64. My Maine Birth: Mid-Week Midwife Episode with Ariel Bernstein
Ariel: 0:00
So, like communication was very limited, often about patients, we really didn't ever get to know anything. You try to ask a few questions real quick what's her name? What number baby is? This Is the baby term. You know, that was maybe it. There was a lot of things afterwards that we were constantly thinking we wish we had time to ask or get the information. What's her HIV status? Because that's something we need to think about there on a different level than we think about in the U? S. Just, you know, hemorrhage or other other things that, like, we don't even get to know.
Ariel: 0:29
It was really like this person having a baby right now. Here you go, so we're in the OR and all these things are happening, you know, and I ask, like, what is the? Why is she having a C-section? And they said, oh, compound presentation and fetal distress. And I suddenly I panicked so hard because I realized fetal distress. This baby's not on a monitor. They don't have electronic fetal heart rate monitors there at all. They have a pinnard horn.
Ariel: 0:59
I start thinking how long has it been since this baby was monitored? What was its last heart rate? What? What is the thing that told them that this baby is in trouble enough to have a c-section, because the c-section is, like you know, that's a big thing for them to decide to do there. There's a lot of implications to that, especially also because the average woman there has five, six, seven pregnancies in her life. Having us, and this was the first baby, so this is a major impact. So we're like, okay, and I just started to think is this baby still alive or what is the condition of the baby? We have no idea. And this baby is going to come out and it's going to be handed to me and I'm now responsible for it and we're looking at what supplies we have in the OR for the baby and we had basically a bulb suction and a PPV bag and that's it. There's nothing else.
Angela: 2:00
I'm Angela and you're listening to my Main Birth a space where we share the real-life stories of families and their unique birth experiences in the beautiful state of Maine. From our state's biggest hospitals to birth center births and home births, every birth story deserves to be heard and celebrated heard and celebrated. Whether you're a soon-to-be mom, a seasoned mother or simply interested in the world of birth, these episodes are for you. Welcome to a midweek midwife episode of my Main Birth. Today's midwife guest is Ariel Bernstein of Saco River Midwifery. This is Ariel's second time as a guest on the podcast. She shared all about her journey to midwifery, as well as her own birth stories on episode 12. When I interviewed her for episode 12, it was June of last year and she was getting ready to start a year at Harvard to pursue her master's in public health. And she is back today to share all about how her time at Harvard's been going and also about her recent trip to Uganda, where she was able to work with midwives to help teach them how to do simulation training so that they can continue to educate more midwives in their country. During her visit, ariel was able to see firsthand the many hardships faced daily by the midwives and doctors.
Angela: 3:28
Ariel is currently on a mission to raise enough money to purchase Doppler's. Her goal is to purchase one for each facility that sent midwives to the training. She needs to raise two thousand dollars to make this happen. So if you have any interest in contributing, please message Ariel. You can find her over on Instagram at SacoRiverMidwifery, or you can send her an email over to midwifeariel at gmailcom, and, of course, I'll have all of her information linked over in the show notes. Also, if you're a home birth family and you have supplies left over, or if you're a midwife and have extra supplies that you don't know what to do with, please reach out to Ariel. She's putting together some care packages for the midwives that she worked with in Uganda. Now, without further ado, let's get into my interview with midwife Ariel Bernstein. Hi, ariel, welcome to to my Main Birth, hi, hi. So to jump right into it and pick back up right where we left off how have you been? How is your year at Harvard going so far?
Ariel: 4:39
Yeah, it feels really wild to think like how close I am to graduation now. It's like one of those things when you're in it it feels like this is going to be forever because it's very hard. And I knew like grad school would be challenging and I guessed that Harvard would be a high pressure academic environment, but I think even then it's. I underestimated that. I think a lot of the challenges too have been balancing being a parent while being a full-time student, because it's more than a full-time job to be in school and it's challenging. So that's been a huge adjustment to figuring that out, and part of it is because the schedule is very unfriendly to parents. Some nights I have class till eight o'clock at night and you know somebody still has to pick the kids up from school and all the things, and that was a big adjustment.
Ariel: 5:28
My kids were homeschooled before we moved here. We had a very different schedule, with me being on call as a midwife and things, and now to move into like a very rigid schedule was a big change for all of us. But my kids really actually really like being in school, which which was, I think, surprising for all of us. I know like in the homeschooling world. You know there's a lot of things about, you know, ever going back into public school, but my kids have had a great time. They're in a. They're in a charter school. They they wear little uniforms which the novelty may or may not have worn off. About that, but I love it because I don't have to question what anybody's wearing to school today. You put on your uniform and it's great. So, yeah, school has been really hard.
Ariel: 6:10
The first half of the program is there's very little room to choose our classes. It's really all of the core, foundational parts of the Masters of Public Health program and I was just very proud to survive biostats and epidemiology. I'm not a very math oriented person or a qualitative research person and I feel like, through everything, I will be most proud that I got through the Harvard biostatistics course. But yeah, I think the best part of my program has really been like the people that I'm in school with. I think the best part of my program has really been like the people that I'm in school with. I'm incredibly inspired, like every day, by the people I go to school with and what they're passionate about, and I feel very honored to be with people that are, I know are really going to go out there and change the world in so many ways. So that's been a very, that's been a really beautiful part of the program. And I think now that we're in February and the school's starting to talk to us about graduation, which is like wait, but we're only halfway through, but it's like it's just moved so fast so everyone's starting like there's a bit of like a sadness now about like not being together anymore and that we're all going to go off on our on our own paths. And this semester I've I really got to choose, take all my electives and choose everything, and I was accepted into being into the humanitarian studies concentration and I'm really focusing my work right now on different aspects of humanitarian work in Uganda and being able to evaluate the experience of the midwives that we trained with the program and how it's impacting their skills and how they feel about handling certain emergencies going forward. So I'm really excited to be able to be doing that work and continuing it and seeing how it can impact other things and, yeah, I'm mostly just really excited to be a part of all that research right now.
Ariel: 8:06
I think you know, before starting school, like as a midwife, I saw myself as a healthcare provider, but I never really saw myself as like somebody in science, like I think sometimes other medical professionals see themselves certainly doctors. I feel like a lot of doctors see themselves as like also scientists, and in science and in midwifery we really talk a lot about like the art of midwifery, but we don't talk a lot about the science of midwifery. So it's been a really exciting thing to really get to be more a part of the science of midwifery now and really think about how research and, yeah, what role research plays in in making midwifery better and making maternity care better. And I really, through this experience I'm I'm the only midwife in school heard there was one like a year or two ago, but I'm currently the only one and I've talked to a lot of people from, like the administration and the program about the need to recruit more midwives into public health and into doing research.
Ariel: 9:10
Because I think part of why you know midwifery is marginalized in so many ways for so many different reasons, but I think one of them is that we're not really typically a part of the research that's going on. We're not the researchers. We're providing care and we're providing excellent care, but we're not doing the things to show, like the impact of what we do or how critical it is in a lot of ways and I know most of the research that I ever read about out-of-hospital birth and CPMs comes from a very small group of people, mostly coming out of Best Year in Washington, or this woman, melissa Chaney, who I really hope to meet someday because I've read all of her stuff but I feel like we need so much more of that in order to really be showing like it's not just this one research article that proves this one thing that we all know. You know that there's a whole body of knowledge that shows that what we're doing is working and I think the way that the medical system as a whole functions. It really functions based on, you know, best evidence and best practices. And we need to be making sure that we're a part of that evidence right now and we're not just having it dictated to us or the things that we know that work, that we're able to really show it so that we can really work with the greater medical community and say you know we do this this way, but we can prove why this works. Because, as much as I feel like a lot of us are hesitant to do that because we're like, well, we know it works. Why do I have to prove it works? But I think in being able to become better integrated into medical systems and have the level of respect that we deserve as providers and the level of integration that we need to practice safely and to practice, you know, the way that most midwives really want to be able to, in a really integrated and respected way, way, then we should be able to have that data that shows that. You know, this is why this works, this is why this is safe, this is why collaborative care is really important, all these different things, and I think that we're lacking some of that in this country because midwifery continues to be marginalized and pushed to the side and often viewed as something that's not, you know, that's really like peripheral to the medical system instead of something that's a part of it.
Ariel: 11:28
I think having the experiences that I've had now like being exposed to a different level of like academia and research. I'm also a research assistant for the Maternal Health Task Force at Harvard, so I read a lot of research articles now and part of my job is to work on this research updates that go out and I see everything that's coming through PubMed related to maternal health, and studies don't have to be huge. Sometimes they're very small, but we know how much of an impact a small study can have. Like the ARRIVE study that now is used constantly to push for inductions at 39 weeks is a pretty small study that is now really used to like. Suddenly, this should apply to everybody, and I think that's, you know, highlights a the importance of people being able to understand research when they read it and understand like is this a good study? Is this something that should be applied to everybody or not? What does this study actually mean? And also, where does research come from, you know? So sometimes, yes, it's funded by other things. Sometimes it's driven by.
Ariel: 12:39
I think a lot of times in our country, though, it's driven by researchers, academics in institutions that are, you know, they have their niche thing that they work on and that's what they continue to publish on in research, you know, and what people are doing, like their, their PhDs and in dissertations and different things. So I think we have the opportunity actually to be able to do more research, but that we need to also then encourage more midwives to be researchers and to be scientists and to take what they know from their practice and their experience and be able to share that on a much bigger scale to really help impact midwifery care. I can just think of so many things where specific studies are used to really harm midwifery a lot like the wax study, and to say that, like out of hospital birth is so dangerous, when we know that there's lots of other things that counteract that. But they may not be as well known or there may not be, it may not get as much attention. So I think a big thing that I've learned through this too is my desire to encourage midwives to be more involved in if not, like you know, always creating research, but but but being engaged with it, knowing what's going on, reading things that come out, you know, sharing it, talking about it.
Ariel: 14:02
I know how hard it is when we're in practice just to keep up to date with basic things. There's so much. The body of knowledge is, just, you know, immense and overwhelming all the time. You know, we all want to be doing the best things for our clients, our patients, and taking the best care of them, and that requires constantly staying up to date, right, that's why there's a whole the website, the portal up to date because it's a challenge. Nobody can do that alone, to just know whatever the most recent thing is.
Ariel: 14:32
But I think this is a thing where midwives in general in America need to be more at the table, have a bigger voice and be more involved and be guiding some of this, because I think a lot of the research sometimes is done by people who they're not providers, or if they are providers, they're obstetricians. You know they're not doing what we do. There's not very many people at all who are doing what we do, who are publishing research on it, and that could be really beneficial when we're, you know, we are negotiating things or there are, you know, there's legislation or there's different things that are happening and we can say like, okay, but here's the evidence for this and I think, especially as we see throughout the country, legislative efforts to harm midwifery, make it smaller, cut down people's scope of practice, all these things that we need the research that shows that counters that and helps move our profession forward. Do you have?
Angela: 15:31
plans to do something like that, to start creating some of your own studies, and I think you make a great point that a lot of these studies are not done by midwives that are doing this work that you're doing.
Ariel: 15:42
Yeah, and I have to say, like when I first wanted to go to pursue this degree and to go into public health, like I never thought about that aspect of it. It really wasn't on my radar, it wasn't something that I thought excited me or that I was interested in. And the more I've been exposed to it, though, the more I see that gap and the more I feel like that's why we need midwives in public health. That's why we need midwives in public health, that's why we need midwives in academia, because those things dictate what we get to do. Right, and if they're dictating what we get to do and we're not a part of that process, like we're being left out. And you know, every midwife I know that is experienced can tell you, like you know, that they do things a certain way because it works, but we struggle to be able to prove that when it comes to fighting for our right to practice. Or, you know, when we interface with other providers or we have to deal with a hospital or a doctor, that is like well, that's not how I do things, and unfortunately we don't always have a culture of mutual respect where one provider says well, I do it this way for these reasons, but maybe you do it this way for these reasons. Instead, it's often just like a very hierarchical concept of like we do it the right way and you're just not on our level, and that's not what is really happening right.
Ariel: 17:01
Midwifery is not lesser than obstetrics. It's a different profession with different goals. We all have the goal of healthy pregnancies and and safe births and great outcomes. That's universal. But how we achieve that and where we're coming from and why patients choose different care providers and what you know is very, very, very different, different. A very low risk birth happening physiologically in somebody's home is an incredibly different experience than a high risk pregnancy happening in a high level tertiary hospital, and they can't just be interchanged, right. So to say that one way is right and one way is wrong, or one way is better or one way is lesser, is not accurate. We're highly skilled, we're highly trained, we are good at our jobs and we have excellent outcomes because we're good at our jobs. Right, I now know exactly what it looks like to be in a situation where even people who are highly skilled, when they don't have access to the tools that they need to make birth safe, can't have good outcomes, which made me feel even stronger about the importance in America of making sure that midwives are integrated into the system, because that equals safety. And I, as I say that out loud, I can like hear midwives I know saying about why they don't want to be integrated into the system and I I respect those, those feelings, but I also see where that creates difficult situations for people.
Ariel: 18:32
We need to access a hospital because we're trained to recognize when something is no longer in the realm of normal and it's no longer low risk or we have unexpected emergency that we're trained to identify and manage. And part of that management means that we need a higher level facility. Maybe we need medications that we don't have, or we need an OR or we need whatever we need we have to have immediate access to that and if we are in situations, especially in rural communities so I think it's very specific to a lot of home birth midwives who are practicing in more rural areas throughout the country If we're shutting down maternity hospitals, we're closing labor and delivery, we're making it harder and harder to access it, we're creating barriers so that midwives can't work together with obstetricians when we need to, or we're making it so that people can't get ultrasounds or lab work or basic things that are a part of creating and delivering safe, comprehensive care, then we're making midwifery less safe. We're making giving birth outside of the hospital less safe, and it doesn't need to be, because giving birth outside of the hospital is not inherently what's not safe for people who are low risk and appropriate for that care. Not having access to what we need to make it safe makes it not safe body of knowledge that we have from our experience and our training and our lived experience of being a midwife and delivering that kind of care, to be able to also have the skills to go into that space of public health and research and really be there to be a part of the legislative process, to be a part of these conversations and not be kept out all the time. That's really was the catalyst for me of wanting to go into public health was that I saw what kept happening in our state and other states throughout the country, and that was that midwives were kept out of the process over and over again. Laws would be written in a way that made no sense for the reality of how we practice. We weren't invited to be a part of it. We were seen as something that should be shut down or stopped or controlled, and that's ridiculous because, also, people want to have their baby at home and freestanding birth centers, and freestanding birth centers are tremendously growing in this country.
Ariel: 20:57
The New York Times and the Washington Post in the past few months did huge articles also about how women of color are seeking out birthing centers more and more and more for their own safety and well-being, that those kinds of facilities and midwives are able to meet those needs of those communities at a much higher level than hospitals are, and we need to listen to that, we need to honor that, and it can't just be saying that like no, no, that's not safe.
Ariel: 21:24
We have to shut that down, especially when it comes to listening to the voices of birthing people of color, because they are the ones who are most affected by all these policies. In our country. We know this. They are dying at rates appallingly higher than birthing people who are identified as white, and when we talk about like the maternity care crisis in America or why our maternal mortality rate is so high, you know midwifery is really an incredibly important part of answering that question and closing that gap and providing the kind of care that's needed to make birth safer here. So demonizing it and saying that midwifery makes birth more dangerous is not helpful. It's not listening to those populations, it's not honoring their lived experience or their desires or their needs, and we need to work on that. And then that just brings me back to like we need more midwives in public health and policy work.
Angela: 22:21
Yeah. So now tell me about your trip to Uganda. How did that project first come up for you?
Ariel: 22:29
So we are required to do a practicum. We don't do a thesis for our masters, we do a practicum that we have to create research around and deliverables around, but it's very open-ended. It's so open-ended that at the beginning of it everybody was like panicking. They go like what do we do? Though? Most people in my cohort so I'm in the Masters of Public Health, global Health and Populations cohort and most of the people in my cohort are medical providers already and the far majority of them are doctors. Most of them are surgeons which is always like a joke in our group. I'm like, I'm not the surgeon. So a lot of them did things focused on the work that they have already been doing. Also, I'm really honored to be in a cohort. That is I should do like the actual number on it, but I feel like it's around 90% students from outside the US, so we're a very global body of people.
Ariel: 23:21
So people were doing work all over the world and I met somebody actually during orientation week who is Kathy Hahn. She's an obstetrician from California and she just recently retired from practice after I feel bad, I should know the exact number between 15 to 20 years of practicing as an OB in California and she is in a different cohort than I am, but we met. We started talking about our mutual interest, obviously, in birth and maternity care and that we both had an interest in obstetric emergencies and obstetric emergency training, and through many, many months our project developed and evolved. She had contacts in Uganda. Our very original project was looking at actually scaling the ability to have C-sections. There was a case somebody had died because they weren't able to access a C-section when they needed it and that was the first thing that we were looking at training midwives to perform C-sections in situations where there are no other options. And then, through a very long process of working with different organizations in Uganda and talking to people, and then we moved to the idea of education around vacuum extraction when we don't have other options. In second stage, to facilitate, like an expedited delivery and when that, when that could, might be life-savingly necessary. But there are a lot of issues around that about supplies and how they get used and different things. And so, as it kept developing and we connected with the Busoga Health Forum, which is based in Jinja, uganda.
Ariel: 25:02
Jinja is the second largest city in Uganda or the third, it depends who you ask, I found I think the numbers go back and forth, maybe between different regions. Kampala is the capital and Jinja is about an hour and a half two hours. It very much depends Further east, right on the shores of Lake Victoria and right at the where the Nile River begins. It's a really beautiful region. So we worked with Jinja Regional Referral Hospital, which is the highest level facility for the Jinja region, and the Busoga Health Forum, which works with a multitude of different NGOs and different partners and the Ministry of Health there on creating a healthier Busoga, which is the greater region, which is also called the Kingdom of Busoga. I learned all about how Uganda has kings, but also a parliament. It's a very interesting system. So we worked with them to really identify and doctors from the hospitals to really identify what are their needs, what can, what can we do? Because the most important thing in in this kind of work is to you know you need to meet the needs of the people you're working with. It's a very colonialized thing to think like, well, we're just going to come in and do this thing for you and tell you what you need or how you should do it. Right, so working with how do we respect and honor this community, their needs, what they want to benefit from, and we created a plan to do simulation training. A multitude of organizations like the WHO and partners in health and lots of really large INGOs are really focused right now on increasing the capacity for simulation skills training as a means of, like, better education, better preparedness. So for this, this region, they currently like they didn't have that.
Ariel: 26:52
So our project was to create the capacity for simulation skills training for obstetric emergencies. That was the that's the title of our project. So we were able to apply for and were awarded a competitive fellowship at Harvard School of Public Health called the Rose Community Engaged Learning Fellowship. That's where we got the money to be able to do this. It paid for our flights, it paid for our expenses there and we part of our funding was to purchase two obstetric simulator. One is called a mama natalie from lairdal, which is being used all over the world to teach about hemorrhage and is an excellent simulator, and the other one we wanted a different kind of. We wanted two different kinds of simulators for to be able to have different kinds of hands-on practice. But the other, the mama natalie, is like soft and what person like holds it like. It looks like a, like a belly, and it has a baby called neo natalie, which you can also practice for cessation maneuvers on. And the other one we bought is a hard model of it's like from like mid thighs to chest and it has two. It comes with two babies so they can also practice twin deliveries, which are not uncommon for them, and you can also feel like the bony markers of a pelvis inside. So it presents a different kind of experience for the person who's practicing. And we we brought these models.
Ariel: 28:22
We had two groups of midwives for two days each, so we did a total. We trained a total of 40 midwives, so there was 20 in each group. They came from different facilities throughout the region and we had come with a list of the emergencies that we were going to review and practice together and every day that shifted because really you know, we came in with a certain set of things and limited knowledge about how those emergencies were handled there. We had received from Busoka Health Forum, like the Ugandan Ministry of Health, their guidelines for management, so like the national practice guidelines. So we had reviewed those and tried to get more information.
Ariel: 29:08
Communication was often difficult before we got there, so we went in with the best understanding that we felt like we were able to have, but it became very clear that if you're trying to teach people, for example, with a hemorrhage, to use drugs in a certain order and in a certain timeline, but those drugs don't exist, that's really going to change what you're doing, right. Or if you're talking about you know just, I feel like the way I was trained for emergencies was to have this incredibly standardized way of handling it and you know how you escalate that emergency as well, right, how you get more help or how you you know what is the next level and recognizing that the next level is often not available where we were. So it really like our perception of also like how to teach things, how to go about it, changed every day, learning, really trying to understand how it was different at the different kinds of facilities. So some of the midwives were from hospitals, some of them were from what they called health centers and there was different levels of health centers that often really dictated what kind of like surgical capacity was available or other options. And, as much as it's everybody everywhere's goal to have a very low C-section rate, we know that, like, surgical capacity is life-saving in birth sometimes and it's necessary. So if you don't have surgical capacity, if you can't have a C-section, that really changes maybe how you're gonna handle something. Likewise, if somebody is hemorrhaging severely and you have limited medications or you can't get a blood transfusion, this changes things.
Ariel: 30:50
I think one of the more shocking things to really witness and experience was also the limitations around neonatal resuscitation and that really there was very, very minimal equipment. Really, there was very, very minimal equipment and the most that they typically have is like bulb suction and an ambu bag and that's it. It was difficult to often think about how I have more equipment myself sitting in the back of my car when I was practicing every day. Right, then they had in the hospital. I had a birth a little over a year ago where there was significant bleeding and I remember I I ran out of gauze and thinking like, oh, that would never happen in the hospital. Right, they have endless gauze, they have endless everything and having to like in that moment, improvise, figure things out. And then from now on I carry so much gauze Everybody makes fun of me about it because it was like, why do you have 12 packs of four by fours in your bag? And I'm like cause I'm never going to run out again.
Ariel: 31:58
And then being in a place where that we didn't even have that, we didn't even have gauze, like there was nothing, sometimes there was really nothing and how do you just completely approach things differently? And then how do you help somebody improve emergency response skills with so little tools? But it also really drove home the importance of training, because the complexities of getting more supplies is, I mean, it's insane. You know there's so many problems. There's so many logistical issues, financial issues, corruption issues. I mean it's a very, very complex problem about why are there not the supplies there needs to be and to fix that is, you know, there's. There's organizations all over the world trying to fix those problems and aren't able to do it Right. So we knew, like we're not able to do that, we can bring attention to it, but like I can't fix that, but I can help people have better skills so that in the moment they have that knowledge to draw on, so that even if they're like, okay, I don't have this thing, but I remember I could try this other thing, you know, or just approach it, maybe approaching something differently.
Ariel: 33:16
I think in the U S we're really really deeply trained. It's really ingrained in us as midwives to work as a team, and I'm not saying like there aren't people who practice alone. Or sometimes you, you end up at a birth alone unintentionally. Somebody is just having a baby really fast, right. But in general in medical education at all levels we're taught teamwork, communication, how we communicate, communicate, communicate. I will never forget when I got yelled at by a preceptor because I was managing a shoulder dystocia as a student and I wasn't communicating because I was so in my head trying to think through the next steps and they were like never again.
Ariel: 33:49
You have to say what's happening and you know just how much that's ingrained and how a team interacts and how you know, if we are all trained about, this is the steps that we're supposed to take. Then I don't have to tell the other person to get ready to do this thing. They know that they are. They're ready to do it because they know what to do next, the same as I know what to do next.
Ariel: 34:11
And that we found is really not typically how they work there and the midwives are often really alone. And even if they're not intentionally alone, they're. They're caring for so many people all at once that it's impossible to have that level of teamwork. You know, in a U S hospital you have one-to-one nursing, you have a provider that can bring in more providers, like immediately. That that's of teamwork. In a US hospital, you have one-to-one nursing, you have a provider they can bring in more providers immediately. That's not there. It really was like if you're at home and there's just the one of you or just the two of you, that's it.
Ariel: 34:41
So I think Kathy and I always brought different perspectives to things. I'd never been in that low of a low resource setting before, obviously, but I had the experience of knowing what it's like to you can't immediately have more team members. If you know everybody's worst nightmare of like mom needs help and baby needs help now simultaneously and you have only this. You know one or two people and how are you going to do that? But that's what we train for and that's what we're prepared for and so, having that experience, I saw like how much that was helpful for me and in Uganda to to know what that's like. Okay, I do know what it's like to not be able to have more help. Okay, if you can't have more help, what else can we do? How can we manage it and they just deal with emergencies, I think on such a higher level than we do so much more frequently. It's a very high rate and for a lot of also different, very complex reasons that are very hard to break down and address. Yeah, so we, we, we were constantly adapting our training and through feedback with the midwives and really just asking them like well, what emergency then do you want to talk about? Cause we're here, like, let's do it.
Ariel: 35:54
I think I gained so much respect for the idea that somebody just goes to work every day doing that, you know, every day, not knowing what resources they'll have or what they're coming into and not being able to like plan for that but just be adaptive to it, and how incredibly, really, just like brave and resilient these midwives are.
Ariel: 36:18
I I really have like never felt more proud in my life to be a midwife, to call myself a midwife, I think.
Ariel: 36:24
In so many settings I have always felt like I have been made by other people to often feel like lesser than because I'm not a doctor kind of a thing, especially in dealing with the hospital, especially during a transfer or something you know, and it's like, oh well, that's the midwife.
Ariel: 36:37
And even in situations that felt like more respectful. It still was like but you're not a doctor, right? And in that situation, like I never felt that you know, even I saw between the midwives and the doctors there's a lot of hierarchy there, but there was a tremendous amount of respect for the work that midwives do and the dedication that midwives have and that most babies who are born around the world with a skilled attendant, that skilled attendant is a midwife. You know, america is a very unique place that we assume that birth should happen with a doctor and not with a midwife, and I think that we have proven now the detriments of that system for so many reasons, with outcomes, with costs, with a lot of stuff. But it was a really soul nourishing moment as a midwife to be in a place where, while you're witnessing all these really difficult things, but also to feel like what an incredible thing we do as midwives we're not lesser than anybody.
Ariel: 37:49
We are so critical to birth throughout the world and I really wish that, like American midwives, like, who have never been able to experience something like that, could experience that in their life to see, like you are part of the most incredible sisterhood of people that are doing this work that you do every day and are, you know, welcoming babies into the world, are taking this journey with families in the most extreme of settings and still, like we do this because we are called to do it, and I think that that was like a very powerful, wonderful thing and I felt so. I felt so like welcomed by them, you know, because they were like, oh, and they call each other sister. You know, a midwife is a sister, so they'd be like this is sister, so-and-so, and I, you know, I was sister Ariel and like I was there with them, I was a midwife with them, and that felt incredible, cause I was like, yeah, look, midwives, like we can change the world. We are, we do it every day and we might be very much like the unsung heroes of birth, but we're not lesser than anybody. We are so critical for what we do and what we know and how we know how to do it because it's different for what we do and what we know and how we know how to do it. Because it's different. We're not taught to perform surgery. We're taught to to use our mind, our body, our heart, our hands. You know all of it in a in a different kind of way, and it was.
Ariel: 39:27
It was a tremendous honor to be a part of that and to learn from them and to get to then work alongside of them, which was not an anticipated part of our trip. We were like, cause? Everyone's like, oh, you're going to deliver babies in Africa. And I was like, no, no, that's not what I'm going to go do. I'm going to go work with these midwives. We're going to teach them how to do simulation training so that they can keep practicing. They can keep having that available. The simulators stayed there. That's theirs now. You know we brought resources about how to keep doing simulation training. We're in contact with them. We want to help them keep growing that capacity.
Ariel: 40:01
I'm working on another project for a different class right now about how to scale this so that they don't just have two for the entire region that we're going to get more similar. Everyone's like can I get one for my hospital. Can we practice this at my hospital? I think we take it for granted in America how much we do continuing education and skills practice. And for NARM certification you know we need to have I forget the number it's like 20, 30 CEUs every three years. We need to do it for our license in Maine. We need to do NRP every two years in BLS and we are constantly being retrained, upgraded, making sure our skills are there. That's not available to everybody everywhere. So helping support them to have the ability to do that, I really believe it'll make a difference. I really believe it's going to save lives.
Ariel: 40:50
And then getting feedback from them every day while we were doing the training and trying to understand, like what do you mean you don't have this? Like what do you mean that doesn't exist? Or trying to like, really understand, like why or what does that look like, or how do you do it without that. So we had had a brief tour of the hospital one day, but and it was shocking, I'll be honest, but it was limited. So it was kind of like, okay, what does that look like all day, every day.
Ariel: 41:18
We had one day off from the training in the middle and everyone's like, oh, like thought we'd go to like do touristy things. But I was like, no, like we, we want to go visit other hospitals. So we spent the whole day we hired a driver. We spent the day we visited other facilities. That was really helpful to really see, like, the differences and the similarities. What is everybody dealing with? What resources do they have? What does this look like in different communities? And I'm sure it looks different, you know, throughout the country or, but it was good to just see, in that region, with the people we were working with, what those resources look like. And then that was really helpful in going back with the people we were working with what those resources look like. And then that was really helpful in going back in the next day, like how you know how we're going to do this, how we can talk about things One day after the training.
Ariel: 42:00
I just said like I'm going to go visit the. Maybe some of the midwives we've met are working right now. We can go visit them and they'll maybe they will kindly let us, you know, hang in the corner or observe or shadow them or something to you know. Then we came and we showed up and this midwife was like, oh, are you here to work? Uh, are you here to help us? And we kind of just looked at each other. We're like, uh, you know cause? We're like can we help? Like is that allowed? Like how does that work? You know, everything in America is like regulations, right.
Ariel: 42:32
So and then somebody just came out from a room and was like oh, dr Kathy, we have a baby that's been asphyxiated for 15 minutes. Can you help us? And she was like what? And then she just went off. And then I somebody was like well, we have four mothers delivering right now, so can you come over here? And I was like sure, and that, like that was our night then. And then we're like okay, I'm doing that, you know, then, every day. That's what we did and I'm incredibly grateful for that, because I learned more from that than being able to be in the classroom talking to people, right.
Ariel: 43:09
Then I really saw A. It was a lot worse than I thought in the sense of like the lack of resources and some of the conditions, and it just it was heartbreaking. There was like a moment where I was just in the corner for a second. I felt like I kind of froze inside, thinking like I was watching this woman, I was like, oh, she's going to give birth and like, this is it. You know, this is her birth experience and I think it's really impacted me how I think actually about a lot of things about birth.
Ariel: 43:41
We focus so much on our experience in America because, generally, we get to take a lot of the safety concerns for granted. We get to take a lot of the safety concerns for granted and, in the sense that we just believe that we have these things available right so we don't have to worry about it, we can put a lot of our effort and I I'm a mom. I've had two home births in two different countries, so I've had different experiences, but both times I never had to question like, are they going to have the things they need to save me or my baby Right? Like we will be safe? And I got to, you know, decorate my birth space and have my birth tub and all these wonderful, beautiful things that are.
Ariel: 44:24
You know, they were important parts of my experience and how I gave birth and just, yeah, it was really hard to think about that that you know there was a room filled with women and I remember at first too, I was like wait, how do you know who's in labor? Because they're all just kind of wandering around the hospital because there's nowhere for them to really be until they're ready to give birth. They kind of just walk around and then when they're like feeling different things, they might come up to one of the midwives and say, like something in the midwife will check her to see where she's at, to determine whether or not they should do something, but like that's kind of it. You know, you're not like in your own room with your own bed and you're like that's it. So and I kept thinking like at first I was like how do you even know who's laboring? Like how? Because they were very quiet. Often I'm used to like really encouraging people to like make noise and all these things. And they said, oh, that's like a cultural thing that it was viewed as like to prove that you're strong enough to be a mother. So they wouldn't make noise and they would be quiet and trying to really like hide maybe the pain or the you know, the discomfort or whatever they were feeling. So that was kind of like a very different thing.
Ariel: 45:38
By the third day I got a little better at recognizing who was in labor in a different way, but also just because they're doing, they do prenatal visits all at the same time, all in the same place. So there's just like, very pregnant people everywhere for all different kinds of reasons, and most people are relying on the support of the family member that's with them. Often they have multiple family members because that's really who's caring for them and who's going to provide them with postpartum care, and that's not any lack of the midwife's desire to do any of that. It's really. It's a logistics problem. There's one midwife to maybe every 20 or so people, depending on the volume that day. At that hospital they had somewhere between 15 to 20 births a day and they might have two or three or four midwives. It seemed like it depended.
Ariel: 46:22
I was always trying to like understand that, but there were other facilities where they had that many. You know, they had that kind of volume and they had two midwives at a time and that's it, and one of, and that's it for all of the laboring people, all of the postpartum people and all of the prenatal people. So how on earth could you be, you know, providing like the kind of support that, like I'm, I'm used to providing, or, like you know, sitting there with somebody through their whole labor, all that kind of stuff, like that's not what's happening there, so and they just can't. There's too many people. So that was like a very that was a big experience to have and to really think about that.
Ariel: 47:02
And I'm always I've had a really strong interest in for a long time in in birth trauma and how do we reduce trauma. And I've been a very big believer for a very long time that traumatic things can happen in a person's birth in the sense of like emergencies or things don't go the way we anticipated or planned for. But we can reduce trauma when people feel very engaged in their care, like they always knew what was happening, like they were always respected and heard. I've had people go through really traumatic things but in the end they said they didn't feel traumatized by it because they said like I understood what was happening, I was you know, it wasn't just like happening to me. When I've worked with people who have a history of birth trauma, that's usually what they say is was really traumatic, was just feeling like things happened to them. They had no idea what was going on, nobody was talking to them, they weren't a part of what was happening, they never got to make decisions.
Ariel: 48:02
So it was an interesting thing to really be in a position where there's very little like dialogue between providers and patients and you know, some of that is like cultural. There's very different expectations about what that looks like, about what consent looks like, how procedures are done. I remember at first I was the first mother that I I caught her baby there. I was like trying to like talk to her and get permission and I was like, can I touch you? Can you know all the things like I'm used to doing, and everyone seemed around me was very confused, like what is the white lady midwife doing right now? Like, honestly, because people were just like, what are you doing? Like you know? Just different cultures, different expectations, different environments and different resources. Right, time is a resource. So I think time is a resource that I realized I had taken for granted as a midwife too, and how much of a resource that is in the kinds of the kind of care that I was used to delivering. So, yeah, and then that was that was it.
Ariel: 48:59
We came, we came back home and nobody got malaria, which we were very, very grateful for, and now the work is really how do we take everything from this experience personally, professionally, academically and you know what do I do with it. I came home really feeling like this changed my life. This changed who I am as a midwife, this changed who I am as a mother and like as a as a human citizen of the world. Um, and how? What do I do with that now? So I am really excited to be able to be working on that research and I do have goals of of publishing things, though we'll see how lofty of a goal that is continuing to work with busoga health forum and the, the doctors and the midwives that we met there. And how do we keep this kind of program going? How do we keep this kind of training happening? How do we reach more midwives? You know we trained 40. That's a drop in the bucket Like there's so many people.
Ariel: 50:06
So part of what I'm doing actually now with my research is I want to see how, if I can interview midwives that work with the midwives that were trained but they didn't get the training, and see if it, if that knowledge is like disseminated at all. Cause we really encouraged everybody, cause they were all like they wanted more training. The number one feedback we got was they wanted more training. They wished it had been a whole week for each group. They wanted more and they wanted more people to be there. So we're like, okay, and they want us to come back.
Ariel: 50:37
I get text messages all the time now, like we're all on WhatsApp and they text me and they're like sister, when are you coming back? And I'm like I'm working on it. So I'm like unfortunately, it's a very expensive plane ticket to Uganda. So I'm like, unfortunately, it's a very expensive plane ticket to Uganda. So I'm like you know I'm working on it, but I'll figure it out. And yeah, I think building connections between midwives around the world is a really powerful thing too for all of us, and I'm really excited about where that will take me and what I can do next yeah, so is there anything else you want to share about, like some of the birth experiences that you saw unfold there?
Angela: 51:19
some of the pictures that you posted were really of the insides of the hospital and the tables that they used in the you know operating rooms. It's just really grounding to reflect on. You know all of the things that we have access to here. Is there any like other other experiences like that you witnessed, that you?
Ariel: 51:37
yeah, you know I I'm thinking about how to put this and how to share this stuff, and I thought a lot about like that when I was writing things on Instagram, like all the things I didn't write about, you know, all the things I didn't share because I wanted to. I also was very torn sometimes about taking pictures of stuff, to be honest, and I recognized that, like I didn't have the ability to like get all the consent that I think we would expect in our societal context here, right, so I felt a little torn about that because I wanted to not be exploitive about what I was really privileged to be able to witness and be invited into and I didn't want it to seem, you know, kind of like that that thing where it's like you're just trying to like get a, get a reaction for a picture that only captures so much, captures so much. So that was, yeah, that was kind of hard Cause I had, like these moments of like oh, I, on the one hand, I feel like there's so much immense value in being able to capture this, even in its limited capacity, and share that with other people and what that might help other people understand, versus also like honoring the depths of that situation and how complex that was also really being very cognizant of like I. I was immediately like, really put in a place of hierarchy that I was sometimes uncomfortable with, just for who I am personally, but, like you know, there was, they often made a very big deal that we were from Harvard, that we were from America. That you know.
Ariel: 53:14
Obviously, like I am, I look, you know, like a white person I'm also, I'm six feet tall, like I stand out and I definitely stood out there, and so there was definitely like this thing of like I was given a lot of power and privilege in that situation and I wanted to be really conscious about how that impacted anybody's situation, and especially when it came to the mothers that were there, because English is the official language of Uganda, but there are 52 languages spoken in Uganda and English is also a level of privilege, of education, education. So while most people have some level of English, their level of English is a reflection of of of the privilege of education and access to certain things. Right, and not everybody has that, especially not women. So I was very conscious about that. I couldn't always communicate with the people who were giving birth and as much as it felt very important to me to like have consent, like are you okay with me being here? Are you okay with me touching you? Like are you okay that I deliver your baby? Like you right, but like it was a difficult thing because also, as much as I wanted to like have conversations and consent and all these things, I recognized like it really wasn't practical or possible.
Ariel: 54:34
It also wasn't expected. You know, it's a very different thing to try to adjust in your mind when you're used to like how you want to do things, how I'm trained to do things, how I believe like out of like, decency and respect, things should be done, but recognizing like that's not how that works. Different, you know cultural expectation, all of all of that and that's very complicated, but trying to be really conscious of that and not be not cause any harm by it. So, on the one hand, I was very happy to just jump in and do whatever I could to support the midwives because they wanted help and I'm like I can help you. But also moments of tremendous responsibility that I wasn't expecting because, like I described it, if you're the one who does it, you're the one who does it, You're alone, that's it, and there wasn't even like the opportunity to be like, oh, but how would you do this and what can I do? You know, it was like Nope, that's it Now. It's like here, now you work, here, now you do this thing.
Ariel: 55:27
And also recognizing that, because we were there in a position to train people, you know that we were really we were viewed as experts and I recognize like, while I'm a skilled, experienced midwife, I'm I would never think of myself really as, like this hierarchical expert in all things Right, I I respected that they've dealt with certain emergencies far more than I have. I just have had the privilege of the opportunity to have a certain level of education but also, at the same time, honoring that like it took a lot for me to say like, no, I am skilled, I am trained, I am good at what I do. I do have the ability to train others. I have done that before. I can do that. So I felt like I really grew in my confidence as an educator in that sense too. But yeah, so I I decided to take pictures of things, sometimes things that were really hard things, because I felt like there was a really important value in being able to describe those things, that they could not be described alone by words. I could tell people what something looked like and I don't think the image in their mind would be what the reality was, even if I really tried to describe it, and I know even like the pictures can't really capture that right. So I was in a C-section.
Ariel: 56:51
That hospital had pretty excellent, consistent capacity for C-sections. It being the referral hospital for the region, that was primary purpose for them. But like everything else there, there are supplies that are lacking. Sometimes there are resources that are lacking. The birth rate is so high. So there's only one operating theater for Sorry, I got very used to calling it the theater and not the OR, right, everything is very British. So there's one OR there and then there was one OR that was like general surgery for the hospital but it wasn't attached to the maternity wing. The maternity, the whole maternity area was like its own building. Everything was like separate buildings in the hospital and the maternity wing had its own OR and surgical capacity.
Ariel: 57:41
But you know, if three people need a C-section at once, then three people can't have a C-section at once. So that's, that's the reality of that and it's not even always a necessity of like who is more critical, because if somebody's in the OR, somebody's in the OR I didn't witness that while I was there, but I was told. You know that that's a reality. So just having enough, even just having anesthesia all the time, right, what anesthesia option? You know you need anesthesia for surgery. You don't just need an obstetrician. You can perform a C-section, right, you need it's a complex setup and then very, very frequently the C-sections are for. You know, what necessitates the C-section is the baby, right. So then, what is there for the baby afterwards? What does that support look like? So there was the C-section going on.
Ariel: 58:30
I had like asked about things, about like, oh, how are our midwives involved in the C-section or not? And they were like oh, yeah, usually a midwife is called in, cause there's no like labor and delivery nurses, right, or baby nurses, or postpartum nurses, it's just the midwives. So like, oh yeah, usually a midwife is called in to receive the baby for the C-section and then the midwife will care for the baby and that's that. And they're like oh, there's a mother in the OR right now. Do you want to be the one to receive the baby? And I was like sure, because I knew also like that meant that one of the midwives who was very, very busy didn't have to stop what she was doing and I was grateful for that opportunity.
Ariel: 59:06
I've I've been in two C-sections in my life in America and it was a very, very different scenario. So I was like, yeah, let's go. And I so yeah, I have that picture. I'm scrubbed in. I have like two sets of scrubs on. It's a hundred degrees. It was very hot. We wear rubber boots. They kept laughing at me because I'm so tall that they didn't have boots my size. So I had to wear the men's boots and I was like, okay, whatever, got you know, to put a mask on for that. And it was so hot in the OR we kept wiping the surgeon's head. He was just sweating so hot. In there there's no air conditioning, you know it's, we're on the equator. It was hot.
Ariel: 59:45
It was an incredible learning opportunity for me to watch a C-section in that way. I've never I've even when I've been in a C-section I never got to see like stand there next to somebody and watch the surgery. So that was really that was incredible. It was very exciting for me. I've, you know, from a learning standpoint. I was like, wow, you know, to spend my to dedicate my life to the, to the uterus, you know, and to see it in that way was was wild. So that was a really exciting thing to really have such a better understanding now of how C-sections are done too, which was great because Kathy was standing next to me and she actually really narrated it for me and I got to ask questions, which was great, and really understand how all these layers are put back together and watch it, which was so helpful, I feel like for me now, um, just in how I, when I, you know, have my own clients, have a C-section, and to understand that on a different level, which is great. I'd seen videos, I've read things, but it's it's different to watch it Right, and that at some point during the surgery I realized so, like communication was very limited, often about patients.
Ariel: 1:00:51
We really didn't ever get to know anything. You try to ask a few questions real quick what's her name, what number baby is? This Is the baby term? You know that was maybe it. There was a lot of things afterwards that we were constantly thinking we wish we had time to ask or get the information what's her HIV status? Because that's something we need to think about there on a different level than we think about in the U? S. Just, you know, hemorrhage or other other things that like we don't even get to know. It was really like this person having a baby right now.
Ariel: 1:01:20
Here you go, so we're in the OR and all these things are happening, you know, and I ask, like what is the why is she having a C-section? And they said, oh, compound presentation and fetal distress. And I suddenly I panicked so hard because I realized fetal distress. This baby's not on a monitor. They don't have electronic fetal heart rate monitors there at all. They have a pinnard horn.
Ariel: 1:01:45
I start thinking how long has it been since this baby was monitored? What was its last heart rate? What is the thing that told them that this baby is in trouble enough to have a C-section? Because the C-section is like that's a big thing for them to decide to do there. There's a lot of implications to that, especially also because the average woman there has five, six, seven pregnancies in her life and this was the first baby. So this is a major impact. So we're like okay, and I just started to think, is this baby still alive? Or what is the condition of the baby?
Ariel: 1:02:23
We have no idea, and this baby is going to come out and it's going to be handed to me and I'm now responsible for it and we're looking at what supplies we have in the OR for the baby and we had basically a bulb suction and a PPV bag and that's it. There's nothing else. There's no, for a while. I've never intubated a baby in my life anyways. But there's no intubation, there's no vacuum suction, there's no delays, even there's no, there's certainly no. You know, giving a baby umbilical epinephrine or you know whatever crazy things.
Ariel: 1:03:01
We learn in NRP that the most home birth midwives are like, why do we even have to know this? Right, like, but I'm thinking, like, but this is, this is the thing. And then now I have no idea and I, I, there's two things I can do for this baby. We didn't even have a stethoscope at any point. I never saw a single person with a stethoscope for any birth. So I'm like, okay, this baby's going to come out and I, I mean, I started praying. I started praying for this baby. I was like, please, god, like I need this baby to be alive and breathe. I had this terrifying moment that I didn't really know what, how that would impact my life to be handed a baby that maybe I couldn't keep alive, and it was like that moment was very, very brief, but it was really. I think, of all the moments that I've been at a birth that I've really been terrified, which are very few, to be honest, even when there have been very scary things, I've always been very, very confident that we have like it's going to be okay, because it has to be okay. And that was a moment where I was like I don't know if this is going to be okay because I don't know if I have what I need to make it okay and it just is.
Ariel: 1:04:12
The baby was born. It turned out the baby was breech. Interestingly, the mother had a very like, differently shaped uterus, which was also really interesting to see, likely contributed to the baby being breech and malpositioned. It was hard to determine maybe how the baby was sitting breech, but like baby came out feet. First. I remember watching her little feet come out and trying so hard to figure out the color of them and like, just I felt like I stopped breathing and my heart stopped waiting to see if that baby was moving. Was she moving?
Ariel: 1:04:48
I also learned, just like as a bit of an aside, but how much I lacked in my knowledge of recognizing and evaluating things on babies of darker pigmentation and different skin colors. That was not part of my education. That's not been predominantly a part of the population that I've worked with. When I first started in birth work, I worked with supporting women who were refugees from Eritrea and Sudan, so those you know were darker skinned babies, but I was not ever responsible for being the person of like identifying things with those babies and I really learned in that week how much that was missing for me that knowledge of being able to really determine like degrees of cyanosis in a baby that's not going to be pink in the way that I have been exposed to. Right, how do I evaluate the color of a baby in terms of, like you know, tone, color, all that stuff. So I feel like I gained so much from that and it really highlighted for me like where that was missing for me personally as a midwife and the responsibility I have to have that information and that I didn't have that previously. So that was important.
Ariel: 1:05:59
But, yeah, so I'm just looking at this baby and it was really like, what color is she? Right, like is this? But she did start breathing. She did need a good amount of help but she did breathe on her own. We did get her to breathe on her own and so she needed so much sectioning. And I didn't have it.
Ariel: 1:06:22
Bulb syringe is quite limited in that capacity and I didn't have a stethoscope, but I could just hear, I could feel her like how much she could not get this out of her because I was trying so hard to get her to really cry, get this out of her, because I was trying so hard to get her to really cry, like I felt, like I was. I was not being rough with her, but like in the sense I was like no baby, I'm sorry, I need you to like scream. I need you to scream so hard right now because that's going to help and that's the only thing I have to do to help you. And I was like, okay, uh, postural drainage. So thank you to Carol Gouchy, the first midwife that I ever apprenticed, because she was all about that, and I just put that baby head down on my arm and I just very vigorously kept patting her and rubbing her and messing with her to make her cry, and trying to suction her sideways to get it out, and just talking to her and I was like you got to keep breathing, I need you to cry. And I could hear like she couldn't really cry. That was it. She was breathing but struggling and there was no other section. So and there's no pulse ox and there's no this and there's no that, but she, she did good.
Ariel: 1:07:30
And then I wanted to be able to have her mother see her, but her mother was out. It's not like we're used to in the U? S where the baby gets passed back to the mom, or you know. So I really was like very conscious, like I was the first person to, to hold her and welcome her, and I just told her. I was like your mom's going to meet you so soon. You know like you're going to be with your mom real soon and I need you to just keep breathing so that you can be with your mom real soon. And then there's no, because there's no. You know, nursery, all these things Right. So the next step is like this baby had to go to the relative that's waiting and the relative is going to care for the baby until the mother is ready and the relative is going to care for the baby until the mother is ready. But then we were onto the next thing. We were done. So I never, I never got to really like see the mom meet her baby or any of those things or follow up with them.
Ariel: 1:08:28
There were some babies that we saw have some very difficult transitions and, again, very limited ability to help them. There was a baby that her oxygen saturation rate was because we were actually able to get her into the NICU there. But their NICU was 40 babies and one midwife or one, one nurse, and that was the that's the whole team. And that NICU was full of babies and they were all. They were really all preemies Some very I've never seen firsthand up close that many babies that are that premature. It was a really tremendous miracle because they had to be breathing on their own. There was no ventilators or CPAP. They could have oxygen, but that was it. So that was just incredibly impressive watching mothers hand expressing milk to give to their babies, cause they don't have breast pumps.
Ariel: 1:09:21
And we brought a baby in there one evening. I I did not like how she was breathing, she was struggling and she was termed Like I. Just I knew something was wrong, but I again I didn't have a stethoscope, I couldn't listen to her lungs. I just kept like touching her, trying to get her pulled. I was like something isn't right. It was very labored breathing.
Ariel: 1:09:43
We were finally able to get her over to the NICU. They kept saying they couldn't take her because they couldn't, which is you know the reality. Finally we did and we needed the pole socks. So they had to take it from another baby, which. But they put her on it and immediately we just kept watching the number like crash and come up and crash, and I was so worried. I was like I think my gut told me like this baby might have a heart condition, right? Uh, it's.
Ariel: 1:10:11
It's not very common for the mothers to have an ultrasound in pregnancy. So all the things we're used to knowing about a baby before they're born, they don't really often know. And I just kept thinking like, based on like the things I know, that's definitely in the realm of possibility. Does this baby have a congenital abnormality or a heart condition or something? But we had no way to know and I left that night. I didn't know how she was doing. Her father was with her. That family had lost two babies prior. I don't know the circumstances of it, but they said because I had asked what number pregnancy, they said this was the sixth delivery. But then the father said they have, this is going to be. This is their fourth girl at home. And I I realized then like they were saying like they'd lost two children. So I knew the baby's name. Her name is Rebecca.
Ariel: 1:11:10
I often never knew their names because people didn't know, like they don't know they're having a boy or girl, they don't know all these things. They don't have a name picked out, Usually, like there isn't that kind of thing. But the father was with me and I said, does she have a name or does the baby have a name? And he said, well, is it a boy or a girl? And I so I undressed her so he could see and he was like, oh, another girl. And he was like, well, this one will be Rebecca. So I said, great, people are often like very religious there. So I asked him like you know, he said they're Christians. So I said, oh, you know, do you know the Bible? And he said yes, of course. And I said you know, I'm Jewish, but I know the Bible. And you know, rebecca was, you know, mother of nations, like she's strong and resilient, and I I'm going to pray that your Rebecca is is just as strong.
Ariel: 1:12:00
And the next morning Rebecca wasn't there anymore. So we asked you know, did she go home? Like that was this. That was the scenario we were praying for. Right, she's not there because she went home and nobody seemed to really know. They're like I guess I guess they went home. So I was like, okay, I hope that means she's okay. People tend to go home as quickly as possible after the birth because there's really not a lot of care for them there, there's nowhere for them to really be and there's a lot of pressure on the mothers to go home right away and take care of their other children. Like they're not coming home to, like being pampered and laying in bed, like every postpartum person should be right, every postpartum person should come home and rest for many, many weeks. They go home and they make dinner that night. So Rebecca was gone. So I just thought like, okay, I hope Rebecca's good and that Rebecca's mom is good. And that was it.
Ariel: 1:12:54
You know, and there are quite a few babies like that I never knew their name. Sometimes I didn't know the mother's name. I think everybody often like looked at me like I was a little bit loony, that I was like talking to the babies or telling them you know, I'm so used to like I'm going to do this for you. Now I'm going to do that, you know. And they're just like what is she doing? But that's who, that's part of who I am, so like that's part of what I'm going to do, right? And yeah, there was like one morning that all these babies are just like lined up and I was like what are all these babies doing here? And they're like well, we had so many babies overnight so none of them ever got vitamin K because we were too busy. So they've literally just been sitting there for hours. It was kind of wild. So I'm like okay, can do, you want me to do that? They're like oh yeah, that's great, give them vitamin k.
Ariel: 1:13:41
And I had to override quite a lot of what I know to be best hygienic practices. I won't like get into it, but like it was, you know. But I had to have this moment of like well, what's better, right? And a lot of these situations is like what's better, what's the? These are your. Well, what's better, right? And a lot of these situations is like what's better, what's the? These are your only choices. So what's better, you know?
Angela: 1:13:59
Yeah, wow, so there are so many needs. What is the emergency that they're seeing most often?
Ariel: 1:14:09
Yeah, so the number one cause of mortality for women in Uganda is childbirth, and the number one cause of maternal mortality is hemorrhage. And that's part of a very complex thing, as we learned. It's not just about not having medications, it's not just about not having access to a blood transfusion. Somebody died one day while we were there because they just didn't have blood anymore. A mother died every day almost that we were there from something related to hemorrhaging, and for very complex reasons, as we learned. Everything we learned made it more and more complex about why, why are so many women hemorrhaging, why is it so bad, but you know. So this access to medication is incredibly important, but that's not something I can fix at this time, but other basic supplies. So I think about how, if you go to a birth at Maine Med or any hospital, really right, there's a cart, usually there's all the stuff, and even if that stuff doesn't get touched, really maybe then that mom ends up actually going for a C-section and none of that stuff even got opened at all. It often gets thrown out. We just throw stuff away at an insane level.
Ariel: 1:15:20
Meanwhile there one day, because I was very conscious, I did not ever want to take any resource from anybody at that hospital for anything for myself. So I went to the pharmacy and I bought gloves. And I bought a lot of gloves and I brought them in and I gave them out. And I bought a lot of gloves and I brought them in and I gave them out and people were joking oh, it's like Christmas Ariel's, just like handing out gloves. We just take it for granted. There's boxes on the wall, everybody can have all the clothes they want.
Ariel: 1:15:43
No, the family brings their birth supplies to the hospital and that's because they have to purchase it. That is a tremendous expense to them. And maybe they bring two pairs of sterile gloves and that's what you get. That's now, that's what the midwife has for that birth, that's it. And they, they rip off. You know, like on a sterile glove there's like a rim on the edge. They rip that off and save it. That's what they tie the cord with and then the cord with a razor blade. They didn't even have instruments. I, the most impressive thing I ever saw was somebody suturing without instruments, just, and I was like I don't, I don't, I don't know if I could actually do that Like. So we asked the midwives all the time if you could have one thing, cause the list is so long. Right, it's overwhelming. But like what is the thing that you need, what will make the most difference for you? And it varied by facility, it varied by things, but you know, if somebody has a whole bunch of excess gloves or birth, you know birth supplies like somebody's kit didn't get used and they don't know what to do with it, like I will gladly send this to Uganda.
Ariel: 1:16:51
My sister is a CNM at a hospital and she also was lamenting like just the insane amount of stuff they throw out. She's like if the gloves say they expired, we have to throw them out. I'm like well, that's crazy, they don't expire, really. You know what I mean. I was like give them to me, I'll send them to Uganda. I told the doctor that we were working with every day about that and he like he was like I was like would you take gloves if they're expired? And he just looked at me like sideways, like I'm sorry what you know, like the gloves expired, like how, and everyone's like I'll take whatever you send me.
Ariel: 1:17:25
I would love to be able to purchase some instruments to send, and the big, big, big thing, consistently, was Dopplers. So somebody very proudly one day did find the one Doppler that the hospital had and showed it to me, but they don't use it. Why they don't have batteries. It runs on batteries and they ran out of batteries and they're never going to get batteries. And I mean like to us that sounds like the most insane thing, right, but like that's the truth. So I've been looking into Dopplers that are can be plugged in and talking to a midwife that works for an organization in Northern Uganda where they train midwives different things she's like these are the Dopplers we've been able to buy. They're from Eden Like. I have an Eden Sono Trax Doppler myself and these are the ones that can plug in. They have the plugs for the Africa, for the outlets there. I'm still trying to really figure out the pricing on it, exactly how that will work, but it's going to be in the neighborhood of $100, $150 a Doppler by the time we deal with all the expenses of getting it and getting it to them.
Ariel: 1:18:37
Everybody wanted a Doppler. They only have a pinnard and they just call it a fetus scope. It's metal so that it can be cleaned. I used it multiple times. I had a very hard time hearing, so it really helped me understand the difficulties then in really assessing fetal condition, really being able to assess how baby's doing in order to make decisions about what's necessary, right? Everybody wanted a Doppler. They were like, oh my God, that would be incredible. They'd be able to just put that on somebody, hear it, make decisions, hear clearly, also, really be able to determine, especially if they can't hear, does that mean that the baby has passed versus other scenarios, right?
Ariel: 1:19:19
So the Doppler is the big thing that I want to figure out sourcing for. So I feel pretty confident if I raised somewhere around $1,500 to $2,000, I could get enough Dopplers to get one to each facility that sent midwives to the training at a minimum. And that's that's my goal, cause I feel like I I promised them that I'm going to get them things and I I won't forget about it. So one way or another, it's going to take me some time, but I'm going to make sure that something I want, I want to give them something.
Ariel: 1:19:56
You know, I just kept thinking about how I own four Dopplers, like so there are less expensive Dopplers, but I have not been able to find less expensive ones that are the kind that can be plugged in, and it's really important that they can be plugged in because the batteries like being able to get them, the batteries is a is an issue, is a resource issue, and there's often kind of a mentality because they're also not used to using them that then, once the batteries are dead, it's just now. The Doppler doesn't work In the sense that like they just go back to doing the other thing because figuring out how to replace that is tricky and like so nobody has time for that. Nobody's like how do we get $10 to buy batteries?
Angela: 1:20:33
Like it's not happening, everything's moving too fast to have time to anyone to think about that. Right, yeah, wow, oh my goodness. So for anyone that's interested in helping you achieve this goal of raising enough funds to send the midwives, these Dopplers, what is the best way to contact you? Should we just send you an email or over on Instagram?
Ariel: 1:21:01
Yeah, I think that's like the best thing right now If people are interested in reaching out or helping to contribute to that, just contacting me, so midwifeariel A-R-I-E-L at gmailcom, or you can contact me on Instagram at Saco River Midwifery, and we'll just talk about how to get it done. You know, one Doppler at a time. I'm hoping that maybe having like a purchase of like 10 at a time might reduce the cost a little bit, but I'm also not sure that that's possible yet. I'm still talking with the American Midwife, with their organization in Uganda, about how we get those, how they've gotten the Dopplers and how we can get them. And I think, yeah, you know, if you're a home birth family and you have a whole, you have a whole box of supplies left over, or you're a midwife who's like I'm drowning in extra supplies, I don't know what to do with reach out. I'm in, I'm in Boston, but we can figure this out. We can literally save lives with these supplies. So let's not let things just go to waste.
Ariel: 1:22:00
I think that was a huge awakening that I had. We have so much in the West because somewhere else people have so little. I really thought about that, and so let's not let that all just be wasted. We can make a difference with it and there are tons of organizations that do that work too on a much bigger scale. But if somebody's interested in like just this small thing with me, with this, with these midwives that I know that text me all the time saying, sister, when's my doppler coming, you know like let's do that for them. Sister to sister.
Angela: 1:22:36
Yeah, yeah, absolutely. Oh, my gosh. Well, thank you so much, Ariel, for everything and for coming on today and sharing all of this about what you've been working on, and I wish you the best as you finish your year at Harvard.
Ariel: 1:22:49
Thank you. Thank you so much. Yeah, I'm trying to wrap my mind around graduation, so yeah, and I'm excited for what comes, what comes next, and if anybody wants to come be in touch about working in Uganda, let me know, because I'm figuring out when the next trip back is. So, oh, that's exciting. Yeah, thank you so much for letting me talk for so long about all of it and share all of this, for letting me talk for so long about all of it and share all of this, and that's the end of another episode of the my Main Birth podcast.
Angela: 1:23:22
Thank you for joining me and listening. I hope that the stories shared here have been inspiring or informative to all of my listeners. If you'd like to contribute and help Ariel raise money to purchase Dopplers for the midwives that she worked with over in Uganda, please reach out to her. I have all of her information linked over in the show notes. Thank you again for tuning in and I look forward to bringing you more amazing birth stories. If you're new here, don't forget to hit subscribe and leave me a review, and I'll see you back here again next week.