Day 199: It's A Girl!

“Birth is not only about making babies.  Birth is about making mothers—strong, competent, capable mothers who trust themselves and know their inner strength.”                                                                                                – Barbara Katz Rothman

First things first: no, I didn’t have a baby; my host mom did!  The baby doesn’t have a name yet, so throughout this post I’ll be referring to her as the Guatemalans do: la nena.  “Nena,” as far as I can tell, is basically a cutesy word for baby girl (the male version is nene).

My host mom has been visibly pregnant my entire time in site.  She’s actually been a little too visibly pregnant; both her family and the local doctors grew concerned about her insanely large belly, leading her to get an ultrasound at a nearby hospital.  It might come as a shock to you, as it did to me, that ultrasounds during pregnancy are not the norm here.  Most women pass through their five-ish pregnancies without once seeking medical imaging.  Only if a woman develops one of the six pregnancy “warning signs”* does she usually seek medical advice, and even then there’s no guarantee that she’ll get an ultrasound.  This is partly due to lack of ultrasound machines and health staff training (there is a $60,000 ultrasound machine in the next town over, gifted to the health center by the Japanese aid organization JICA; the machine sits unused, because no one in the health center, including the doctor, knows how to operate it).  But the lack of ultrasounds is also a matter of tradition: women aren’t used to getting ultrasounds, and health centers aren’t used to promoting them.  Pregnancies simply aren’t as carefully monitored here as they are in the U.S.  Oh, and each ultrasound costs about $25, which is a big chunk of Guatemalan change.

In any case, in November, my host mom went to Sololá, a fifteen-minute car ride away, to get an ultrasound.  The imaging unfortunately revealed that the fetus was breached, which in turn meant that my host mom would probably require a Cesarean section.  In the U.S., Cesareans have become fairly passé: no one really wants one, but if it’s necessary, it’s no big deal.  Here, it’s a big deal.  The procedure is dangerous, and the recovery period is really dangerous, mainly due to lack of personal hygiene.  I recently met a 19-year-old with an infected Cesarean wound (she had been cleaning it once daily with hand soap, and didn’t seem to know how to apply clean dressing).  My fellow volunteer Hannah had an even more dramatic encounter, with a 17-year-old permanently paralyzed from the waist down following a botched Cesarean (I know I’ve mentioned this story before, but I still feel horrified every time I think of it).

So my host mom came home from her ultrasound, understandably upset about the idea of a Cesarean.  In an attempt to cheer her up, I asked her if she had learned the sex of the baby.  With a smile, she said no, that the ultrasound technician had told her husband, but that her husband had forbidden the tech from telling her.  He wanted to be the only one to know.  This was another shock for me.  In what kind of world can a man prevent his wife’s doctor from telling her the sex of the baby?  It just goes to show, to me at least, how deep the machismo runs here.

The plan after the ultrasound was follow-up: Maria, my host mom, would return to the hospital in one month for a second ultrasound, to see if the fetus had flipped.  But she never went in for the follow-up.  When I asked her about it, she said, “I don’t really need to know.  Better to keep it a surprise.”  In other words, better to see what happens when I give birth.  Her blasé attitude toward her health (and the health of her fetus) was alarming, and pretty much the norm here.  I was comforted by the fact that she at least planned to give birth in the hospital (not the norm here).  If anything went wrong, she would be in a place with somewhat adequate staff, equipment, and capabilities.

Yesterday morning, at about 2:00, I was woken by the sound of movement in my house: my host dad practically yelling in his loud voice, my host mom responding in hushed murmurs, and, inexplicably, someone taking a shower.  This isn’t the first time my host family has woken me up at strange hours with their strange goings-on (a couple weeks ago, my host dad got up at three in the morning to drive to Mexico in search of a pick-up truck), so I didn’t think much of it.  I rolled over groggily, pressed my head harder into the pillow to muffle the sound, and went back to sleep.

At around 7:30, as I walked out of the house to go to work, I ran into my host dad—disheveled, bleary-eyed, and clutching a roll of toilet paper.  We exchanged our usual morning pleasantries, and then he said, “Oh, by the way, Maria is in the hospital giving birth right now.”  SAY WHAT?!  He told me that she had woken at 1:00 am with contractions, and that they had driven to the hospital at about 3:00 am, when her labor pains were coming five minutes apart.  She had showered before leaving, because “the hospital is such a dirty place.”  The nurses in the hospital, finding her to be about 5 cm dilated, predicted that she would give birth at about 7:30 or 8:00—in other words, at exactly the time Juan and I were talking.

And here we come to another shocking fact about Guatemala: in public hospitals, family members are not permitted to be present during births.  Pregnant women are attended by doctors and nurses, and no one else.  None of the Guatemalans I’ve talked to have been able to explain this rule, and none of them seem to like it.  And I have to agree: wouldn’t it be better to allow mothers, sisters, husbands into the room, to hold hands, verbally encourage, and just generally provide support?

Not only was my host dad barred from attending his daughter’s birth; he couldn’t even visit until the afternoon.  The hospital allows visitations only between 2:00 and 3:00 pm.  At all other times, the hospital entrances are guarded by men with guns, and anyone trying to gain entrance is questioned.  This is silly for a lot of reasons, not least of which is that emergency patients have to waste time explaining to hospital guards why they’re seeking medical care.

This weird (read: stupid) visitation policy explained why my host dad was working a half day in San José Chacayá, and why when he came home for lunch he ate at a leisurely pace.  I had scarfed down my meal, raring to go to the hospital, but he knew there was no sense in leaving early.  We would just be turned away at the hospital gate.

Before going to the hospital, we had to stop at the grocery store for supplies.  See, another crazy thing about the maternity wards in Guatemala is that they don’t provide diapers or clothing for the babies, or any personal hygiene items for the mothers.  My host dad had packed clothes and towels from home, but he needed to buy soap, toothpaste, diapers, etc.  He also bought bananas for my host mom, a detail that will become relevant in several paragraphs.

We finally made it to the hospital, and started pushing our way through the crowded waiting room.  There was no one to greet us, ask us who we were, direct us to the correct ward, or anything like that.  Instead, there was a single woman charged with corralling children.  The hospital has a rule that no one under 12 can visit any patients, presumably for hygienic reasons.  As my host brother is only seven, he was quickly picked out as underage and targeted.  The hospital worker swooped down on us, and basically detained my host brother in the waiting room.

We continued down a long hallway, searching for the maternity ward.  But, before we found it, my host dad spotted a woman and her clearly-less-than-12-year-old son walking the hallway, most likely visiting an ailing relative.  My host dad insisted on storming back to the waiting room, grabbing my host brother, and basically dragging him through the halls to the maternity ward.  This did not sit well with the hospital authorities.  We were soon surrounded by a group of security guards with large guns (I wish I was talking about biceps here, but I’m talking rifles).

Jon Isaias, my host brother, was soon returned to the waiting room, and my host dad, host grandmother, and I walked on to the ward.  Each “room” (really more a cavernous space with an opening to the hallway in place of a door) held six to eight new mothers, each lying on a twin bed, and about three bedside tables.  I guess only the lucky patients got a place to store their things, besides the floor.  We had no idea which room my host mom was in, so we had to look in each room, scan the tired faces, and move on.  We finally found her tucked snugly against a wall, cradling a nondescript, and allegedly sleeping, baby bundle.

Here we come to some comforting good news: the delivery went very well.  The nena had spontaneously flipped to the correct position, and Maria didn’t require a Cesarean section.  Both mother and baby were healthy and happy.

Apologies for the poor image quality; I didn't feel like I should use my flash around all the tired new moms!

My host dad quickly picked up la nena, and I eagerly began my duties as family photographer.  But, within about twenty seconds, my host dad had turned to me and asked if I wanted to hold the baby.  I was shocked—if I had just had a baby, I think I would want to hold it forever.  He had held her for twenty seconds, and was now offering her up to this weird gringa who happens to live in his house!  I was so blown away that I almost said no.  But I took the baby and nuzzled her fuzzy little head for a few seconds, before my host dad took her back.  He redeposited her at Maria’s breast, then LEFT to go continue waging his war with the security department.  Seriously.  He went to go fight with the men with guns.

His mother stayed, and promptly busied herself pouring out sugary flour atole for Maria (atole is the hot beverage of choice here, and comes in many different varieties: plantain atole, chocolate atole, rice atole, corn atole, you get the idea.  It’s almost always loaded with sugar).  As Maria sipped away, her mother-in-law started sorting out all the stuff we had brought her.  When she got to the bananas, she and Maria turned to me: Would it be safe for Maria to eat some bananas?  Are they healthy enough to eat after giving birth?

Something you have to understand about Guatemala is that university degrees are very rare here.  Anyone who has a university degree is regarded with the same respect afforded to a PhD in the United States.  Seriously, most Guatemalans think I’m basically a doctor.  The whole respect thing is nice, but I’m often asked questions that I’m not really qualified to answer.  For instance, earlier in her pregnancy, my host mom had asked me if I could tell her how to flip her breached baby.  Now, I was being asked for dietary advice.  Back in the United States, while working as a medical scribe, I would never have considered it safe or okay to tell any patient what he or she could or could not eat.  But here, after glancing at the hot sugar water my host mother was happily sipping, I felt quite comfortable telling her that yes, bananas are okay.  I did make her promise not to give any to the baby, though.  After all, one of my primary Peace Corps jobs is to promote exclusive breastfeeding.

All too soon, visiting hour was at an end.  We had to leave the maternity ward, but we hung around outside the hospital for another half hour, because my host dad wasn’t finished hashing it out with the guards.  I get where my host dad was coming from—it’s ridiculous that a healthy seven-year-old can’t meet his healthy new baby sister.  It’s even more ridiculous that the hospital has no limit on the number of visitors.  Two beds over from my host mom, one new mother had about twenty friends and family members clustered around her bed.  I’m pretty sure those twenty people were carrying more germs than my single host brother.  But, I didn’t understand why my host dad was making such a big deal out of this silly hospital rule, when he only had an hour to visit his new daughter.

The germ-ridden (presumably) crowd

I’ve thought a lot about whether his behavior has anything to do with the fact that la nena is a daughter, and not a son.  The sad truth in this country is that men are literally valued much more than women.  I say literally because midwives actually charge more to deliver a male baby than a female one.  With a male baby comes the promise of an educated child, an asset to the labor force, and income to support the parents in their old age.  With a female baby comes early marriage and housework.  Slightly less appealing.

The new nena also has the disadvantage of being Guatemalan, whereas my host brother is an American citizen (he was born in the United States while his parents were living there illegally).  My host dad even brought this up while fighting with the security guards.  He told them that his son was an American, cleaner than Guatemalan children and with more right to visit the hospital.

So, all of that, combined with the ruthless machismo of Guatemala, has me a little worried for la nena’s future.  But for now, she’s at home, safe and healthy.  And for now, that’s all I can ask for.

*The pregnancy warning signs, as my health center teaches them, are: fever, headache, shortness of breath, epigastric abdominal pain, vaginal bleeding, and swollen feet.