What I wish I were doing

Rivera moves her hips around and around on the ball, even as contractions
force groans from her throat. Newly minted nurse Katherine Ryan rubs her
back.

The motion on the ball should help keep Rivera's pelvis relaxed and assist
with her dilation. In her upright position, gravity should help the baby
descend. But Rivera's first child will not arrive easily.

It's going to be a long night.

The kind of night that Katherine has left a comfortable home in the Pacific
Northwest to experience in Texas' sultry Rio Grande Valley. The kind of
night that she will live again and again at Holy Family Birth Center, where,
for 20 years, nurses and certified nurse-midwives have cared for pregnant
women and delivered their babies. After a year of nights, and days, like
this one, she will walk away transformed and having learned what she values
most in life.

Only months into her service, Katherine has already gone through a rebirth
of sorts. Inspired by an aunt who has served the homeless on the West Coast,
she left her middle-class life complete with family, friends and a Starbucks
on every corner, to live in a place where migrant families can sometimes
scrape together just one meal a day and where several groups of them
sometimes live together in one small trailer.

The day she arrived, Katherine, 23, was tempted to turn around and leave.
But she knew she had to stay.

"I think I'm here for a lot of different reasons," says Katherine, a
soft-spoken woman with red hair and a sprinkling of freckles across her nose
and cheeks. "Kind of exploring, trying to figure out where I want my career
to go.

"I've already learned so much from this experience," she says. "Just in my
four months being here. … I'm just almost overwhelmed. It's a very
overwhelming experience."

Holy Family Birth Center was founded in 1983 by four nuns, including Angela
Murdaugh, a certified nurse-midwife and a Franciscan Sister of Mary. She's
the only one of the original four still practicing midwifery at Holy Family.

The center, located in Weslaco, a town of about 28,000 that sits between
Harlingen and McAllen on Texas Highway 83, is funded by private grants and
donations. It comprises 15 small buildings that sit on four acres. Three
buildings are duplexes where women give birth.

At any given time, there are three certified nurse-midwives serving on staff
for three years, six registered nurses volunteering for a year and a couple
of midwives doing clinical fellowships for a period of months. The women
come from all over the country - Oregon, Colorado, Wisconsin, New York - to
work under Sister Angela, a legendary figure in midwife circles.

The center's mission is to serve the poor of Hidalgo County. A few clients
seek out Holy Family solely because they prefer midwives to deliver their
babies and they don't want to give birth in a hospital. But about 90 percent
of Holy Family's clients fall below the poverty line.

Many are here illegally and don't qualify for government aid. Holy Family
offers them delivery, including care before and after birth, for $1,500. If
they can't afford that, they can pay the bill through volunteer work hours.

But for Sister Angela, 63, recruiting women like Katherine has become as
important a ministry as that of serving the poor. One cannot exist without
the other.

"I just didn't understand it at first - how important it was to have a place
for people to come and serve," Sister Angela says.

"I think, so often, everybody gets savior complexes," she says. "You're the
one that's going to teach somebody or show somebody."

But working with families so poor that they sometimes live "in what winter
visitors drag down here behind their cars" is a lesson most of the midwives
and nurses will never forget, she says.

"To see that kind of impoverishment and to see how people cope with it and
live with it and do well and have a good disposition - that's a good life's
lesson," she says. "A very good life's lesson to find out that money isn't
everything in this world. Sometimes you can do extremely well just being."

It's a lesson Katherine began to learn immediately upon her arrival at Holy
Family.

She grew up in a close-knit family in Oakland, Calif., the second of four
children born to a stockbroker and a nurse.

"I've always gotten everything I've ever needed or wanted," Katherine says.

She attended private Catholic school from kindergarten through high school.
Her nursing degree is from the University of Portland, a private Catholic
school. During nursing school, she even studied in France for a semester.

Katherine had always wanted to be like her aunt, a nurse practitioner who
founded a prenatal clinic for homeless women in San Francisco.

During her freshman year in college, Katherine spent some time in Mexico.
She hoped to work with the Latino community after graduation.

She went to the university volunteer services office and inquired about
organizations with opportunities to volunteer her nursing services for a
year. Someone there put her in touch with a nurse who had spent a year at
Holy Family.

"She sent me all her pictures," Katherine says. "She actually told me it was
one of the best years of her life."

She contacted Sister Angela, applied for the job and was accepted.

It was a sweltering 105 degrees when she arrived last summer at the cluster
of yellow wooden buildings that is Holy Family. She was exhausted because
she had just taken her nursing board exams the day before. Some of the
nurses at the center were ending their year of service. They didn't have
time to begin new relationships.

There were no skyscrapers in Weslaco, no shiny downtown offices and no
Starbucks with lines of people waiting. Instead, what she found was a rural
area known mostly for its orange and grapefruit groves and its proximity to
Mexico.

"It was so different," Katherine says. "I'm coming from Oakland, the Bay
Area. Then you come to this small, tiny little place with no family. … I
didn't know anyone here. And I didn't know what I was getting myself into."

Almost immediately after arriving at the center, she drove to a nearby store
to call home. "Mom, the only thing in this place is Wal-Mart," she said
through her tears. She cried for four days.

"No one thought that I would make it," Katherine says. The rest of the staff
was placing bets on how long she would last, she recalls.

Margarita Flores, a staff midwife for more than two years, watched Katherine
struggle with her transition. Margarita agrees that life at Holy Family
isn't easy, but that's why she came.

She left Chicago to work with and learn from Sister Angela. But she had
another need, too.

"Just to learn how to live simple was starting to become important to me,"
says Margarita, 33. "When you're used to a certain lifestyle, making a
certain amount of money, thinking you want to spend more, you don't
appreciate the importance of saving, and material things."

At Holy Family, nurses earn about $300 a month and staff midwives earn
$1,000 a month. All get health insurance. Sleeping quarters are simple: a
twin bed, a dresser, a closet. The bedrooms have no air conditioning, and
there is one computer at Holy Family with Internet access.

Lunch is eaten as a group, and each woman is expected to cook the meal twice
a month. Each must also clean up after herself.

"The community living is hard, especially when you come from different
lifestyles," Margarita says. Sharing living quarters requires consideration
for others.

"If I were in my own apartment, I would leave my dishes for about a day,"
she says. "Here, there are expectations. You need to respect their space."

But she has been here long enough to see women come, fall in love with their
work and their colleagues and then have to move on.

"A lot of people have called this place `magical,'" she says.

"I will tell you, it's hard to say good-bye," she says. "You meet so many
people, different and interesting people. And you develop relationships, and
then you have to leave. You'll always remember your time here with the
people that you've met."

In the green-walled duplex it's about 8 p.m. when Katherine squeezes into
the bathroom where Rivera, going on her 14th hour of labor, rides out her
contractions in a tub of warm water. Rivera's mother-in-law, Anita Rivera,
and midwife fellow Yuliya Groyzburg are sitting beside the tub, so Katherine
sits on the toilet lid.

Blanca Rivera's husband, Daniel, has stepped out on an errand, but his
brother and sister have also arrived to lend their support. They wait in the
duplex's tiny kitchen.

By 8:30, the mother-to-be is back on the exercise ball, and Margarita, who
just delivered a baby in one of the other duplexes, has arrived to coach her
through the final hours of labor. Yuliya sits on a tiny stool cradling
Blanca Rivera from behind. Katherine waits quietly for instructions.

With every contraction, Rivera clutches the mattress in front of her, then
leans back mightily against Yuliya, panting all the while.

Finally at 8:37, a gush of water flows down the ball.

"Oh, se rompio la fuente," Margarita explains.

Rivera's water has broken.

It's after 10 when she has Blanca Rivera kneel on the bed, lean her forearms
on the ball, and push in that position.

"Mas, mas, mas, mas, mas!" the midwife says, urging her to push. In the dim
light, Yuliya uses a flashlight to see whether the baby's head is visible.

"Breathe deeply," Margarita instructs in Spanish after the contraction.
"Well done."

An hour later, an exhausted Rivera squeezes her husband's hand as Margarita
asks her to push harder yet: "Mas, mas, mas, mas, mas … respira profundo ..
Bien hecho."

"There he is!" Margarita says. "He has lots of hair, black hair. Push him!
Push him!"

The days leading up to this birth were busy for Katherine. A couple of
nights before, a woman arrived in premature labor. Katherine and another
nurse drove her to a hospital.

The day before, Katherine did baby checkups in the clinic. And in the
evening she and another nurse made a home visit to see Lucy Rodriguez, who a
week before had been transferred to the Weslaco hospital for a cesarean
section.

To get to her home, Katherine had to follow a small hand-drawn map. On the
way, the blacktop gave way to dirt, and the passing orange groves and
shotgun shacks gave way to tall green stalks. Katherine was certain she was
lost.

"I think I'd know if they lived in the middle of a cornfield," she said. But
she drove on, and, suddenly, the green and gray trailer she was looking for
materialized in a clearing. In the middle of the cornfield.

As the nurses made their way to the door, chickens pecked at the ground
around them, and kittens of various sizes scurried under the trailer.
Overhead, gray clouds thickened and threatened to burst.

In a tiny bedroom cramped with a bed, nightstand and dresser, Katherine
gently removed Rodriguez's stitches. Her husband, Arturo Gonzalez, watched
from the foot of the bed, his Adidas cap flipped backward on his head and a
picture of the sacred heart of Jesus at his back. The ceiling was warped and
water-stained, and as the nurses examined mom and baby a hard rain pelted
the trailer roof.

On their way back to the car, the nurses stepped along chunks of cinder
block to avoid giant puddles left by the passing storm.

"As a new graduate it's very difficult to get a labor and delivery job just
coming out of school," Katherine says. "They usually work postpartum first
and then they ease you into labor and delivery after a couple of years."

"Here, the midwives are teaching you as you go," she says. "Not only are we
doing labor and delivery, but we get to do pediatric care `cause we take
care of the babies until they're a year old. And we get to do public health
since we're going out into the community and seeing the patients in their
homes. … You're doing like four or five jobs in one."

Learning Spanish in order to speak to clients hasn't been easy, but "the one
thing I've learned is that sometimes … your actions speak so much more than
words," she says. "Just being by their side when they're in the birth room
and touching them and wiping their face and just smiling."

Part of Katherine's transformation has come from reflecting on the people
she serves.

"It's just amazing how much you can learn from them just by the way that
they do live, and the simple lives that they lead, and the strong faith that
they do have," she says. "How they're so family-centered. And what is
important to them in their lives.

"We get so caught up in consumerism and money and having stuff and needing
all this stuff," she says. "… It just makes you realize that you don't need
all these things. All you need is love and faith and family and friends."

Katherine still misses big-city life. She knows that she will leave Holy
Family eventually.

"But I know that it's going to be very difficult," she says. "I think it's
going to be very challenging to leave. … I feel like this is my home now. I
love it."

In the softly lit duplex, there is still no baby.

Earlier, Katherine had described the awe inspired by being present when a
client delivers. "They have the birth, and it's the most intense moment of
their life," she said. "Their most vulnerable moment of their life. And
you're a part of it."

But tonight, things are not happening the way the midwife would like. The
baby never changed position, and Rivera is exhausted from pushing.

"I don't think you're giving me all your strength," Margarita says to
Rivera. "I need more. The baby needs you right now."

After another round of pushing, Margarita listens to the baby's heartbeat.
He's tired; he isn't tolerating the pushing well anymore. And there's an
urgency in her voice when she says, "Anesthesia!"

Katherine hands her a syringe, and Margarita does a quick episiotomy. The
nurse wheels over an oxygen tank and puts a mask over Rivera's mouth and
nose.

"Push it out!" Margarita says. "… Breathe deeply."

"Here he comes, mi'ja," Rivera's mother-in-law says.

At 12:10 a.m. a dark, damp head emerges. Margarita doesn't wait for the
whole baby to slip out of the womb; she immediately suctions his mouth and
nose so he can breathe.

He draws a breath and cries. In one fluid motion, the rest of him slides out
and the midwife takes him in her hands. Even before she is handing him
toward his mom, Rivera is reaching for him. With a moan, she pulls her son
to her chest.

Katherine leans over and kisses Rivera on the cheek.

Daniel Rivera huddles with his wife and they look at the damp-haired baby
named after him: Daniel Antonio. Daniel Rivera's mother sighs with relief,
and her daughter and other son tiptoe into the room to greet the new member
of their family.

It's the kind of moment Katherine came here for.

"It's beautiful," she says. "Every time it's a miracle."

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Posted on Mon, Dec. 22, 2003
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