From my journal entry December 1, 2011:
I woke up at about 6:30am with a list of things to do because I knew it was going to be a busy day. I was in the outdoor kitchen cleaning my bike chain from sand like I had been meaning to do for 3 days. The next door neighbor came by and asked for some of our concrete so they could plaster their outdoor kitchen, and I had to say “no” so I felt bad, as I don’t quite have saying no mastered yet. Then two young sons of another neighbor came by for what seemed like an eternity just to say hello and play but all I wanted to do was get all of my chores done and get ready for the school writing/letter exchange program before heading to the clinic to assist with the pre-natal clinic. I knew this was the last opportunity for Scott and I to help the students write the letters in English because they were leaving the next day for a 5-week Christmas holiday.
At 7am, my host mother came by the outdoor kitchen and mentioned something in Lunda about a pregnant village woman needing my help. She pointed to the hut across the dirt road. As I’m still learning Lunda, I didn’t really get the gist of it, and said, “fast, fast so we can prepare for our school program.” In my head, I was thinking to myself: “they know I’m not a doctor. I wish I could skip all these visitors and just get my morning chores done.” She seemed in a hurry, and I didn’t even get a chance to tell Scott that I had started cracking eggs for breakfast inside the hut.
She led me across the road. I was very surprised as she led me into a side door of one of the small mud brick homes. This was my first time inside the home of someone I did not know, so I figured there was definitely something wrong. We crossed a small living room with the only furnishings being a few stools, and into the bedroom, which had two beds made out of bricks and covered with reed mats.
Lying on the floor was a female traditional birth attendant (TBA), at the foot of the young woman. She was surrounded by four other village women, most of whom I recognized as my neighbors. She was lying on the floor on a reed mat with another woman helping prop her head up and covered only by chitenge fabric. I knew at that moment that I couldn’t just politely excuse myself. There were no men in the house, and I could hear the sound of children playing in the front yard, as if they knew something was going on, but knew very well not to interrupt. I felt honored and helpless at the same time that the village women would invite someone they knew less than one month to this intimate birthing experience.
Luckily I had seen one other birth of a good friend back home, so I knew a bit what this was about, but at the same time worlds apart: no hospital, no heart rate monitors, epidurals, or labor-inducing drugs at hand, much less electricity or running water. No sutures, suction, or forceps. No nurse for over 19 kilometers, and no cell phone service. There were a few buckets of water near the mat for washing. The TBA had with her only disposable latex gloves, a bar of soap, and a jar of petroleum jelly. Was this really happening? I had read about a similar experience from a Peace Corps volunteer in the mid ‘90’s, but I naively assumed that most births these days happened in the clinics.
The mother was about 10cm dilated and I could already see a little round bump of the head when I walked in. The TBA was skillfully stretching the labia in between contractions, where all the women coached through with soothing words. The woman in labor had found a small crevice in the mud brick wall to her left, and was using it as a foothold during the contractions. Her right leg was braced against another woman’s knee as they all sat in low stools surrounding her. I asked how many other children she had, and she said this was her fourth. She looked no older than 25.
When I entered around 7am, I assumed this would probably happen quickly since the head was protruding out. She had already been in labor for a few hours. The minutes ticked slowly away and each one seemed like an eternity as the contractions came no closer together. The mother made hardly a sound and was not sweating, but I could tell by the expression on the TBA’s face that things were not going as planned. Between each contraction, the little one’s head kept disappearing back inside the mother. The women helped the mother change position by supporting her a few times in a squat or half-stand, which exposed the traditional Lunda scars in the shape of intricate designs that had been etched on her back during a woman’s initiation ceremony probably a decade before. The mother was unable to stand on her own and looked several times as if she would collapse into the arms of the assisting women.
Around 9am, things got downright scary. My host mom led the women in a round of Christian prayers, and I could see both the mother and the rest of the women taking turns giving it their all to get this baby out. Some began praying very fast as if they were speaking in tongues. I’m no expert, but I think at this point at a western hospital, she would have been given some type of drug to assist her in labor. I couldn’t understand exactly what the women were saying, but I kept hearing the word “ambulance” being called out intermittently, which I knew could not be good. I even volunteered to bike to our rural clinic to radio the hospital, but deep down inside everyone knew that it wouldn’t come. In my three months at our village, I have never seen the ambulance up our road. Three of the women heard a cantor truck (one of about 5 vehicles per day that drive our road), and went to flag it down to see if it would stop to give the woman a ride to the BOMA. For awhile, it was just myself, the TBA, and the mother, and all I could do was hold her hand.
My heart sunk, and minutes turned into hours. I had a sinking feeling that there was something horribly wrong as the amount of head showing was less than it was when I arrived. I heard the rumble of the truck go down the road and knew then that the women were unable to negotiate a ride (would you let a lady give birth in the back of your pick-up truck?) and that whatever was going to happen would happen in that home. The mother-to-be said another prayer for strength. The TBA and village women surrounded her once again with a second wind of energy.
Finally, around 9:45 am, contractions started coming closer together and the water broke. The head came out and was out for what seemed like an eternity without crying and looking very pale yellow. I still had my suspicion that this would be one of these horrible statistics you hear about rural childbirth in Africa when a little body came out, the baby started crying, and everyone breathed a collective sigh of relief. All I could think of to say was “amayala,” meaning “it’s a boy!”
My stomach was still in knots from the close call, and I didn’t think I could handle watching the afterbirth, so I volunteered to prepare a drink of oral rehydration salts at my hut for the mother, who was at this point sweating and shaking. When I came back into the house, the poor mother was just seated next to the water buckets like a forgotten piece of clothing while all attention was on the baby. The women took turns washing him and then swaddled him with no less than 3 clean blankets and a cute little hand-knitted outfit. I don’t even think he got to taste his mother’s milk (even though he was making sucking motions with his mouth) before they whisked him into the arms of the TBA, who rode on the back of a bicycle powered by a neighbor 4 kilometers to the local clinic to be weighed.
They invited me to ride along, and really wanted me to register the baby. Before we left the hut I asked what his name was so they could mark it on the register. I must be used to the U.S.
I walked into the clinic and helped the child get registered, and then saw the three off again on the bicycle ready to unite the baby with its mother. I walked next door to the school, my head still spinning and somehow mustered the energy to assist Scott with the letter writing activity with 30 energetic 7th and 8th graders. All in a day’s work!
Follow up:
Golden is doing well and I always see him strapped to his mother’s back as she goes to the fields or to meet the other village women. I always say “Golden wakola?” meaning literally “is he strong?”, and she confirms, saying “Golden wakola.” It will be fun to see him grow over the next two years. I never found out what prevented his mother from going to the clinic for the birth, but thank goodness he is a happy, healthy infant.
I was invited to observe another home birth about a week later, but came a little late (this one must have been without complications) and was only able to see the afterbirth and the cord cutting by the TBA using a piece of string. Of course they wanted me to name that one too, so I named him Philip.
Without my prodding, the in-charge of our clinic announced that we should work with the TBA’s to implement a program that encourages women to come to the clinic for deliveries. Although the clinic has no running water, electricity, or a nurse, it does have beds, latex gloves in stock, and access to a short wave radio which is a step up for the home births. Most importantly, this gradual change in behavior is getting the women used to the idea of traveling somewhere for labor for the sake of their own health and that of their children. I’m working with the TBA’s to create ways to dialogue with their villagers about safe birthing practices.
