The mom, very poor, without Medical insurance, lives in  Tijuana, Mexico, I live in Southern California, I am a Male Midwife, and I  have done prenatal care, and births for close to 80 poor mom's there.

This is a story of Miriam Ramirez Gonzales, 19.  It is a story about how we came together,  her Prenatal care, and the births of her twins.

On Monday, 4/21/01, as I was unloading things from my car, in the  Colonia Morita, Tijuana, an old mini pickup stopped along side my car and a large mom got out.  She looked a bit familiar, and she immediately asked me, "do you remember me". I  said, as it came back to me, "you are Miriam's mom! right!" "yes, she said, and I am so glad  to have found you, we lost your phone number, Miraim is pregnant again, and this time she  is pregnant with twins, and she is close to her due date. I am sure that she wants your help, if  you can. Could you go, and visit her? She lives close" "OK, I said, but I first must talk with this  mom, for a bit, and then I will go to your house, and then you can show me where Miraim  lives."After I checked Rosa Maria, and reassured her, that she was not going to have her baby any time soon, I left to go to Miraim's mothers house. A younger sister of Miraim came out, and she said, that she would show me where Miraim lived. It has been almost 2 years sense I have seen Miraim. She is very likable, as soon is you meet her, you will fall in love with her. Miriam is very soft spoken. As soon as I arrived, Miriam showed me some ultrasounds, which were taken about a week ago, definitely showing twins. Miriam was then about 33 weeks, by her ultrasound. She was unsure of her LMP. The ultrasounds showed that the boy is head down, in her pelvis, and on her right side, the girl is breach, and on her left side, and mostly behind the boy. FHT's are easy for the boy, it took me a bit, to locate the girl, but once I found her, it was then easy to return get more FHT's. The baby's are active, and reactive. I talked to Miriam about eating well, to prevent premature labor, and if premature labor should start, what to do. I now know where she lives, so I will visit her this Saturday. She has no medical insurance, so she has been seen at the old downtown Tijuana General hospital, where they gave her the standard response, for a twin birth. "Better to have a cesarean." they told her. Even though Miriam does not want a cesarean, she understands that there are more risks, for a twin birth, especially for the second baby. I told Miriam, that I would do some studying on twin births, their risks, etc. and we would then discuss all of the risks, when I would visit Miriam next Saturday.

One day, a few months after her first birth, I saw Miriam, in an open-air market, and I was remarking to her, how beautiful her birth went, especially for a young, 17-year-old first time mom. Miriam told me, that she was studying to be a nurse, and that she had read, and asked a lot of questions about birth. She had a beautiful birth, Miriam then was only my 5th. patient, and the memory's of her birth came back to me. I think that Miriam would like to have this birth with me, but we need additional information, to make a better decision. This is a big responsibility for me, as this will be my first twin birth. . As I set here, thinking, about how beautiful it is to have a mom come back, looking for you, because you did a previous birth for her, and she trusts you, Miriam will be my first repeat birth, but TWINS. I am caught between the desire to take care of Miriam with this next birth, a milestone for me, and the fear, of doing my first twin birth. I will gather some opinions, and experiences from other Midwifes on the list, which I will translate into Spanish, along with a "Twins" information Document from another mom, on the Internet, She is going to make up her mind, on my next visit with her, if she wants to have a home birth.

When I visited Miriam on Saturday, 4/28/01, she had had a chance to think about things, was apparent, that the only thing, what she wanted to hear, was that I would take care of her. Apparently, Miriam, and her mother had talked about risks, etc., and how her previous birth went, so she had already made up her mind on where she would birth, and was only waiting to her from me, if I thought that everything was OK, and that I would take care of her. I reiterated about risks, both in the hospital setting, with the proposed C. section, and the risks of a twin home birth. I think, that the chances of a good outcome, for Miriam are very good, as she had a NSVD with me, when Miriam was 17. I re-stressed the importance rest, nutrition and hydration. Miriam's  EDD by LMP is May 22, and the recent April 6 ultrasound lists EDD by CGA as June 7. I know that the my knowledge, and experience, and those who will be assisting are very important, so I have contacted a Tijuana Midwife friend, who lives about 25 minutes away from Miriam's house, who will assist me during the delivery.

A bit before 8 PM, 5/17/01, I got a call from my Sister in law, saying that she received a call from the husband of Miriam Ramirez, who told my Sister in law, that Miriam had not been feeling well, and that they took Miriam by Ambulance to some hospital. I immediately grabbed some clothes, jumped into my car, and headed for Tijuana. I arrived about 2 hours later, at their house, and was immediately met by Miriam's husband. He told me, that he didn't know what happened, as he was at work, but it had something to do with a nearby neighbor. We went to the neighbors house, where the husband told us, that his wife was very concerned about Miriam, Miriam wasn't eating, and was having contractions. They had tried to call me, but said that they could not get the call to go through, and the recordings were in English, so that they did not understand why. This neighbor then called an ambulance, and the ambulance took Miriam to the old Tijuana General Hospital. So I decided to go to the Tijuana General Hospital, and maybe, somehow salvage this. Miriam's husband went with me, to the hospital.

It is difficult to get any information in this hospital, as there is an unmanned window, which they check about every 15-20 minutes. After waiting about 15 minutes, a doctor opened the door to the triage area, and called to someone in the waiting room. Miriam's husband took this opportunity to stick his foot in the door, and ask the doctor, if he, or any other Doctor, had seen his wife, and if she was still there. The doctor said that “yes, he had checked a young women about 1 hour ago, who was pregnant with twins, and she was not in active labor.” The doctor also said that they had tried to talk the young women into doing a Cesarean Section on her, as she was very close to her time, and they recommended that a Cesarean Section would be faster, and safer for the babies. Miriam had told them that she only wanted to be checked, as a "Partero" was going to attend to her birth. This raised the hackles of the staff, they could not believe that a mom with twins would deliberately choose to do this, and so they made Miriam sign a statement, saying that she would release the Hospital from all further liability, so that she could leave.

So, then we knew Miriam was not in the hospitals clutches, but where was she? I was outside, wondering around, looking for Miriam, and just then my cell phone rang. It was Miriam, and she was talking very fast, I couldn't understand what she was saying, I ran inside to give the phone to her husband, and by the time I found him, the call ended. A few minutes later, my cell phone rang again, and it was Miriam, I immediately handed the phone to her husband, and Miriam told him, that they had walked to the "gray bus line" waiting area. He knew what street the gray bus line ran on, so we left the hospital, and found that street, and began to drive the length of it. By this time, it is 10:45 PM, it's dark outside, so we are wondering, how are we going to find Miriam. Finally, after about 45 minutes, Miriam calls again, this time, she gives us the names of the streets. It was in a slightly different area, but we soon found Miriam, and took her home. Miriam had walked about 10 blocks to get to the bus stop. It did not seem to faze her.

It was now about 11:45 PM. Miriam's husband soon excused himself, as he needed to get up, at 4 AM. I began to check Miriam, listening to her babies. They were rather active, and responsive to your touch. Soon, the husband, of neighbor lady came over, and talked to me about the fact, that they were very worried about Miriam, and how they were worried that Miriam could now not return to the Tijuana General Hospital, as she had signed the paper releasing them from further liability, and I guess that they thought that Miriam could not be seen there again. He further told me, that he, and some other neighbors were "putting a fund together, as he knew a nearby doctor who would do a C. section for a reduced rate." It was certain, at this point, that these neighbors thought that it was rather dangerous for Miriam to have her babies at home, and were making plans for Miriam to do otherwise. I turned, and looked at Miriam's eyes, and I could tell, that she did not like what she was hearing. The man was talking rather loudly, and scaring Miriam's little boy. Finally, the man left. Miriam began to explain, how the day had happened. The neighbor lady had come over to visit Miriam. Miriam did not have any desires to eat, was just lying around, and having mild contractions. After trying to call me, and apparently did not know, that they needed a long distance calling card for their telephone, to  make the call, the neighbor lady began to panic, and then called an ambulance. the rest, you know. Miriam said, when she was in the Hospital, they treated her very gruffly, hurting her when doing a vaginal check, (2 doctors), and when feeling the baby's positions. One doctor, would not believe, that she was carrying twins. Miriam said that there was a lot of blood on the floor, and the place had a bad odor about it. She has no desires to deliver there, in any manor. Miriam retold me, that she has no fear of having her babies at home.

As I was checking Miriam, I noticed that she had protein in her urine. It was no surprise to me, as I knew that she had not been eating well, for a couple of days. I told her, to please go, and eat something, your babies need it. It was then apparent, that there was very little food in the house. Now, I understand the problem, always the same, for everyone, Money. I told Miriam, that we would bring some food to her this weekend. As we sat, talking, and watching her babies move in her tummy I looked at my watch, It was now about 12:30 AM, and I still had a hour drive home. I told Miriam, to please be careful, stay away from her neighbor, and to call me, if she should have more contractions. I will get some food donations, and take then to Miriam on my next Saturday's visit. This was in an email, from a Midwife friend. “Please tell Miriam for me that there are others in the U.S. who care about her and believe in her.  And to please eat. It's so hard when people don't believe in you.  Perhaps that fund her neighbors are taking up for a doctor could be used to buy her some good quality proteins and vegetables.”

I visited Miriam Saturday, 5/19/01, and everything was all right with her. She has been eating better, so her cx. had backed off. Miriam is now only 3 days from her EDD, a miracle, I think, considering what has taken place in her life. The babies feel big, so I think, that she will be calling very soon. The meddlesome neighbor has backed off, which is a big relief. My helpers will be Angelica, the Tijuana Midwife, Miriam's mom, who studied to be a nurse, but never finished her schooling, and my latest helper, a Doula from So. Cal., Susan Scott-Gill. And maybe some others, depends on what Miriam wants. Miriam despite her many late twin pregnancy discomforts, continues to be very positive, and has not wavered in her plans to deliver at home. My worry, continues to be with the ever continuing "Telephone problem". This is the perils of living in one country, and doing prenatal care, and births in another. I just hope, when the time comes, that the call will come through.

Wednesday night, 5/23/01, just as I was getting into bed, at 10:05 PM, my phone rang. It was a younger sister of Miriam Gonzales, saying that Miriam had started labor, and could I come. I told her, "yes, I will leave in a few moments, and I will be there in about 2½ hours." Miriam's sister said, that Miriam was in their house, not in hers. I knew where the house was, as that house is where Miriam gave birth to her 1st. son, almost 2 years ago. I didn't know why Miriam was at her mothers house, maybe she just happened to be there, or maybe she wanted some distance from the persistent bothersome neighbor, which had talked Miriam into taking an Ambulance ride to the old downtown Tijuana General Hospital last Thursday. I then called my new helper, Susan Scott-Gill, but her husband said, that she was not home, and he would "pass the message." She did not return the call. So much for this Midwife wanabe, I have not found one, who is reliable yet. It is hard to believe, that she would not be available for a twin birth.

I arrived at Miriam's mothers house about 12:15 AM. Miriam greeted me outside. I had given Miriam pacific instructions, to call me early, so that I would have ample time, to prepare for this twin birth, so it was no surprise, that Miriam had not started to dilate, when I checked her, shortly after arriving. She shows me a wet spot on the bed, clear fluid, which later I attribute this to the girl baby, as it never did show any signs of rupturing later. By 3:15 Miriam has started to dilate, 2-3 cm. I decide that it is time to go, and get Angelica, the other Tijuana Midwife that I had planned to assist me, with this delivery. Angelica lives about 20 minutes away, almost all on dirt roads. I pound, and pound on Angelica's door, and I am hollering her name, seemingly waking everyone in the neighborhood, except Angelica. Angelica finally responds, and tells me, that she just went to bed, as she also has a mom in labor. Soon, Angelica comes out, and gets into my car. Angelica tells me, that we must first go by her patients house, so Angelica can check her. Luckily, Angelica's patient lives on the way, to Miriam's house. Angelica's patient is dilated the same amount as Miriam, except that Angelica's patient was been at the same dilation since early evening, so we continue on to Miriam's mom's house. I

t is now about 4:15 AM, and Miriam is having stronger contractions, although she is only slightly more dilated in the last hour. I can feel the membranes bulging with the contractions, so I decide to AROM her. I then ask Miriam, to get up, and please walk for awhile. I can see that she is now starting to have stronger, and more effective contractions. At 4:50 AM, Miriam gets back on the bed, on her knees, leans against the wall, and starts pushing, with her back toward me. At 4:54 AM, I have Miriam's new son in my hands. The mood instantly changes in the room, we start moving about, I clamp off her newborn, and hand him to Angelica. I ask Miriam, to please lay down, as I want her in a better position, for her breech daughter. After about 10 minutes of no contractions, Very slowly, Miriam starts to have more contractions, as we clean up her new son. As Miriam's 2 year old comes in, and sees and hears his new brother, we weigh this new little one, 3.4 Kgs. Good size for a twin birth. I am constantly taking FHT's on Miriam's unborn daughter, and although I see Miriam passing a lot of clots, the unborn girl continues to have a strong, and unwavering heartbeat. Finally Miriam's contractions are becoming very strong again, and almost as painful, as with the first baby. About 5:45, Miriam is getting the urge to push, and at at 5:49 AM, she pushes out a little breech girl, 55 minutes after the first twin. Other then the fact that this baby's genitals are a bit swollen, because of her breech exit, she is healthy, pink, wide eyed, and breathing well from the start, as was the first baby. The girl weighs in at 2.5 Kgs., small, but just a miniature of the other. Now, the room is full of Miriam's sisters, mom, and us. The placentas come out about 1/2 hour later, as one big placenta, the biggest that I have ever seen, with a small cord one side, and a large cold on the other. It appears, that Miriam is now going to bleed, so I start to clean up everything, and then a few minutes later, I see the signs, that I don't like, but am very ready for. I wait a few minutes more, checking her uterus, it feels very hard, but she continues to bleed, I know her BP is OK, as I checked it earlier, so Angelica prepares an injection of Ergotrate, and just a few moments later Miriam's bleeding stops. Miriam is now nursing her girl, I took several photo's of her, and the baby's, but something happened to the flash on my camera, and only one came out, not a good shot of everything, you can barely see the bigger twin's hand in the left edge of the photo.

Although I am quite tired at this point,  I am on cloud 9 now, SO happy, that all turned out well. Miriam's never wavering decision, to have her babies at home probably has a number reasons behind it. She certainly did not like what the medical community was offering, as an alternative. She had had a very nice 1st. birth, with me, and I am sure, that this contributed heavily to her decision to have her twins at home. I asked Miriam, as I do all of my mom's, "Miriam, are you scared to deliver at home?" A simple, soft spoken "No" she said, with a smile. Even her mother remarked about Miriam's decision, after the birth, while talking to Angelica, the other Midwife. Miriam had told her mom earlier, that "I want to have my babies with the Partero, I feel safe with him." This made me feel very proud.

As I was thinking back, about the birth, and before, I was struck not only about Miriam's extreme calmness during this event, but also Miriam's family's reaction during her labor, and birth. I had asked Miriam, how many sisters do you have, when I visited her this last weekend, "5" she said. I am the oldest, the rest live here. I made the comment, that "you better keep the paper with my number, as someday one of your sisters may need my help." She said "yes, I intend to keep your number." The thing, that I found different about this family, is their apparent attitude about birth. It seemed that even in Mexico, most people who choose home birth, worry a bit about possible complications. And a Twin home birth, even more. (Remember Miriam's neighbor, the ambulance, and the ride to the hospital) When Miriam greeted me, the night that she was in labor, she was alone. The rest of her family was asleep! It seems to me, that Miriam's sisters, and mother, who were in the next room, as I could hear them snoring, were so unworried about this soon to be twin birth, that they may just have considered this to be just another "body function"? Miriam's mom, and sisters began to rise after 5:30 AM, between the time of the 1st. and 2nd. birth. They came into the room, for a while, and looked at the babies and talked to Miriam for a moment, and when went about their business, of getting ready for the day. I was elated, and somewhat jumping up, and down inside, trying to contain my feelings for what I thought was a great achievement for Miriam, but it seemed the rest of the family was not too concerned. Maybe this family just does not show many of their feelings. Maybe there was some family resentment, as it was now apparent, that Miriam, and her husband were separated, and that Miriam had moved back into her mothers home. To me, Miriam always showed a lot of courage, and self-confidence, but, to Miriam, maybe it was something else. I went to her house, Saturday, 6/9/01, and gave her copies of the last Photo's that I took of her, and the twins. I said good bye, and hoped that she would be happy in the future. I hope that someday, our paths will again cross.

Jerry 

Contact info for:

Jerry Whiting 

26480 Peach St. 

Perris, Ca. 92570 

Home 909-657-7734 after 5 PM weekdays, and all day Sundays

Cell 909-553-5344 Anytime