finished. I felt much better about the state of things once I was done, but still not entirely convinced that it was responsible on my part to do the repair. We gave her intramuscular antibiotics and a started a course of oral antibiotics to prevent wound infection.
She breathed a giant sigh of relief when I was done and we put the baby to breast. She smiled down at her son, David, who arrived on a stormy, rainy night on the full moon. He was born on the day of the Mayan Nahual Tzi, symbolized by a wolf or coyote. His path into this world was not an easy one, but he was greeted with joy and relief by his Mother and Grandmothers.
I went to bed exhausted from the physical and mental energy of the baby’s difficult passage into the world, worried about her healing, and thrilled for the gift of a new life. My pathway here to Guatemala was not easy and not accidental and so many events in my life, both painful and joyful, led me to exactly where I am. The journey or pathway to healing, to transformation, or to being born is full of obstacles which force us to fight and to grow. We may acquire a lot of scars along the way, but if we’re lucky we’ll find that midwife within ourselves that holds our hand, reminds us to breathe, and stitches up our wounds.