About 2 months ago I had a patient named Ramos, who was coming regularly for prenatal check-ups, ask me to deliver her baby. I explained to Ramos that I had a deal with the indigenous midwives here, where I would only attend births as an assistant. But Ramos was relentless and insisted at each visit that I catch her baby. I finally agreed on the condition that she would find a local midwife to come to the birth as well. The bargain was made. A week later I met Juana, a very popular midwife from San Pablo (where Ramos lives) and we talked about doing the birth together. It was a bit challenging to communicate with Juana because she doesn't speak Spanish but one of my student midwives Julia translated for us.
Ramos continued to come for prenatal citas up until her 37th week when she stopped showing up. I asked Julia why she thought Ramos hadn't come and she explained that it is customary for the women to stop traveling a month before the birth. Since the clinic is in the next town over, Julia said she wasn't surprised that Ramos had stopped coming. I thought this was totally hilarious given my experience with gringa patients who would come everyday for a prenatal check-up I'd let them. But the tuktuk (motorized rickshaw-like golfcarts that serve as the main form of transportation at the lake) rides can be pretty rough sometimes so I decided to pack up my things and go to Ramos' house for a home-visit. Ramos lives in a really cute place that is very "upscale" for San Pablo with its fenced in front yard and tiled floors. And for the next few weeks I continued to go to her house to check on her until her 39th week. At 39-weeks and 3-days my friend Hannah was coming to visit from the states so I went to do an exam to see how close Ramos might be to birthing. She definitely had some signs of progress but I thought it could be a few more days so I chanced it (for my midwife readers: she had a Bishop's Score of 4). I told Ramos to call me right away if she had ANY signs of labor....you all know where this is going, right? Yup, I got all the way to Guate and checked into my hotel when I got a phone call from Ramos's sister that she was in labor. It was 4:30pm when I got the phone call but apparently Ramos had been in labor since noon and now had contractions every 10 minutes. Every 10 minutes wouldn't be so bad, however the drive back to San Pablo is about 3 1/2 hours and the last shuttle had left at 4pm. So I called my friend Juan who has a private shuttle service to find out what he was up to. Turns out he was in Antigua so he said he would come right away. Juan showed up an hour later with Julia (my assistant and Juan's girlfriend). We headed home but there was a ton of traffic. Julia took this opportunity to lecture me about how crazy I had been to think I could go to the city with a patient so far along in dates. Finally at 9:30pm we arrived and Ramos looked completely exhausted. Juana had a glove on but she told Julia that she hadn't done a dilation check yet. Ramos asked me to check her so I quickly put on a pair of gloves. When I lifted Ramos' skirt (the midwives here deliver babies under the women's skirt) I saw the amniotic bag. I told Ramos to go ahead and push but she was having a very hard time. I checked the baby's head and realized the baby was posterior. I suggested to Ramos that we change her position but Juana did not like this idea and said Ramos should stay put. After a few more pushes without change I became more insistent and had Julia translate to Juana that I wanted Ramos to move onto her side. As soon as Ramos moved the baby came instantly. It was a baby girl who was born persitent posterior (face up) at 10:05pm and who was healthy as could be. The postpartum was just beautiful...the baby was an expert breastfeeder from the start and Ramos had no complications. About 30 minutes after the birth Ramos' two other sons came home to check out their new baby sister and it was just a precious scene. We weighed and measured the baby: 7lbs.7oz. and 17 inches long. And then a few hours later once everyone seemed to be doing well Julia and I went home.
Ramos and baby 1 hour postpartum.
Super blurry pic but here is Juana the Comadrona (who is sleeping in the corner about an hour after the birth) and the big brothers.
Big brothers: Alvaro and Jorge
More of Jorgito who I think might be the cutest 3 year old in all of Guatemala.
1 day postpartum visit...
Checking baby out.
Jorgito loves to listen to his own heartbeat.
Preshie Presh!
Julia and me with the baby girl who has yet to be named but who I have taken to calling Ramosita (Little Ramos).
