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Midwifery in the Mountains

Caitlin Dahmer has her work cut out for her.

As the newest midwife at Hospital Mision Tarahumara in rural northern Mexico, she serves a local indigenous population without a cultural tradition of midwifery.

Young mothers among the Tarahumara people often give birth alone in villages nestled within the forested Copper Canyon mountains, far away from a hospital or healthcare providers.

In such a rugged environment, where communities rely on subsistence farming to get by, these mothers are burdened with nutritional issues, undiagnosed conditions, and severely lacking access to healthcare facilities.

Nearly half of all babies born in the communities near Caitlin and her colleagues may die before the age of five.

Caitlin knew things were going to be difficult when she signed on with Hospital Mision Tarahumara six months ago. The hospital is tiny, serving around five to ten patients at any given time. Most of their local nursing staff is unequipped for pre- and post-natal care. The nearest hospital with better capabilities is over an hour and fifteen minutes away by car, connected by rocky, curving switchback roads.

“Because we’re so small, we just don’t have high acuity care,” Caitlin said. “If there’s anything that needs really intensive care, or if there’s anything outside of normal, that needs to be transferred because our nurses are not trained in labor and delivery.”

But the remoteness of their hospital makes Caitlin’s position all the more important, as she learned firsthand in several incidents this past month.

Mireya

Birthing babies in a hospital, even a tiny one like Mision Tarahumara, can be a breeze for Caitlin, but preparing for birth in the back of an ambulance driving along mountainous terrain is uncharted territory for the midwife. Yet that’s exactly what she had to do when working with a young mother named Mireya this month.

Mireya came to the hospital in the middle of the night on a busy surgical outreach weekend, presenting 9 centimeters dilated with a baby coming prematurely. Short-staffed and incapable of caring for preemie babies, Caitlin and her colleagues had to transfer Mireya to another facility over an hour away.

The transfer wouldn’t be just a simple car ride.

“She suddenly told me that she had a lot more pressure below, like she needed to push,” Caitlin said. “When that happens, it can be like two pushes and the baby’s out, super fast. I thought, ‘Oh gosh, I need to get prepared to potentially catch a baby in the ambulance.’ I definitely thought it was going to happen because we had a long time left to drive. I frantically set up everything – not that there was much to set up.”

The bumpy roads jostled all the gear and people in the ambulance as they swerved around tight curves through the dark night, nearly knocking Caitlin down on top of her pregnant patient multiple times. Meanwhile, she tried to teach a nursing student with no experience in pre-natal care how to deliver a medication meant to keep Mireya from excessive bleeding.

Caitlin coached Mireya the whole ride, trying her best to keep the young mother from pushing. If Mireya couldn’t hold off on pushing, her baby would arrive in an ambulance without the proper equipment to care for a premature child.

Thankfully Mireya held on for the whole ride and safely delivered her child at the other hospital. Caitlin called the birth “miraculous.”

In the states, Caitlin is used to seeing mothers through all the way to birth. Patient transfers and speedy handoffs like in Mireya’s case are something of a new normal for the midwife now that she is working in an environment with less resources.

Despite the challenges, she continues to approach each situation with a smile, even during life-or-death emergencies.

Elena

In the same week as Mireya’s delivery, Caitlin faced yet another set of complications with a young mother named Elena.

Caitlin and Elena met multiple times over the course of her pregnancy to care for the mother and her upcoming baby boy. Elena’s delivery at Hospital Mision Tarahumara went smoothly under Caitlin’s care.

Elena’s baby was doing fine following the delivery, but Caitlin noticed something wrong with Elena almost immediately: her placenta had not come out after 30 minutes of waiting.

If left alone, the remaining placenta would keep Elena bleeding to the point of death.

Caitlin had seen a situation like this only a handful of times before during her years of practice in the U.S..

“When this happens, we have to manually remove the placenta with our hands.” Caitlin said. “She was gushing blood without any pain medication… My arm was literally inside of her up to my elbow to try to scrape out the placenta from the uterus.”

In any other hospital, this kind of procedure would call for backup from an OB/GYN. Caitlin didn’t have this luxury, but she did have quality training and a God who listens to prayer.

“I wasn’t doubting myself or nervous, but I was like, ‘Okay, Lord, let’s do this. We have to do this. Please stop her bleeding,’” Caitlin said. “Years and years ago when I was in school, my preceptor had me do the manual removal during a C-section, just to get what it would feel like if I had to do this. Because of that, I remembered what it felt like and was able to do it really well.”

Caitlin completed the procedure in around three minutes with no complications. Elena handled the pain well, and her bleeding slowed soon afterwards. Caitlin left her midwife duties to catch some much-needed sleep at home.

The problems didn’t stop there. A couple hours later, Elena was facing yet another battle. She entered hypovolemic shock, when organs begin to fail due to heavy blood loss. She too would require transfer to another facility for intensive care.

Elena survived, but Caitlin wouldn’t be able to see her through to recovery.

Both emergencies Caitlin fought through left her without much immediate closure. Their endings took place in another setting with other healthcare providers, but things still worked out for the better.

In fact, they serve as a reminder for how God is slowly transforming the communities around Hospital Mision Tarahumara. Without Caitlin, two more mothers could have lost their children, or their own lives. More mothers are approaching Caitlin and her colleagues for pre-natal care and deliveries despite a culture that often leaves women alone in their time of great need.

Most importantly, without the hospital, many in the Tarahumara would have never heard the Gospel. Caitlin hopes she can spend more time learning Spanish to at least pray over patients in a language they know, like she could in the states.

A handmade stone wall near Hosptial Mision Tarahumara

In a recent newsletter about the emergencies, Caitlin had this to say about her experiences and the hospital staff:

“All of these recent examples illustrate perfectly the importance of a team in mission work. Most of us will not see the end result, but we are all working together over the years and decades towards the same goal. We won’t save all the people personally (both medically and spiritually), but we are part of the team that builds on each other. Together we are like one of the many rock walls I see throughout these communities, each of us an integral part to the overall structure.”

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