When Marisa came to the clinic that stifling October afternoon, she didn’t say much. But then she never did. If not for the village gossips, I would not have known how she suffered.
“They live upriver all alone on that island, and her man almost never lets her leave the house,” they told me. “They say he beats her when he gets drunk and sometimes he hurts the children too. He refuses to buy her any maternity clothes and always makes her wear jeans just to shame her. We don’t know if he is a little slow, or just plain mean.”
Upon entering the clinic she needed no gown since her eight-month stomach protruded from below her cute blouse and above her fitted jeans. I gently performed her prenatal exam and ran through my standard questions. Because so many of my prenatal patients were teenagers, my questions were basic, designed to educate and make sure the mother-to-be was planning and preparing for the birth.
When I asked how she was planning to travel out to the hospital she hung her head and quietly stated that as much as she would like to obey me, she didn’t think her husband would allow it. My heart sunk. Her island was an hour upriver from my clinic which was three to four hours and across a river from the hospital. The only midwife in the area was eighty-five, illiterate, and blind.
Thinking over the times she had already refused offers from me and other to help her leave her man, I knew she didn’t believe she had many options. I wasn’t qualified to deliver her baby, and neither was anyone else on this side of the river. Even though I was convinced that the natural childbirth most of my patients experienced needed no intervention, we were just too far from the hospital to risk the complications that could appear mid-labor. I explained that by planning to give birth so far from a hospital, she was risking her life and the life of her baby.
Unwilling to discuss the subject further, she gathered her things and paid the small consult fee of 5 Quetzales. The equivalent of 85 cents, the consult fee was designed to avoid charity and did not include any necessary medications. I filled a small black plastic bag with the standard: prenatal vitamins, iron supplements, and a few sheets of patient information that explained the benefits of colostrum and encouraged mothers to nurse their babies immediately after birth. As she left, with the bag in her hand and her children by her side, I wondered if I would ever see her again. Would she end up being just one more statistic of Guatemalan maternal/fetal death?
I sent a short prayer heaven word on her behalf and then returning my attention to the small stack of charts and group of waiting patients. I knew that if I allowed my heart to get too wrapped up in one case, I would useless to everyone else. Still, pushing thoughts of her from my mind wasn’t easy as I focused on the wide eyed eleven-year-old with a tooth infection in front of me.
Marisa and her husband arrived at our dock in a small boat just a few weeks later, and I confirmed that she was in labor.
“I’ve come to take you back up river to deliver the baby,” her man strongly asserted to me. “She’s going to have this baby at home just like the last two.”
Marisa’s man had never spoken to me before, and I wondered if all the things they said about him were true. He didn’t raise his eyes to mine, and there was no clue in his quick, loose body movements. What was his story? How did he see himself and his beautiful little family? A new contraction of Marisa’s stomach cut off my ponderings, and I considered her options.
While Marisa had no signs that suggested complications, the idea of labor and delivery in a dark little home of sticks didn’t appeal to me. I quickly reassessed my feeble midwifery skills. No formal training, twenty hours of study on the subject, and participating in less than ten other births; no, it didn’t make sense to travel in the opposite direction of the hospital.
Her pleading eyes, set in that strong, young face started to sway my decision. Obviously, the hospital was the best option, but she was headed back up river with or without me. Should I go with her to support her? Should I make myself responsible for any problems or complications, when I wasn’t even sure if I would recognize them? Or should I let her on her own with two preschoolers and the man who had a lousy record of taking care of her?
Feeling myself start to lean towards helping her, I called my superiors for advice. ‘’The ultimate decision is up to you Ashley, but it certainly isn’t the recommended course of action,’’ was the response I got from everyone.
Finally, I decided to put into words the prayer that had been running through my mind. ‘’Lord, what should I do? I can’t bear to say no. If something goes wrong and she or her baby dies, I will always ask if I could have done something to help. But if I am present, and something does go wrong, am I strong enough to face the guilt and the certain recriminations?’’
In the past, I had an unfailing track record of following my superiors’ recommendations. I trusted Holly and Norma implicitly, and after all, that was why I had called them. But the sense of stillness, of peace and the assurance that my hands would know what to do made the decision for me. The security that God would get me through, not only the birth, but also through whatever followed, overcame my heart.
I ran to the river’s edge to the waiting couple in the boat, and asked them to give me just a few minutes more to collect some supplies, and get Yalonda. I rushed to the clinic and grabbed the large, almost suitcase-sized, plastic, mickey mouse printed bag I had packed for emergency deliveries.
Always game, Yalonda hopped into the small wooden boat behind me. We sat opposite each other balancing our weight on the sides of the boat, and settling in for the sixty-minute ride up river. I alternated between prayer, and worriedly watching Marisa shift uncomfortably on the bottom of the boat. “Just not in the boat, Lord, please not in the boat.’’
The boat finally slid through the reeds at the river’s edge, and bumped softly against the mud. We were here. Her home was even less than I hoped for. It was indeed one dark room. Strips of light shone through the saplings that formed the outer wall. The alternating shadow and light was disorienting and my eyes struggled to adjust.
A few minutes into my assessment and preparation of the scene my one consolation was dashed. I heard the motorboat being started and driving away.
Apparently, considering this women’s work, her husband decided he would rather be off with friends, abandoning us to the island with no transportation in case of emergency. My last link to help and civilization gone, I asked Yalonda to search the island for cell phone service. She was no novice and had become adept at climbing trees and waving the clinic cellphone around. Then I repeated with wide eyes what would become such a common instruction, “And Yalonda, keep praying.”
It was nearly 1 o’clock, and Marisa seemed more concerned with being hostess than birthing a baby. She started a fire and began patting out the toasty warm tortillas to go with the boiled potatoes she served us. Her movements were the fluid almost subconscious movements that come with a task so often performed. Every few minutes, she would hesitate, almost stopping as she leaned against the elevated platform where her fire was located. I recognized these hesitations and started timing them. Every suggestion of mine to lie down, or to head to the bed was countered with a soft, ¨Not yet.¨
I started to wonder if she would insist on finishing the tortillas before giving birth. Just how strong was this woman? Continuing to eat my potatoes with salt, and completely enjoying getting acquainted with her two dark eyed beauties; suddenly her eyes locked onto mine. My heart started to pound as I realized that there was no turning back.
Without a word, she moved towards the bed with me close behind, a prayer on my lips and my prayer warrior Yalonda on my heels with the oversized Disney bag. As I adjusted her on the small string bed, the large square of light provided by the open door went dark. Unfortunately, we were not the only ones to enter the house. In behind us walked a six-week old calf who nudged Yalonda’s back, almost knocking her over. Marisa pointed to the oversized bottle filled with milk, and was pleased that the calf’s feeding time had so coincided. “That will keep the children busy,” she murmured.
No more than ten minutes later, I was holding a most precious little black-haired bundle. Suctioning they baby’s nose and mouth, I wrapped her gently in the flannel Yalonda handed me from the delivery packet. Passing her to Yalonda, Marisa and I delivered the placenta quickly. After getting Marisa and the baby comfortable, I went outside to stretch and quiet my mind from the still running danger scenarios. Allowing mother and baby to rest, Yalonda swept her little yard area and played with the children while we waited for her husband to return.
A few hours later he appeared, apparently unconcerned and obviously intoxicated. On the ride back down river, we were surprised to feel how much the satisfaction of the safe delivery and the deflation of our worry had tired us. It was a thankful prayer and a sigh of relief that filled my heart that night when I crawled under my mosquito netting just before the generator went off at 9. My worries for the day were over. My hands had been guided and new life had come to the little island home. For tonight, at least, I would fall asleep without worrying about tomorrow. I’ll let it in God’s hands. I’ll just show up.
In the next few weeks I noticed a growing confidence in my medical practice. I stopped questioning my own judgement, and I started trusting God’s guidance. My best was all I could offer these people, and it was enough.
Hearing nothing from Marisa for several months, I was pleased to see her waiting on the bench outside the clinic one afternoon. Her husband had come to town to drink, and had brought her along so that she would help navigate the boat through the rapids on the trip home. Taking advantage of the trip, she came for a well-baby checkup. To my delight everything was fine, and the baby seemed to be gaining weight.
I’ll never forget, how just before she left, she looked at me with a little sparkle in her eye (the most emotion I had ever seen from her) and said, ¨You know, the children say that now they know where babies come from.
Soon the news had spread among the children of the village too. They had figured out what no adult would tell them. The origin of new babies was no longer a mystery.
“Keep an eye out for the Mickey Mouse bag.” the children whispered among themselves. “If the Gringa ever visits your house with that bag, there will be a new baby when she leaves.”