La Parterita en Mendoza- Parte 1

 

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For those they haven’t been in the loop, I have spent the last week and a half living and working in beautiful Mendoza, Argentina. I have been working with midwives here in a very busy public hospital, in a high risk obstetric unit.  While I always knew from the beginning that things were going to be really different here, I had no idea the extent of how much I would be surprised by. Also, the language barrier caught me quite off guard on my first day. I have had pretty good knowledge of the Spanish language before coming here, being able to translate and speak with patients at work etc. I knew how to ask questions, take a 

medical history, instruct someone through child birth, and give discharge education. ImageBut it never occured to me that it wouldn’t be the patients I would have difficulty talking to, but rather the staff. Being able to have normal everyday discussions became the biggest obstacle. Also, I never realized until being here how much of my knowledge of Spanish was quite dependent on “Spanglish,” and being able to throw in a word or two in English if I didn’t know how to say them. Here at the hospital NO ONE knows ANY English. Nada. So it was definitely a bit of a struggle my first couple days to be able to keep my mind in constant focus every minute to what’s being said, and training myself to stop translating in my head, but rather to simply think in Spanish. Fortunately, we have a really great Spanish teacher at the house who comes a couple hours twice a week to do lessons. I am happy to say I can finally speak outside of the present tense at last! This has definitely opened the field for conversation in the hospital, and I am becoming quite confident in my ability to talk with other people in the hospital about the differences between their practices and ours in the States, the things that quite literally blew my mind. ImageFor starters, when women come in labor, they are taken into a “dilation room,” which has about 6 or 7 “beds,” which are more like a table with a paperthin mattress, and they are required to basically lay there and suffer until they are complete. No epidurals, no pain medicine, no visitors with them, just sitting or laying on the beds sobbing and moaning for hours. There is absolutely no privacy, they do vaginal exams in front of everyone else, and the door of the room wide open, but no one seems to mind it nonetheless. What really surprised me however, is  when they do get to completely dilated, the woman holds her bag of IV fluid and Pitocin, and walk down the hall to the delivery room, dripping amniotic fluid and bloody show on the floor like nothing.Then they go into the delivery room which is basically a metal table with stirrups (if they are lucky) otherwise there is just 2 metal poles they have to prop their feet against. No pillows, no adjustable bed, nada. Not even a baby warmer, no oxygen or resuscitation supplies, nothing. 

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And because I understand we in America are probably a bit overly aggressive about 

continuous fetal monitoring, I was not surprised that they only listen for heart tones every 30 minutes. Even the patients on Pitocin. 

But I was quite surprised that, even after the long walk down the hall with the baby basically crowing, they really don’t monitor the baby while she’s pushing, except when they were using forceps to deliver. And might I add no pain medication is given. The patients are draped with this “sterile” white cloth and instructed to push right away, the doors of the room wide open and everything.Image What really astonished me, one of the midwives told me that for primagravidas, it is routine to just go ahead and cut a mediolateral episiotomy before they start pushing. They do give some lidocaine first, but I couldn’t help but feel the pain of it for the patient.

ImageAs if that wasn’t enough torture for this sheltered little midwife, they have a tech or one of the other nurses or doctors stand or straddle the head of the bed, and apply fundal pressure. Knowing that just the mention of fundal pressure could cost you your license, I felt mortified at the site. After all is said and done, the patient and her baby are put on a stretcher to cuddle and bond in the hallway for a few hours until they are taken to the postpartum unit. ImageAfter a first impression like that, it was hard to get the courage to go back. But the following day, it was a little better in the hospital, as there was a class of medical students there, and they invited me to join in their class for the day. I still mostly was just observing things, helping to get some heart tones and check a cervix here and there, but I felt more confident in communicating with the others, and the professor there was very helpful and very easy to understand. But after a few hours of paying super close attention to every word around you, it gets quite mentally exhausting. After a beautiful walk home in the Mendoza sunshine, it was time for Spanish class and “social activities” with the roommates.  

The end of the first week definitely wrapped up on a good note. There are different midwives every day, and where as the midwives there on the other days were not unfriendly, they were not able to slow down and interact with me as much as the midwives there on Friday, which was a guy midwife and a woman midwife. After having seen the work flow from the previous days, I had a little bit better idea of how everything works, who is who, etc., and so there was less need for them to explain all that, and we were able to have really good conversations (in Spanish), drink Mate, and they were very facilitating to me, letting me check dilation and they even let me assist to deliver 3 babies today, which was really great.  

This past week was a bit funky in terms of the work week, because Monday and Tuesday there were problems with the buses working, and the bus never showed up. So I spent the day being productive with my Spanish studies. Wednesday I went in, but it seemed like it was “C-section day.” When I arrived, there were about 7 patients all gowned and prepped for surgery. ImagePossibly a day for the residents to practice their surgical skills I suppose. There were a couple midwife students from Mendoza there with me that day, so it was nice to be able to bond and work with them, as I still basically see myself in the student role. However, the same way I needed to do so many deliveries in order to graduate, they also do, and we did have one vaginal birth we did do. The patient came in contracting every 1-2 minutes, and before they even checked her in the dilation room, I could already see the head presenting. Thinking were just going to have a baby in the bed, I went ahead and grabbed my gloves, and to my surprise, they actually had her get up and walk down to the delivery room. By the time the patient was on the table the head was crowning, and the student still had not got her gloves on. I went ahead and kept my hands supporting the perineum, and basically told her to get her gloves on or I’m going to deliver this baby myself. Like any ambitious midwife student, she made the sacrifice of trying to get the other glove on, and delivered the rest of the baby with only one glove. Priceless. ImageAnd, ironically, as much as I am not a fan of doing routine episiotomy for first pregnancy births, this was the first one that they didn’t cut (obviously there was no time), and go figure, she gets a third degree tear. 

While a lot of the practices here have reason behind it, some of their habits will never fail to surprise me. Particularly, the common use of open toed sandals, flip flops, and even heels. One day, after a resident put a foley catheter in for a c-section patient, there weren’t any foley bags, so she just tied a glove around the end of the catheter and taped it instead. I also don’t ever think I will understand the “sterile technique” here either. A doctor might put on sterile gloves to do a cervical exam, and then dip her sterile gloved fingers into the jar of KY jelly they use for the fetal heart monitor. What?!

Nonetheless, I am having a really great experience out here. I am so much better able to appreciate not only the quality of the healthcare back home, but also the philosophy behind it, driven by empathy, compassion, and lawsuits. It is so strange to see these high risk women, no prenatal care, minimal fetal monitoring, and strangely aggressive birth interventions have babies that always come out screaming, with no need for oxygen, suction, or calculating Apgar scores. Yet back home, we practice with such strict protocol, doing everything by the book, and still seem to have more problems with babies needing some resuscitative efforts. It is both very humbling and enlightening to acknowledge such a concept. I feel like in comparing the conservative/aggressive nature of birth interventions here versus the US, I don’t really find  that one medical culture necessarily has does or doesn’t do more than the other, but they almost sort of compliment each other like a Yin and Yang, by being more aggressive in some practices, and more conservative with others. And its not that they do these interventions just because thats what they were told, but they just take a position on the other side of the controversy than we do for that specific intervention. Between learning the language and learning their practices and philosophies, it has definitely been a very mind stimulating process thus far. And as such, makes a perfect welcome for a doing some wine tasting after work. Image

La Parterita en Mendoza

Hola a todos. Por todos que no saben ya, he venido a Mendoza, Argentina para trabajar como una partera en un hospital por seis semanas. Aprendere’ como trabajar y practicar con los parteros en un hospital publico.

Puedo dicirles, en este semana pasada, he tenido una experiencia muy interestante en mi trabajo. En Martes esta mi primer dia, yo encontre’ muchas cosas muy differente. Primero cuando la paccientes llegaron en trabjao de parto, ellas tienen quedar en una cuarto de dilaccion hasta tienen completar dilaccion. Estan en un cuarto con 6 o 7 otras paccientes, todo con mucho dolor y estan sufriendo. no hay epidurals o medicinas por el dolor, y la familia no puedan visitarle. Despues han completado, es el tiempo por el parto. Ellas caminaran a la cuarto por parto, y acuestense en la mesa por parto. Si esta el primer parto, es routina por hacer un episiotomia para evitar laceraciones grandes. Esta una practica muy differente en los Estados Unidos, hacemos episiotomias solo cuando necesario, y entonces, lo hacemos en media. Aqui, lo hacen mediolateral. Es el primer vez he visto un episiotomia mediolateral, yo fue’ sorpendida. Despues el parto,no hay una cama con calor o equipo para resuscitar en el cuarto por parto. Dieron el bebe a la madre, y se le seque, y nada mas. Si el babe necesitaria resusitacion, los neonatologicos tomarian el bebe a la NICU mas rapido. En mi primer dia, fue’ un poquito agobiada de todo he visto. Tambien, nunca mis campaneros en el hospital hablan ingles, y es necesario para hablar y entender todo Espanol.
En el segundo y tercero dia, esta lo mismo la experiencia, pero aprende’ mas la forma de las cosas, yo hable’ y entiende’ mas con las parteras, y viernes fue el mejor dia. Yo entiende’ todo, hable’ mucho mas, y me permitaron revisar dilaccion, y ayudar con tres partos. Fue un buen dia en la hospital.
Espero que este semana esta buenissimo en trabajo. Pero hoy y ayer, no fucionan los buses, asi, no fue’ al hospital.