We visited the hospital several times this week, checking up on the women who were of particular concern to Barbara. Their outcomes ran the gamut:
- The woman with the seizures and infection had been doing better, but then her infection returned and she seemed to be retaining fluid at an undiminished rate. They had transferred her to a hospital in a city four hours away.
- The woman who had had a cesarean after her labor stopped was much improved and, by our visit yesterday, had gone home with a healthy baby.
- The woman with uterine cancer was gone from her bed, the sheets neatly folded. I assumed she had died, but was later told by a nurse that they had sent her home to die there – nothing more they could do for her at the hospital anyway, and they needed the bed.
For the record, I think this last outcome is probably a good thing. Just as a system in which hospital births are the norm for all women leads to lots of money being spent in achieving relatively poor outcomes, I think the same may be true of a system of hospitalized death.
In death, of course, unlike birth, the outcome is eventually the same for everyone. On the other hand, hospitalized birth and death have much in common: enormous potential for trauma; unnecessary and invasive procedures being performed, often without consent being given; massive quantities of money spent on these procedures; the transformation of a private, family affair into a sterile, clinical one. I’m still formulating my thoughts about this, and, in truth, have seen a dead body but have never actually seen someone die. Still, I think that establishing a system in which the beginning of life and the end of life generally occur out of the clutches of hospitals will be one in which more people have a good birth and a good death, instead of the undignified medical disasters so common now.
One of the nursing schools that I’m applying to has a minor in Palliative and End of Life Care; perhaps I’ll be their first midwifery student to take it up!
One of the days we were at the hospital, Miriam (a foreign nurse friend of Barbara’s who has lived in the Valley for years) came by for a prenatal check up and ultrasound. The hospital staff were perfectly happy to lend Barbara a spare bed to perform the prenatal check up herself. Having seen Barbara do a few prenatal check ups, I knew that she would begin by asking a series of questions about Miriam’s general health and comfort, anything unusual during the pregnancy (Miriam has a number of children already, so she is very familiar with her pregnant body), and fetal movement. She then performs a Leopold maneuver, which is the process of manually palpating the woman’s belly to determine fetal position. Miriam said it would be fine if I wanted to palpate her belly as well – and judging from how exciting I thought this was, I can already tell what a geeky midwifery student I’m going to be.
Let me tell you: feeling the position of the fetus is not as easy as it looks. You think that if you palpate a pregnant woman’s belly you’ll be able to feel something concrete in there, but Miriam is around 7.5 months pregnant, so the fetus still has plenty of fluid around it. For the first few moments I couldn’t feel anything at all – just a dense orb of fluid, like a medicine ball. But then I felt a solid, unbroken line between her belly button and left flank – the fetal spine! – and followed it down to the head above the pubic bone. Her baby has been moving around a lot, but for now it’s in the perfect position for birth.
After using a Doppler fetal monitor to listen for the heartbeat (again, not as easy as it looks to get the fetal heart beat instead of the mother’s), we went with Miriam to another hospital building to get an ultrasound. I’ve only ever seen fetal ultrasounds done in China, so my experience is limited to what they do here, but so far I can’t tell a damn thing from looking at an ultrasound screen. It occurs to me that they may intentionally do them very quickly here, avoiding prolonged views of things you might recognize like the fetal torso, because ultrasound technicians are forbidden from revealing the baby’s sex. This is because one well-documented side effect of China’s “Family Planning Policy”, as it is known here, has been an exacerbation of the population’s lopsided male-female sex ratio, and a high prevalence of sex-selective abortion.
Supposedly, ultrasound technicians can lose their jobs if anyone finds out that they revealed the baby’s sex to the parents. However, I have also heard that bribing the technicians is common, and that technicians sometimes drop hints to eager parents – saying “Congratulations!” if it’s a boy but nothing if it’s a girl, for example. At the end of Miriam’s ultrasound, she and the technician exchanged a few words:
“It doesn’t matter to us what the sex is, since we’re definitely keeping the baby.”
“It may be a boy. We’re not allowed to give you any information because of the Family Planning Policy.”
Perhaps that was a hint, or perhaps they just say that to everyone.