yikes, a thinking blogger award

Thanks Preemie Experiment for the thinking blogger award. I was caught a bit by surprise, as I have just returned from some fieldwork in the town of Leh, Ladakh, smack in the midst of the Indian Himalayas, where I did not spend much time in the cyber cafes, because I was having far too much fun in the labor room and delivery ward of the Leh hospital.

Picture this. The Sonam Norbu Hospital in Leh, Ladakh is the larger of two hospitals that serve an area roughly one and half times the size of Switzerland or Denmark. Although vast geographically, the region is only home to 250,000 people, making it one of the least populated areas in India.

Why so so few people? Did I mention the forbidding landscape? In fact, Ladakh is a desert, with some of the lowest precipitation in India, but where most villages are situated between 10 and 15 thousand feet, many higher than the Alps and the highest peaks in the continental US

Why all this talk about altitude?

Imagine a hospital, where electricity is intermittent and the back-up generator takes about 5-15 minutes to kick in, depending on how cold it is and whether or not the guy manning the generator feels like getting out of bed to start the thing. I asked Dr. Padma, the chief obstetrician what it was like to do cesareans and difficult breech extractions in the operation theater when the electricity went out and she laughed and said, "I now carrry a headlamp."

Imagine a delivery room where the heating is spotty, the mother gets up on the operating table by means of a tiny rusty step-ladder, lies down on a cold rubber surface that has just been scrubbed from antiseptic from the last delivery, and is then asked to put her feet into straps that hang off two poles situated at the end of the table. These odd looking stirrups---combined with the rusty oxygen tank, the little stainless steel vat that is supposedly sterilizing the surgical instruments and gauze unless a nurse forgot to turn it on---lend the room the ambience of a medieval torture chamber as much a birthing room.

Despite the limited aparatus, the obstetric staff are amazing. Tireless, trusty, and professional.

I smile when I think of an American obstetrician attempting a difficult delivery, using only a headlamp. This is where finesse and experience help. Padma does not shy away from doing difficult deliveries vaginally and she does them well, but she is also not loathe to send a primi gravida in for a cesarean if she feels the labor is not progressing. She's also happy to discuss the latest literature on antenatal corticosteriods with me. She graduated from one of Delhi's most prestigious medical colleges and then left a lucrative fellowship to come and work in her home hospital, in one of India's most remote and least developed regions.

There will be more on birthing in Ladakh anon.

The five blogs that I vote for thogger awards are:

Babycatcher: fascinating tales from a midwife in Africa

Midwife with a knife: Great post on a breech extraction

pinwheels: a mother, a writer, a son with downs

Blog,MD: a fascinating blog about oncology, medicine, life

maternal digressions: a blog about motherhood, work, balance. on hiatus, but coming back


Here are the rules for those of you nominated:
1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
2. Link to this post so that people can easily find the exact origin of the meme,
3. Optional: Proudly display the 'Thinking Blogger Award' with a link to the post that you wrote

Blog Temporarily In HIatus

Dear Readers;

Buddhist Mama is in temporary hiatus, while I focus on my main blog, Breechmama.  I look forward to seeing your comments there.  In the meantime, peace & blessings to all you Zen Mamas and Zen Papas out there. I should be back early in 2011 when more travels commence. 

Going to the Field, No Internet

There will be no new posts for the month of April. I am headed up to Ladakh on March 31 for a few weeks of fieldwork and will be off the internet. Not that there aren't cyber cafes in Leh but I'll be too busy to use them. I won't be able to get into Zangskar as the passes are deep under the snow and the avalanche danger is too great this time of year. Then we pack up and move back to the US, along with several hundred kilos of stuff we seem to have mysteriously acquired during our year in India. Skalzang is coming with us to the US.

This is her first visit outside India and Nepal. I can't wait to see what she thinks of the US. Not only that, but she is the first Zangskari person to visit the States as far as I know. Not just the first woman, the first Zangskari period. A nice step for Zangskari feminism.

Why toddlers cry, a Zangskari analysis

Just the other day I had a chat with Skalzang about why toddlers cry. Skalzang, who is one of my oldest friends from Zangskar, is spending the year with us here in India, and has had much opportunity to see Tashi and Krishan have tantrums.

It was interesting to learn that there are two Zangskari words for the crying of toddlers and infants. One, nyid shrin, literally translates as 'sleepy crying', while the other, stod shrin, translates as 'hungry crying'. So there you have it---a simple theory about why babes/toddlers cry---they are either hungry or they are sleepy. Or both. Not sure what word is used in that context. Sure put things into perspective for me; I think I'll try and forget the hundreds of reasons that cause me endless worry and aggravation. It is not that those reasons aren't at fault----but they are more than likely to be in combination with 'sleepy crying' or 'hungry crying'.

I have to hand it to Skalzang, a nun, for clarifying this parenting issue for me!

Twin Birth in the Himalayas

N with her twins, Stankyong and Tsering

In some ways, N's delivery and my own were uncannily similar.

We were both old to be having our first child, we both had twins, we both had them vaginally, and one was breech.

We were both outside the full day, having delivered babies in early May after a long, cold winter. But here our paths diverge.

Unlike me, N knew she would give birth at home, as her five older sisters had. Moreover, her sister–––a trained midwife with over 20 years experience across Zangskar–––would be her primary birth attendant. While my sister had helped deliver babies in a rural hospital in Uzbekistan and had worked for years in reproductive health, I don't think she would jump at the chance to deliver my twins at home.

Unlike me, N had conceived her twins naturally without drugs or other interventions. In fact, she didn't know she was having twins until the night they were born. She hadn't seen a single obstetrician or ultrasound technician during her entire pregnancy. Her first indication came at at six months when Lhaskyid, the midwife, noted that her belly was riding too high and out front for a single birth. N was so scared she wished this thought away the moment it was uttered.

Unlike me, N's exercise the day she went into labor had not been yoga, but watering her fields. She was laboring long before she knew she was in labor. She delivered on one of the busiest times of the year, when the entire village is engaged in 'first watering' or sgrol chu. This involves racing up and down sinous waterways to open and close the 'mouths' of the channels that wind their way through the landscape bringing wate to the barley fields. Climbing along this vast and spidery web of channels and subchannels is a strenuous job, even when the sun is not burning overhead.

It was her turn to go out from dawn to dusk, flooding each and every field, square meter by square meter. Flood the field too fast, and the seedlings are damaged; too slow, and your fields won't get done by the time your turn is up in the village-wide water rights scheme by which each household gets just enough water for its fields.

When N came back at the end of the day, she felt a slight ache in her back, but assumed it was just soreness from bending over the fields with her shovel all day. She said nothing, but fell asleep shortly after dinner in the kitchen while her sister cleaned up. A few hours later, L heard N cry out in her sleep.

“Ahhroohwahhh. Ahroohwahhh.”

When L heard this cry, she guessed that N was in labor. This was no random lament but one scripted for female pain, especially for labor. This cry is mostly by women and often to signify suffering above ordinary or mundane pain. It is a polite way of registering agony that does not disturb the mask of stoicism women wear in Zangskar.

L got up and looked around the kitchen for the implements she might soon need to use. Once she found a match and lit the kerosene lamp, she began to boil some water for tea. While N stayed snug in her warm blankets, L dug around in the cluttered shelves until she found her syringes and the ampules of glucose and epidosin (a muscle relaxant to relax the cervix that she used more and more often). She had sent them over to Karsha two weeks before her arrival, just to be safe. N heard her bustling about about next door in the parlor laying out a new set of rugs, a plastic sheet, and then some clean blankets for the imminent delivery.

It wouldn't do to deliver in the kitchen, N knew. The hearth was a sacred space for both the thab lha mo or hearth goddess and the subterranean klu, both of whom were responsible for household fertility and were offended by the blood of birth. While women are banished to the stables to avoid offending the klu on the Tibetan plateau and nearby Kargil, N was free to labor inside her home, in not the warmest but perhaps the cleanest room of the house.

When Lhaskyid performed her first internal exam, shortly after N went into labor, she discovered two things in rapid succession. First, N was already ‘two fingers’ (3 cm) dilated after only an hour of labor. But the real surprise lay beyond the cervix. Rather than the comforting roundness of a head, she felt buttocks. As she manipulated her fingers around to be sure, she felt the little one’s lingam and almost cried out. Not because he was a boy, and she had just touched the organ that signified this. But because this baby was not headfirst. 

She had delivered many breeches in her life, but none of them twins, and always with a backup helper. She knew the problems a breech could cause---the cord could squeezed or tangled and cut off oxygen to the baby, or the head or shoulders could get stuck on the way out. Even more critically, Zangskar's only labor room, at the primary health clinic where she worked, had no emergency facilities for a cesarean. The nearest hospital was an 18-hour drive away, over a high pass that still lay under several feet of snow. 

L finished her exam, smiled, and told her sister she would soon have the baby. Then she went into the next room to think. She sent her mother off to call Karsha's most skilled birth attendant, a medical assistant, while she made some butter tea. 

The medical assistant was perplexed when he arrived. Lhaskyid had delivered many babies in her life and usually did so on her own. Why had she called him. When he performed his exam, he nearly gasped, but kept his face as straight as possible for N's benefit. Maybe it helped that he talked to Lhaskyid in Urdu rather than Zangskari so that N never suspected anything. Maybe it was that N never realized she had twins until after the whole thing was over and so she wasn’t overwhelmed from the beginning. Maybe it the fact that two very experienced birth attendants knew as much to follow the ‘hands off the breech’ policy. A few short hours, the twins were born, an hour apart, in perfect health. 

In the first year after their birth, N's twins had a few bouts of fever and diarrhea. My twins spent the first three months in the Intensive Care Nursery at Dartmouth Hospital with very few complications and showed no signs of prematurity at the end of twelve months. 

Both sets of twins, for very different reasons, outwitted the odds against them.

three sisters

The three Tinguling sisters have a lot of experience when it comes to Buddhist birthing. L, on photo right, is a midwife with 20 years experience, who delivered alll of the children in this picture, safely, at home, with minimal medical equipment or drugs. N, who stands in the middle of the back row, is holding one of her twins, while her sister, K (on the far left) holds the other twin, and stands in front of her own children, daughter Nyima and son Thayas.

I get by with a little help from my friends

Ani Skalzang Lhamo, my first roomate at Karsha nunnery. An amazingly patient woman, she is a far better parent than either I or Ashok. But she is committed to lifelong celibacy, and so she's not planning on having kids, in this lifetime at least or the next, when she's hoping to be reborn as a monk.




Ani Putid, one of my 'aunties' and mentors at Karsha nunnery, helps Tashi and Krishan familiarize themselves with our backyard. They are sitting on the steps of one of the oldest temples in Zangskar, owned by our gracious host, the Karsha Lonpo.



Our neighbors, Sonam and Stobldan, were a whole lot better at taking care of little kids than the average 10 year old in the States. It didn't hurt that they were older and wiser than my twins and had not been spoiled by having too many toys in their life.

potting training in the himalayas

Warning: this post has offensive language and images. Not for the squeamish, unless you have potty trained a child...

There are a few drawbacks to starting potty training on a cliff in a desert, where the water supply is spotty at best. On good days, the water came to the cliff via a 1 inch diameter black rubber pipe, for an hour or two or less. That is whenever the Nepali laborers who were "fixing" or "improving" the water supply had not accidentally or intentionally disconnected the pipe or rerouted it for their construction purposes. There is a certain haste and intensity to these projects as they can only happen between May and October in Zangskar, before the Nepali workers leave and the streams freeze up. Given that everyone is fighting over the same water, for a range of uses, during a very short work season, you can begin to imagine the subtle, but always Buddhist, tensions in water sharing.

Back to potty training. The cloth diapers and rags, as well as dishes, pots, and pans would pile up through the day as we did other things like fetch the water from the pipe. Often there would be a pile of soiled diapers outside our door under a rock, so that the stray dogs would not get at them. In Zangskar, many stray dogs eat shit, as food is scarce. Even if, like our strays, they live near a nunnery or monastery where kind nuns or monks are constantly setting aside ritual dough figurines or throwing out leftovers, the dogs are still hungry.

On not so good days, when Tashi and Krishan had diarrhea or had decided to poop OUTSIDE not inside the potty, things got a bit more complex. Suddenly, we were playing the game of "where is that poop". In other words trying to find the places that Tashi and Krishan had been after or during their poop. It was highly likely there was poop spread on all kinds of other surfaces including, but not limited to clothes, hands, rugs, walls, etc. We had dirt floors and it isn't easy to clean poop off dirt floors. All of this required more and more water. You begin to see the crux of our problem. Sometimes there was a toss-up between whether to clean the floor, or do the dishes, or cook up a meal. Or at least decide which took priority.

I had a huge burst of compassion and insight into the lives of rural women in India, whose children often get diarrhea, even as they struggle to keep their kids and houses clean. I've read some public health literature pertaining to the problem of diarrhea, which continues to be one of THE MAJOR causes of infant mortality in India and other parts of the 'developing' world. Some people may rant that this problem is entirely preventable if more people (they usually mean women who are taking care of most infants) had ready access to clean water, public hygene awareness, and literacy.

I would like to note that our household had all these things and we were still unable to prevent at least one member of our household from getting diarrhea once a week. Our household was entirely literate, AND aware of basic hygene methods (excepting Tashi and Krishan), AND, we had fairly ready access to mostly clean water. Ok, there was the odd fact that everybody in the village was suffering from dysentery and we all used the same collection tank upstream of the village. But the water in that tank was clean enough, or as clean as its going to get in rural Zangskar for a very long time. In the meantime, Tashi got sick pretty much every week, Krishan every fortnight. Mom and Pop were sick only once a month, mercifully.

I have a huge amount of respect and appreciation for what many mothers in India are up against. They may be trying to keep track of two or three kids, with a limited water source that may be an hour's walk away or rationed due to scarcity (as in urban India where water may arrive by truck but be strictly rationed by household). Furthermore, the actual water kept in the household is limited by the size and number of storage containers available. One tends to forget that if you don't have running water, every drop brough to the house has to be stored, preferably in a clean pot. You should have seen the frantic filling of pots and other containers wheneverthe water pipe was functioning. Ashok once joked that the arrival of water seemed on par with the arrival of the Dalai Lama in Karsha. He was worried about what might happen if the Dalai Lama and the water showed up on the same day??

So, I now understand a lot more about how impossibly hard it is to keep infants (or adults) free of dysentery in rural India.

Our neighbors on the cliff in Karsha

NK with her daughter Deskyid, who is the same age as my twins. NK is my "nomo" (ie. younger sister) and her father, the Karsha lonpo, is my mentor, teacher, host for our visit to the cliff above Karsha.




We sit in the hallway of the Lonpo's modest medical institute with NK's husband P; his daughter Deskyid; my twins, Krishan and Tashi; and our roomate, Skalzang, who is also P's half-sister.




The joys of water collection. From left: my son Krishan, pouring water from pot A into pot B; Deskyid, thinking "what's all the fuss? I've got the rest of my life to gather water p"; Stobldan, watching it all, and my daughter Tashi looking dubious.

two recent poems on being a buddhist mom

The ICN
[for Tashi]

Respirator Bubbles
Monitor flashes as IV drips
Fontanelle rises and falls.

Modern Mothering
[for mothers on the day that bears their name]

Are you ready for long term madness?
The experts agree that
Life may never be the same again.
But why attempt to step backward
When the only move possible is forward?
The Buddha and Heraclitus agree
You can't step into the same river twice.

Here is what I know
Not what I necessarily want.
There is no black market in sleep,
No method of storing calmness
No bore well of rest I can dig,
No advance of sanity to pay down.
No way, really,
To prepare for the chaos.

Mothering is
The best I can and will do,
Completely unprepared.

introduction

This is blog about birth, buddhism, and biomedicine. I'm a literary mama interested in birthing from a Buddhist perspective. My first book, Being a Buddhist Nun, covered the life of Buddhist nuns, while this book is about Buddhist Moms. I will be researching Buddhist birthing practices in the Himalayas for the next year, with toddler twins in tow. It am interested in how Buddhism and biomedicine shape birthing practices in the Zangskar region of the Indian Himalayas as birth moves from the home into the hospital. The blog will cover Buddhist and biomedical perspectives on birthing in Zangskar. I will write about women who gave birth at home and those who do so in the hospital, as well as the doctors and midwives who attend these births. What are the main concerns these women have and where do they agree or disagree? I hope to look at birth from a number of perspectives, so that a single narrative, Rashomon-like, fragments into many stories, each equally valuable.