Thursday, September 16, 2010

Birth Around the World: Origins of Plenitude birth center

This is a long, but fascinating, account of the origins of the Plenitud birth center in Guadalajara, Mexico. It was written by Joni Nichols in 2004 and reposted here with permission. You'll read about how women began leaving their physicians and changing hospitals in favor of Dr. José Luis. You'll see the transformation of a physician as he learns what undisturbed birth really looks and sounds like. You'll gain glimpses into the institutional protocols of Mexican hospitals and understand how truly different the Plenitud birth center is.

Asking how we built a birth center is a little bit like asking how any of us made a baby. Certain aspects are pretty universal to everyone’s’ experience ... but what folks usually mean is that they want to hear the details that make the event a “story” rather than a “how-to” guide. In this way we savor the unique details, the personal anecdotes, and perhaps even the ideas that we might want to borrow to make our own dreams come true. To this end, I share with you how our center Plenitud came to be.

So who am I? I am a childbirth instructor (Informed Homebirth/Informed Birth and Parenting), professional labor assistant/doula (ALACE & DONA), midwife assistant, full time wife, and mother of three. My partner is José Luis Grefnes, an obstetrician & gynecologist, homeopath, childbirth educator certified through the Mexican national association, DONA workshop attendee, husband and father of four. We both live and practice in Guadalajara, Jalisco, México.

We met in April 1994 when I was a faculty member for the childbirth certification course in which José Luis was enrolled. Asked to speak about birth practices in the different countries where I had lived and birthed, I meticulously prepared an hour-long talk in Spanish. Although fluent, I sometimes confuse the pronunciation of similar words and I wanted this presentation to be flawless. During the course of the talk I departed from my well rehearsed “script” and mentioned hand reflexology. I began to explain how grasping combs during labor can exert pressure on the balls of the hand and mid finger tips to facilitate smooth and less painful functioning of the uterus. To my great chagrin, rather than say “peine” (pay...nay) which is “comb”, I said “pene” (pen...nay) which is....gulp.....”penis”! The audience was either dumbfounded or else very polite, but in either case stifled their response. It was only after the talk was completed that José Luis approached me and said, “Those must be some homebirths you attend....maybe a little hard on the husbands, but I’d sure like it if you invited me to one some time.”

At the time I was attending some of the most marginalized women of the state in the vast public teaching hospital known as the Hospital Viejo or Old Hospital in the city center. I offered free childbirth preparation in the corridors and accompanied the women during their labors and births. It was really a two-pronged educational program because I was also given the opportunity occasionally to teach their doctors as a guest of the faculty of the medical school. Those three years were exhausting, exhilarating, frustrating and fruitful.

One particular woman attending my classes was extremely faithful. Without exception, every Tuesday and Thursday morning Sandra and her toddler son took two long bus rides in order to participate in these active learning sessions. Perhaps you are imagining a quiet nook in the hospital where childbirth materials are on display and the women have mats to sit upon the floor. A place where a push of the button displays videos on the television monitor and the women share their dreams and hopes with one another. Our 10am classes began instead with the question “How many of you have felt your babies move today?" When only one or two hands among 20 or more women would go up, I would ask how many of them had eaten that day. Nearly all would respond that they were in “ayuno” or fasting from the day before. As the basket of homemade fruit bread threaded its way through the group I would remind them to raise a finger during the course of the class when their baby moved. And so began a practice that has continued to this day of providing homemade breads, fresh fruit and raspberry tea to every pregnant woman who attends my classes, consultations or meetings.

The “classroom” seating was a combination of hard wooden benches and molded plastic seats. The floors were a speckled linoleum, and the walls showed the effects of the hundreds of women who had leaned upon them in labor. Our instruction was punctuated with young residents calling out the name of the next woman to be examined from the row of cubicles at one end of the room, and with the cries of labor from the women being examined to determine if their labor was advanced enough to allow their admission to the hospital’s labor rooms at the other. What the atmosphere lacked in coziness was definitely balanced by realism!

The classes were a joy to impart. The women were initially shy but loved brainstorming sessions or “lluvia de ideas” -- meaning a “rainstorm” of ideas and suggestions. Over time they were up and out of their molded plastic seats and adopting kneeling, squatting, all fours and variations of all the upright positions. We had some very difficult realities to face. These women would be required to labor without any family members once they were accepted in the hospital. Issued a hospital gown which might not even have ties, they were required to place all their personal property in large plastic bags which were given to their family members waiting outside the building. No beverage (not even water) or food was available and the toilets had neither doors nor toilet paper. Their caregivers were young residents in their early 20’s under the supervision of one experienced obstetrician who wasn’t always eager to be disturbed. Each woman was assigned a bed and her presence indicated on a large blackboard. Denied an identity, most were referred to as “mi hija” (literally, my daughter) or “fulana en cama # 2” (the one in bed #2).

The women were gathered in one large communal labor room, each confined to her bed with its plastic mattress and one flat sheet which generally came loose within minutes of her lying in the bed. The bed were iron and only rarely adjustable. The sunshine filtering in through the tall windows contributed considerably to making the room hot and uncomfortable. The student doctors ate their tacos from the street and read their newspapers and overall acted as though the laboring women were an inconvenience.

I saw how early on many medical caregivers were learning to distance themselves from their patients and offering automatic and robotic answers to the infrequent questions they posed. Knowing that this teaching hospital was the gateway to further medical practice for the doctors throughout the city, I grew more curious about this José Luis who seemed so eager to see a natural homebirth. Could it be that he had been trained in an environment such as this but remained loyal to his profession’s commitment to compassionate healing?

About this time I received a phone call from a very young woman insistent on having a truly natural birth. She had already taken some childbirth classes with another educator I knew and seemed to be ready to take the next step of making the classroom theory of natural birth a reality. I met with her and her husband (both still students) and their enthusiasm, willingness to work for their birth, and faith in their ability to do so was contagious. I reported back to their childbirth educator whose response was probably meant to be cautionary but to me was incendiary .... “Oh they probably won’t even be able to pay you!” That was all it took for me to ask José Luis to consider attending their birth. He told us about a tiny charity hospital near his office where he frequently attended births and this young couple agreed it would meet their needs perfectly..

Accustomed to all-in-one LDR rooms in the United States I didn’t think twice about remaining in the room where Flor and Horacio were laboring when she began to push spontaneously. Having seen women use any position they wanted in the homebirths I saw during my years living in Holland, I was completely at ease when she assumed a hands and knees position on the bed. As her baby emerged over a completely elastic perineum I looked over to see José Luis scurrying to put on hospital scrubs and a mask!!! That was the only indication I had that this kind of natural birthing was perhaps a couple of standard deviations removed from what he had previously experienced. Fluidly and gracefully, José Luis passed baby Paola through Flor’s legs and Flor sitting back on her haunches smiled broadly. How was I to know that this doctor was seeing a baby born facing him for the first time in his career?

Months passed and Sandra (the mom from the public hospital) continued attending classes and asking more pointed questions of her doctor concerning the VBAC birth she wished to have. She approached me after class distraught saying that she realized that her caregiver wasn’t invested in the idea of a vaginal birth and asking if I knew of any other doctor who would help. Knowing her economic resources were severely limited but that her determination was abundant, I again thought of José Luis’ enthusiasm at seeing a birth without interventions. What could we lose by asking him? And so it came to be that José Luis attended a VBAC in the same tiny charity hospital a few blocks from his consultorio.

A birth that began early one fall morning and continued as the mother swayed and rocked and crooned to her unborn child into the long hours of the night. A birth in which he saw his first rice sock and then disappeared for a brief while, only to reappear with a thermos containing an identical rice sock he had gone home to make! A birth in which the mother ate and drank and walked and moaned. A birth in which after hearing the campana (bell) announcing mass, the mother dressed and walked to the chapel to take confession. A birth in which a classical trained medical doctor pulled up on a small bench and gently massaged the mother’s belly with herbal creams sold by a Zapotecan midwife. A birth with intermittent auscultation and constant support and company. A birth that was a triumph!

When Sandra’s posterior positioned baby descended and she floundered for a moment looking for a way to support herself, I climbed onto the bed and with her husband Enrique. With each of us beside her, we held her aloft in a supported squat. Baby Diana slid into José Luis' waiting hands and was immediately enfolded in her mother’s arms. The euphoric look on José Luis' face told me that this was truly a unique experience for him. Sandra brought her daughter to breast and her suckling was interrupted by a sudden grimace. With a laugh and crinkling eyes showing his mirth, José Luis cried out, “of course, the placenta!” A classically trained caregiver in this city would have never seen a spontaneously expelled placenta, because like everything else related to birth, it was a doctor-controlled event with cord traction. When the pediatrician joined us shortly afterwards he was told “No, there will be no need to send this baby to the nursery, thank you.” And so Sandra passed the night with her baby in her bed.

For a casual passerby this was a poor person’s hospital. A slightly shabby and dimly-lit building with toilets lacking lids and a sad air about it. A place that closed in upon itself at night when the throngs of waiting families were no longer clogging its corridors and the food vendors were no longer hawking their wares. To us it was a magical and sacred place. A transformation had occurred. Sandra’s: her vaginal birth after cesarean in an atmosphere of trust and respect. José Luis’: his further introduction into the world of midwifery.

This first in a succession of “firsts” occurs in November of 1995. I continued teaching childbirth classes and attending births as a doula in the Hospital Civil 3 days a week while teaching private childbirth classes in my home. José Luis continued his daily employment at a governmental hospital 7 hours a day and at a governmental health agency another 9 hours a week while maintaining his private practice in the evening hours and giving childbirth classes on Saturdays!

On the surface our daily professional activities continued with a certain “sameness” but really nothing was the same at all! We knew about each other and that in itself changed everything. How to be satisfied with the work we were accomplishing individually when the possibilities for forging some kind of work together are unspoken but definitely “there.” I knew normal physiological and uninterrupted birth as a mother, childbirth educator and labor assistant but certainly lacked the skills to responsibly attend births alone. José Luis had the credentials that permit him to attend births but has had so few opportunities to see birth completely uncontaminated. Who was supposed to ask whom to dance?

My certification letter from Informed Homebirth/Informed Birth and Parenting reminded me that I was not to recommend a particular birth attendant, but rather to give parents the choices available and the help to make an intelligent and informed choice. What’s a woman to do? Why, share the news of the new option of course! I trusted that the women I am teaching would be captivated by this possibility and I was not disappointed.

And so the additional “firsts” followed. Home visits in anticipation of home births were scheduled and attended. There was Minou’s homebirth in May, followed by Becky’s the day after. Two homebirths in as many days.....what an adventure! Guadalajara is enormous and these women lived at opposite ends of the city’s borders. Minou’s birth was completed at midnight in a bustling apartment complex amidst labyrinthian crowded streets at the edge of the deep forested gorge that marks one end of the city. Becky’s took place in a large home in a sylvan residential golf community an hour drive in the opposite direction. One family spoke only Spanish and the other only English. Oh yes, the possibilities were definitely abounding and José Luis’ eyes were sparkling!

Less than two weeks elapsed. A couple taking private classes with me received approval for their formal request that they remain in their private hospital room rather than make the mandatory trip to the OR for the actual birth. We entered one of the more protocol-ridden institutions of the city with some trepidation. This was the most American-like facility in our community with formal registration procedures, bustling nurse stations, and a very rigid protocol. Each time a nurse entered the room and saw Sylvia in her own clothes she returned with a hospital gown. By the time the baby was born with Sylvia on her knees, the room was festooned with three of these gowns and the chairs were littered with the IV equipment brought to us that we never used. When we straggled out of the birth room euphorically a couple of hours later, we were stopped in the corridor by a nurse who asked, “what religion are you?”

A couple of months later I was called by a laboring woman during my Saturday childbirth class. She and I had met at a MANA conference in San Miguel de Allende earlier in the year and her 3rd homebirth was going to be attended by the midwife who had come from a small outlying community for the other 2 births. This time, though, the labor was imminent, and the midwife woudln’t be able to arrive in time. She requested me to come. I called José Luis and asked him to join me. He responded as though I were inviting him to a celebration. It turnsed out that he was correct!

We walked into her house and were greeted with a radiant mother holding her newborn while her two other young children looked on. A neighbor produced the plastic tub with the placenta and shyly explained that she was keeping it in another room so the children wouldn't trip over it. The mother’s words echoed in our hearts and spirit: ”I always believed that women could give birth, but now I really know they can!” We listened to her happy and proud story and were witnesses to her triumph. We remained with her until her husband arrived from work and spent some additional time as the father repayed us by offering to draw our Mayan astral charts. José Luis and I left their home with the satisfaction of having shared a woman’s strength and determination without even being present for the actual birth. This birth laid the foundation for the trust she has to birth twins at home two years later with José Luis and for my first solo homebirth as a caregiver that occurred within the week!

Monica was a fervent LLL apprentice with a little 3-year-old boy. She graciously helped me during my public childbirth classes in the hospital. She was at my side during many births I attended at the Hospital Civil. I had more formal birth education than she, did but she was bilingual and often translated my garbled Spanish with humor and patience. She and her husband requested I attend their birth; their second planned homebirth. I explained that the births I attended at the hospital were always in the presence of an intern or a resident and with an experienced doctors on call and that I wasn’t a midwife. They agreed to come for hour-long talks at my home, but the emphasis was on education and their emotional and spiritual needs. This was now my opportunity to make a discovery. Faithful attention week after week to what the woman identifies as her “needs,” independent of whether clinical responsibility is assumed, IS midwifery care!

They continued their sporadic visits with their midwife (actually an MD living about 2 hours from Guadalajara) and the plan was that I would attend their birth as a doula. When the call came asking me to join them at their apartment, it was accompanied by a deep guttural ahhhhhh heard even by my 8 ½ year old son, who offered me his primary school scissors with the admonition ”You might need these mommy” as I left my home. A few hours later, I took off my white linen outfit appropriately baptized by the placenta and came home in the father’s jogging clothes. My son’s scissors were useful after all .........they cut the umbilical cord!

Throughout the rest of 1996, nearly all of my private childbirth students transferred care to José Luis, and I attended their births as the labor assistant. We thought we had found a supportive hospital with a small birthing room housed in the short corridor leading to the OR and considered ourselves fortunate to promote and attend natural childbirth with little interference.

In the new year, Carolina Oropeza, a childbirth educator who had mentored my participation at the Hospital Civil, took on the enormous project of organizing a DONA doula workshop for more than 75 participants throughout the Mexican Republic. While other doctors registered for the 2 ½ day course, only José Luis and another general practitioner completed the entire weekend’s program. (That MD was to ask us to attend his first child’s home birth 5 years later!)

At the time, no provision was given for documenting/certifying a male doula, but that didn’t dissuade José Luis from becoming everyone’s favorite "doul-o." No sooner did the workshop end on Sunday than did José Luis and I experience another “first”. A cesarean. This was to be this young mother’s ONLY birth (something she emphasized beforehand) and looking back at the hours of labor leading to the surgical decision, I know we gave the best of with-woman care in spite of the attendance of a cynical partner who mocked the use of our newly-learned comfort measures. We were still somewhat at a loss as to how to utilize them once we were confronted with the indication for a cesarean. But taking to heart Penny Simkin’s admonition that preserving the mother’s positive memory of the birth was vital, we ensured that the baby roomed in with her immediately, and we stayed with the mother and her baby for the first hours postpartum.

About this time another obstetrician, Tonatiuh Nuñez, whom we had met in 1995 at the International Childbirth Conference in Guadalajara, contacted us to participate in a conference he was organizing for the educational and investigative division of obstetrics at the Hospital de Ginecologia y Obstetricia. This was a wonderful opportunity, but I insisted that I had to work alongside him in the monolithic IMSS medical facility in preparation for the 3 hour long talks I would give. My rationale was that the OBs and nurses participating in the conference would doubt the feasibility of offering with-woman care and so the only way to show that it could be done was to jump in and do it under the same working conditions they had to contend with!!

During 3 months we attended births together--cheerfully offering beverages instead of IV’s, walking with the women instead of talking to them while they remained tethered to their beds, introducing the birth ball, drowning out the incessant noise and clamor of the hospital with cassette players, and transmitting confidence that they could birth naturally and in whatever position they wished within the labor area and without being channeled through the anesthesia department on their way to the OR. Tonatiuh kept the statistics on 50 births in order to show quantitatively that the APGARS of the baby’s born with expectant management fared as well as or better than the babies born with active management. Best of all, we videotaped it and I could assuage all the naysayers at the conference!

José Luis and Tonatiuh were natural allies, since each man was a single voice within the highly routinized and interventive facility where each worked. Tonatiuh’s participation, though, was directed more to working within the system, while José Luis was growing more desirous of leaving the institution with each passing day

Another major “first” occurred just a few months later. Gaby, a VBAC hopeful, asked José Luis to help her have a waterbirth. And so on July 6th 1997, all three of us experienced our first waterbirth using an inflatable tub in a small hospital. The only rupture we had to contend with was the pool, which flooded the OR while the mother joyfully and obliviously caressed her 9 lb baby son! Throughout the rest of the year we continued to use water as a comfort measure. However, there were no more waterbirths until early February 1998, when one of the OB residents I knew from my activities at the Hospital Civil called to ask for my labor support during his wife’s homebirth.

José Luis and I arrived as a doula team. He for the father and I for the mother. The laboring woman, Arcelia, had taken group childbirth classes with my dear friend Adriana Peregrina but had met us both during one of our tri yearly “swim with the dolphins” excursions which Adriana organized. Though her only experience with water had been the dolphin swim and no mention had ever been made about waterbirth, Arcelia began to murmur about wanting to labor in water during active labor. Her husband disappeared into the granero (barn) and returned with a metallic wash tub. I have a photo of the two OBs intently washing it while the laboring woman (at 7cm dilation) is mopping the floor, ridding it of all the water left in its wake! I kept imagining how fabulous it would be for Arcelia to have both of the women who had accompanied her during this pregnancy with her now. She agreed and I called Adriana, who got to experience her first waterbirth as well. In keeping with the Midwifery Today motto of “each one teach one,” Arcelia’s husband Gustavo later invited me to offer labor support for two more of his family members who wanted waterbirths after seeing the video we taped of his wife’s birth.

By now José Luis and I had established a great synchronicity at births and found our skills complementary. It wasn’t until March, however, with Bety’s birth that I discovered just how flexible he really was. Bety and her husband Peter came to Guadalajara from the mountain town of Mascota. Her parents were doctors and had made all the arrangements for the birth. As they began investigating their childbirth options in private classes with me, Peter realized that they weren’t birthing with caregivers compatible with their values. When labor began, their caregiver dismissed Bety’s belief that she was in labor and suggested that she have a pelvic x-ray to find out whether her pelvis was “adequate.” They called me instead and I invited them to come to my home. It didn’t take long to perceive that she was actively laboring and I invited them to use my bedroom and Jacuzzi tub.

When Bety left the pool to use the toilet we received a phone call from her OB asking how she was doing. When I suggested a home visit to confirm that her labor was well-established--since a couple of hours earlier she undermined Bety’s confidence when she laughed that this was NOTHING compared to what was to come--she indignantly told me that SHE had a consultorio for “these things” and hung up. I called José Luis, described the situation, and asked if he would pleeeeeease come by. When he arrived at the house about a half hour later, he gently introduced himself to Bety and asked what she needed. She wanted to know her dilation. He agreed and with a broad smile told her she was dilated to 8cm. We suggested that if she was planning on going to the hospital this was a good moment to be moving in that direction. Instead, she looked wistfully at the tub and asked “can I just get back in?” “If you are committed to birthing right here than yes, of course” we told her. She and Peter left the tub an hour and a half later with their daughter Justina in their arms.

There was still another member of the group we-are-to-become, but I didn’t meet her until the next month at José Luis’ 40th birthday. He told me about a very passionate neonatologist, Rosy Gonzalez, and she and I left the party to review a video on Kangaroo Care and “talk babies” instead. A MANA conference was being organized the following month in Oaxaca and we made plans to attend together. This “equipo” or team of birth professionals was starting to come together!

We attended 24 more births together in 1998 both at home and in the hospital, but we are constantly having to “pedir posada” or request/beg permission to stay in the hospital room rather than use the OR, or assure the staff that the baby is better off in the mother’s arms (and her bed) than in the nursery. The constancy of the arguments, “favors” we have to ask, and unfavorable climate for births in the midwifery model of care sometimes made us weary. We'd tried so many hospitals…. Mexico Americano, Guadalajara, Versalles, Sta Monica, Guadalupe, San Javier…but the protocol and the administrative obstacles were always the same.

José Luis recommended two smaller hospitals in two very distinct parts of the city. Santa Isabel and Hospital Atemajac. We attended a few births at them and indeed, the protests were a little less forceful. Throughout 1999 the three of us attended 38 births together (14 at home) but we still didn't have a place that felt like “ours”. We had a small flotilla of water tubs, and an array of hoses, wrenches and a vacuum for tub inflation. We made quite an entrance when we arrived! Sometimes the family members in the adjacent rooms looked at us quizzically and wondered about the noise of our vacuum at 2am. Odd hour for housekeeping! When we told them that we are attending a waterbirth, they were always surprised since the majority of them were accompanying a family member who was recuperating from a cesarean. With private hospitals having between 50 and 90% cesarean rates this was hardly surprising.

We felt badly about disturbing their recuperation, but we really had no other options within the hospital setting and frankly, even homes had their problems. At one homebirth there wasn’t enough water pressure and so grandpa, grandma and the doula formed a water brigade from three different faucets in the apartment. At another home the water heater wasn’t working and so we heated pots on the stove all night long. We’ve prevailed on a neighbor to cart over water on occasion and many times just hit the water boiler and pleaded! The time after the birth was sometimes a struggle too with having to empty, clean and collapse the tub when everyone was exhausted or simply wanted to bask in the endorphin afterglow!

When MANA held its next annual conference in Oaxtepec we attended in force. Marilu Navarro (a childbirth educator who teaches in the classroom adjacent to José Luis’ consultorio and attends the births of her students who select him as their caregiver) joined José Luis, Rosy, Adriana and me when we traveled to Oaxtepec.

During those three and a half days we attended workshops, commiserated with the rural midwives, recognized the strength we have in our camaraderie with each another, and relished meeting with the midwives we have come to know and admire over the past three years. We were starting to identify with one another and talk about “us” and “we” when describing our birth activities.

With 2000 came the opening of a new hospital in Guadalajara and the possibility of attending births in their spacious private rooms with ample hot water and plenty of water pressure. Inevitably though, José Luis had to face the barrage of questions from the administration after the birth asking why we don’t use the OR like everyone else, questioning how they were supposed to run a business if we don’t use any materials or services, confused that our babies aren’t in the nursery and wondering why we don’t consider using epidural anesthesia! We had to agree it was better than the hospitals where I have had to hold my foot against the door while the mom is birthing the baby or where we have received phone calls every 15 minutes from the reception checking that we aren’t going to “cheat” and remain in the room rather than go to the operating room for the birth, but it was dispiriting all the same. Half of the births I attended with them this year turned out to be at home, but we don’t have enough families considering that option to have a full-time practice.

We all gathered at my house one morning and discussed what we needed to do. While some were talking about attending another conference or the possibility of us offering a workshop or bantering about the idea of taking continuing education coursework, it occured to me that we have everything we need seated right there in my living room! Why not collaborate with each other and do more than just attend births together? We need an identity and a way to make our presence felt in the community. The group grew animated and we began brainstorming ideas for our name. Marilu, our resident numerologist, starts her calculations and suddenly the group was abuzz. This city has 5 million residents and we have to make our presence felt. We have appeared on television programs and on the radio, had articles published in magazines and journals, given talks at schools, universities, conferences and workshops but with each of us acting independently. Now we need to do these activities combining our energies and using one name! There is no hierarchy. We are an “equipo” or team. Looking for a word that characterizes abundance and the fullness of pregnancy and birth,  we decided upon “plenitude” and thus is born our official name, “Plenitud; embarazo, parto digno y lactancia”. (Plenitude; pregnancy, birth and lactation)

We decided that we will offer free monthly informational meetings, during which we can promote private and group childbirth classes, explain the advantages of labor support, and extol the benefits of the midwifery model of care. We vacillated between the idea of showing a film or not, and then we lit on the idea of offering two visualizations that will compare traditional active management birth versus gentle respectful woman-centered birth. Rather than provide the images, we will allow the families to “see” them in their own heads and decide which feels best for them. José Luis contacted the hospital and within the month we were holding our first evening meeting. We wrote a script and had the obstetricians (José Luis and Tonatiuh) speak about the benefits of natural birth from the perspective of the mother, while the neonatologist reviewed the advantages for the baby. The three childbirth educators/doulas had more than 35 years of combined experience teaching and were definitely in their element without any scripts! We invited a family to share their birth experience with the audience and the 2 hour meeting was a success.

We continued to meet monthly at the Hospital Atemajac for the rest of 2000 and all of 2001 using the facility for the majority of the births we attended. It was a small facility of only 18 beds, but we noticed that one corridor leads to a 4 room cluster that is a dumping ground for broken fans, rickety chairs, extra bed tables, and all the by-products of hard use. The debris was staggering but then so were the possibilities! José Luis asked permission over and over again to use these rooms for Plenitud’s births. He is told that the “socios” (financial backers) needed to approve this idea, which takes an additional 4 months, but finally, they hesitantly agree to let us transform the rooms.

Once we received approval we were off to visit tub makers, plumbing stores, tile setters, lighting departments and furniture makers. We were going to have a simple and rustic place to call our own! Our waterbirths in March 2002 were accompanied by the steady cadence of the plumber’s tools as he carveed out the niche for our fiberglass tub. With each clunk and thud our dream was turning into reality. Fabrics for curtains were selected, the old metal blinds were taken down, beds were tested and dimmer lights were bought. We marched off to furniture showrooms and mulled over price and quality. We definitely had a small budget but we bought a few durable and serviceable pieces. We looked over our personal collections of posters and prints and started to imagine this group of rooms as “ours.”

Finally in April 2002 the first waterbirth took place in our small cluster of rooms. Outwardly, it was only the presence of the fiberglass pool and the double beds that signaled that there were other expectations for birth here, but the sense of this being a safe haven was palpable.

We are only slightly removed from the activity of the hospital (which has a 90% cesarean rate), but once inside our doors a completely different atmosphere reigns. We avoid the “institutional” with furniture that is simple but homelike. We have plain white candles available for every birth (though our families can bring in whatever they would like to personalize their space) and Gentle LED Birth Lights grace the bedside tables for safe illumination during the night. The nursing staff enter only to bring supplies and do not return until after the birth or at our invitation. The maintenance and security at the hospital can be shoddy though and we are plagued (again!) with a recalcitrant hot water boiler, theft of our new sheets, and a dearth of towels and bed pillows. We hang blue curtains in one room and green in the other and somehow return to always find the blue bedding in the green room and vice versa. Finally we take the finials off the ends of the curtain rod and are often seen marching from room to room to exchange the curtains so they will match! Considering the difficulties that our sister midwives face in other communities, these are small annoyances though.

What prevails is the sense of faith in birth. Once through our doors there are no clocks, machines that go ping or otherwise, no blaring messages relayed on the intercom, no televisions, no hustle or bustle. The rhythm of each woman’s birth is the drummer to which we march and she is the leader of the band. The months of dreaming and planning have arrived and the unknown of labor is shared with her loved ones, the OB/midwife and the doula.

Now when we hold monthly meetings we congregate afterwards with the families to enjoy fresh fruit juice and homemade breads in our center aglow with candle lights and soothing music. Why shouldn’t we enjoy the only took 8 years to create!


  1. Thank you for taking the time to read it all!

  2. If the Spanish version of this story would be useful to anyone I have that too.

  3. "Whatever you can do or dream you can do, begin it. Begin it now". (Goethe)
    This is a great story. My son just wrote me from Puebla, Mexico (where he is finishing up an LDS mission) to tell me that he spoke to a woman who is acquainted with many traditional midwives in the nearby highlands. She says she would like me to come there and see if there are connections that could be made for the mutual learning and benefit of all of us. I have no idea how to begin this process, but this story gives me hope that if it is to be, the way will open at the right time as long as I am anxiously engaged in the work before me. I'll take my NARM exam in February to be a CPM, and after that, who knows? Thanks for posting this, Rixa.

  4. Rixa, Thank you for sharing this story. Although I have met Joni (and LOVE her!) I had never read this story. It is powerful...what loving caring people can accomplish with wit, prayer and determination. Lucky women, blessed babies, happy fathers all around the world are such joy to read about!

  5. I loved reading this story. Thank you both for working so hard to give women these incredible birth experiences!


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