Teen Pregnancy

A teenage mother in labor for the first time is likely one of the more frightening human experiences possible.  The teen pregnancy rate in the U.S. is 26.6 per 1000 girls aged 15-190.  Just imagine: You’re sixteen.  You’re currently thirty pounds heavier and always experiencing new pains, kicks, and spins.  Your pregnancy was out of wedlock, so now you have to deal with guilt, shame and judgment from everyone around you.  Peers.  Parents.  Religious leaders.  Everyone.  You’ve never done this before, so you can’t even be sure that this series of pains is labor.  After all, you’ve “cried wolf” a dozen times prior to now and some resident keeps telling you you're not in labor or you just peed yourself.  Your confidence in understanding your own body is shook. 

Now walk for several days.  Perhaps all the walking is what helped initiate the labor process.  Maybe your water spontaneously ruptures coming down the side of a mountain.  Your feet carry your weight as well as they can, delicately dancing along the rocks as one misstep will likely lead to a tragic miscarriage.  You’re exhausted.  You can’t catch your breath.  You don’t have your bottle of Smart water with you.  You try to eat but more than three bites and you feel like you have to vomit.  You’ve been wearing the same clothes for several days.  You actually discarded your underwear because this new discharge had already ruined it.  

You arrive at your destination.  This land is completely foreign to you.  The people.  The facilities.  Maybe even the language.  You’re here to register, but this baby isn’t going to wait.  Unfortunately the facilities are overrun with passersby and you’re told there isn’t space available.  The Story has probably become a little clearer at this point, but this

story is duplicated every day in Haiti.

Mary gets pushed to the “manger” for her delivery.  I remember growing up and seeing our nativity scenes.  Mary is dressed in a beautiful robe.  She has a sense of peace about her and she is smiling.  They’re chilling in a wooden barn with a couple animals and Joseph is right by her side.  Our church program were similar.  I was a donkey, then I graduated to a shepherd and then finally the creme de la creme - a Wise Man.  So I thought I knew all about how the miraculous birth went down.  

The real story is that they were likely in a cave, or a small chamber carved out of the rock.  It was used for feed storage and animals likely sought shelter there as well. #Newsflash Animals stink.  They poop all over the place.  Spoiling grains stink and were likely infested with rodents and bugs.  Labor hurts #FromMyPersonalExperience.  Labor pains would be banned by the international community as a form of torture.  As a first time mom I would say that once her labor contractions started baby Jesus wasn’t born until 28 hours later #RoughEstimate.  Joseph was in a corner or outside, terrified. He had no clue how to help Mary in her time of struggle #NoLamazeClasses.  Also, what was he thinking wedding a woman pregnant out of wedlock?  It was social suicide. 

I’m sure Mary had never prayed to God like she did that day and night while she was in labor.   I’ve heard several of those prayers, albeit in a different foreign language, but the tone says it all.  “Dear God, this hurts like hell.  I don’t think I can do this.  Please give me the strength and help it end as quickly as possible.”  I’m paraphrasing of course.  The animals not only were terrified of the noises and screams, but probably assumed she was crazy and dying.  There were no interns or around to provide encouragement and anticipatory guidance.  She just kept contracting until she felt the need to push.  And then she did.  Thank goodness she didn't bleed or seize.  No one received the baby.  He was probably born on the ground.  She would have been exhausted, so Joseph was probably the first to pick him up.  The placenta would follow.  Did they tie the umbilical cord and grab a nearby rock to sever it?  In the age before tetanus vaccines that was a roll of the dice.  I always joke to the delivery team nurses that I assume Jesus's APGAR scores were 10/11 at 1/5 minutes.  But I highly doubt it.  He transitioned.  He might have been early, or small for gestational age.  But what were they going to do?  Odds are he was a breastfed baby too.  #WWJD #Breastfeed

My last day in Haiti I was in the delivery suite with the Haitian resident.  Our patient had come to the clinic in labor earlier the day before, and now it was about 2 in the morning.  It was her first child.  My alarm to get ready to head to Port au Prince was set for 330.  I’m 90 minutes ahead of schedule.  As we continue to labor with her a frantic family runs through the front door.  The older woman is holding a bundle in her hands.  I get the story through Dr. Leo.

This is the grandmother of a new baby.  She looked thirty.  The mom had delivered at home and they were concerned about the baby.  That was it.  I don’t know how long they walked.  I’m not sure if they made an attempt to come to the hospital for delivery and just got caught at a house before they could get here.  How long ago did she deliver?  What was her prenatal course like?  How far along was she when she delivered?  Ugh.  So many questions left unanswered.  But there isn’t time for questions like this sometimes.  When you’re in the hospital, you develop a sense about those sort of things.  This patient looks sick, I will probably forgo asking about their social history and focus more on getting them taken care of.  Or, this patient is 100% healthy, maybe I can use this opportunity to address vaccination status #GetThemAll

I take the bundle from her hands and immediately my heart sinks.  I place the infant onto the resuscitation table.  I’m not sure it was ever cleaned from any of the other times I had been forced to use it during this stay.  I know for fact the bag mask hadn’t had a chance to be cleaned; it still had evidence of other babies on it.  Sanitation be damned.  Breathing is more important than germs.  But the mask has no role here.  I fully uncover the baby.  The placenta is still attached to the umbilical cord.  He’s not moving.  He’s cold to touch.  I place my stethoscope on his chest.  Silence.  I glance over to Dr. Leo standing by the grandmother in the doorway and without saying a word he knows.  He asks the Haitian resident if there is any epinephrine, but I had to use it up three nights ago.  I begin compressions and rescue breathing, but stop.  I don’t think I can handle giving CPR to an infant again, so I don’t #EmotionalBurnout.  There was nothing to be done from a medical standpoint.

Mary’s home delivery was a blessing from the start, but one that was wrought with suffering, fear, doubt, and a roller coaster of emotion.  Women and children die in the U.S. at a rate we care not to admit and we have the most advanced care in the history of human existence on our side.  Just imagine the odds Mary and Jesus were up against that first Christmas.  An unwed, pregnant teenager in a foreign land being tended to by complete strangers and having to deliver in a stinky cave next to a donkey.  Sounds like a circus sideshow.  But what an awkwardly poetic present from the Big Guy (or Gal) upstairs.

Jean working for HandsUp!

My thoughts and prayers are with that poor family this Christmas Eve and Day.  In fact my thoughts go to Haiti most days, but especially when my faith or consumerism is front and center on my brain.  Hello, Christmas in the U.S.  

I think of Jean Gabin who defines living paycheck to paycheck.  Yet this is the first thing he wanted to do with the money I gave him for his work: Buy the thirty children in his “Hands Up for the Children of Haiti” program a large Christmas feast so they would be happy and want to sing Christmas songs.  He’s an unbelievable human being.  

I think of Dr. Leo and what he and his beautiful family are doing for the people of Gran Bois.  Again, unbelievable.  And I think about my own life and family and how ridiculously blessed we are.  Blessed to have a loving family.  Blessed to be an American.  Blessed to have the freedom to travel to a place like Haiti.  And blessed to be a Christian #ToWhomMuchIsGivenMuchIsExpected

I want to take this opportunity to wish everyone a Blessed Christmas.  Being home with my family after spending a week with my Haitian family has been amazing and I truly feel spoiled.  To say I appreciate all the support from my friends and family doesn't properly characterize how I feel.  Even amazing doesn't.  So thank you all #ThanksgivingWasLastMonth