In Mayan culture, the moon is represented by a female deity who is thought to have power over terrestrial events. The waxing moon symbolizes a young woman, youthful and fertile, whereas the waning moon symbolizes an old woman, experienced and ruling over childbirth. The full moon is a transition, in the lunar calendar and in a woman’s life, from child to adult through childbearing.
In Western culture, the full moon is associated with bad luck and cyclical insanity, hence “lunacy”. Multiple studies have attempted to associate the lunar cycle with psychiatric breakdowns, crime, illness/death, and animal attacks. There have even been studies attempting to confirm the existence of werewolves. (Really).
I am a true believer of the supernatural, even as it contrasts the evidence-based reality of science. As the moon waxed to its full bright potential last night, it coincided with both birth and bad luck.
I spent the morning performing ultrasounds – I provide free ultrasounds on Saturdays for women from the poorer neighboring towns as part of the hospitalito’s outreach program. These women wait months for a volunteer OB/GYN to perform an anatomy evaluation, which serves as the only form of genetic screening, aside from a nuchal translucency (rarely is there an OB available during that short time frame). Most of the time, the findings are normal and women walk out feeling reassured, as abortion is illegal in this strongly Catholic and Evangelical country and the financial burden of caring for a disabled child is unbearable.
My first diagnosis – anencephaly. I had only ever seen one case of this, diagnosed early in the first trimester and treated with a D&C. The fetus was approximately 26 weeks in gestation and had a heart beat. I counseled the patient regarding the diagnosis, emphasizing the fact that it was incompatible with life. She nodded and stated that God will keep it alive. I repeated myself, pointed to where the cranium should be and told her the fetus would not survive once born. Again, she nodded and stated that God will keep it alive. The conversation went on like this for 30 minutes, with multiple Spanish and Tzu’utujil interpreters and her comadrona. In the end, the patient decided that she will continue to carry the pregnancy to term (terminations are illegal, even for fetuses incompatible with life here anyway) and await spontaneous labor, which in most of these cases, doesn’t happen.
My second diagnosis – IUFD at 33 weeks. She was 42 years old, 9th pregnancy. She had not felt her baby move in three days. She apparently had gone to her local Centro de Salud the day before who told her everything was fine because they found a fetal heart rate on Doppler. She, like everyone else, had not had an ultrasound then or in her pregnancy because there was no OB to perform it. She came to the emergency room prepared, with her husband, mother and comadrona by her side and a small plastic bag filled with baby clothes (one outfit for a girl and one for a boy) and a tiny coffin. The ultrasound confirmed what her experienced body already knew. She opted for an induction of labor and delivered stoically 12 hours later. The female infant had the characteristic markers of Down’s Syndrome, which provided small but significant relief to the family. Without hesitation the comadrona soothed her patient with Tzu’utujil chanting, wrapped the infant in a traditional Mayan scarf, and locked the coffin under the waning moonlight.