Birthing 101

April 7

Monday, after work, my African mother, Julie and I headed out to the market. We picked up some soap and coal to cook on and then stopped by a tailor's small shop to pick up Julie's dress that she had made from the leftovers of my fabric. Everything took a while, it's not just a quick run to the store. This is Africa. So after stopping to talk to countless people we ambled along slowly down a dirt path between huts, passing women with pots on their heads.

Julie decided to spend the afternoon visiting, which I would have rather foregone, but it would have been very impolite to leave her,so I resigned myself to not getting home before dark.

An hour later, things got interesting as we walked into a courtyard to find a bunch of women gathered and a woman in labor! I was finally going to get a chance to see a home birth. Women here only come to the hospital to give birth if there is a problem or if it is their first baby.

The woman was laying out on a reed mat, obviously having close contractions, with a bunch of people fanning her. Julie and I were given chairs to sit on (a luxury since I'm white), and brought water to drink. It's like a show! Everyone sat around just watching her. It was explained to me that this was her sixth pregnancy with 4 living children right now. So we settled in to watch and wait, expecting the baby to pop out easily since she had birthed so many already.

When another hour passed with no progress, I started to watch her more closely. She started to actually yell some which usually means that they are having a harder time then usual because these women hardly make a peep when giving birth. If they do yell out, they usually get scolded by family members.

Some blood started to come out of her and as the worry started to circulate among the women, I glanced at Julie who gave me a little nod. We both stood up and went over to the woman, Julie explaining that I worked as a nurse at the hospital. I started rapidly asking questions, Julie translating my French into Nangjere. It soon came out that she hadn't felt the baby move for over a day and had now been in labor for 6 hours. I checked her pulse and conjunctiva color which was very pale. O God, she's already anemic!

Immediately I turned to the relatives and started explaining that she needed to go to the hospital. She was going to need blood right away and there we could check her out better to determine if the baby was still alive or not, if she would need a c-section, etc. I realized soon that I was talking to deaf ears. They ignored me, only answering with excuses and the usual, "We don't have money."

"What do you mean you don't have money?!" I cried out, easily seeing they were well off. "You can take your bike as collateral and pay for it later." The husband countered that he needed his bike to get to work with a smile on his face. How can he smile about this? "Don't you need your wife to cook for you and give you babies? She is going to die if you don't take her to get blood!" Anemia is one of the biggest reasons for death here among pregnant women.

A loud cry from the woman moved my attention back to her as a gush of blood came out. Kneeling down next to her, I looked into her panicked, sweaty face and knew I couldn't just leave her. Sending up a quick prayer for guidance, I started preparing to help as much as I could. I knew I needed to examine her and see if I could feel how the baby was positioned or if there was a problem, but...no gloves? I've gotten used to some blood on me from IVs or other random little things, but we always use gloves for pelvic exams.

Letting out a sigh of decision, I asked the family for water and soap to wash my hands. Maybe at least I can keep from giving her an infection. Then with a quick mutter under my breath, "I hope she isn't HIV+, God protect me!" I pushed my two fingers up her. She was fully dilated and I could feel the baby's head, but for some reason, she was having a hard time pushing the baby out.

After rinsing off my hand, I went up to her head and started trying to coach her breathing and pushing to coincide with her contractions. Minutes passed and it still wasn't progressing, with her getting weaker. So I ordered a couple women to help her get up and squat.

There was way too much blood coming out of her for my liking but my constant pleas to take her to the hospital were still ignored. In the squatting position, she was able to push better and I started running my fingers inside the edge of the cervix trying to open it up more fore the head that was now showing. Finally, getting desperate, knowing this baby hadn't been moving for over a day, I reached in and put my fingers in the baby's mouth like James has taught us, and started pulling with her contractions.

Suddenly in a rush of blood and fluid, the baby slipped out almost easily. The cord was wrapped tightly around his neck and he was blue and still. After slipping the cord off, I thought, "What do I do now?!" I don't have the instruments to suction its mouth or clamp and cut the cord or bag air into him.

Sweeping mucous out of his mouth with my fingers, I quickly put my lips down on his little blue ones and started sucking and then spitting onto the ground next to me. The family brought string and a knife to cut the cord and I stopped long enough to tell them to wash it and pass it through a match flame in front of me before using it. Then I continued rubbing the baby vigorously, starting chest compressions, hoping it would stimulate the lungs too, and breathing into his little mouth, watching for his chest to rise.

Liz! I wish you were here to help me right now!

Some of the women started their mournful wailing, so I turned to them frustratingly, "He isn't dead yet! I can feel a weak pulse." I was determined not to stop for at least a half hour, remembering a time earlier this year when Liz and I were able to resuscitate a baby in almost the same situation as this one.

Little by little, the blue started to dissipate from his small body and he gave a few weak gasps every few seconds. Picking him up in my arms, I went next to the woman and reached down to show the grandma that she should be massaging the stomach harder. I figured they could deliver the placenta since they've been through so many births. I continued with the vigil of breaths & compressions and slapping his feet and hands. I saw his eyelids flutter a little and kept praying constantly. Finally he let out a weak, but throaty cry that gave me hope that he was going to make it. After letting him cry a few more times, I laid him down next to his mom and tried to get him nursing a little to help the uterus contract to deliver the placenta.

Just as I let go of him, I saw the women pulling the cord, jerk rather harshly, pulling the placenta out...but only part of it. God, could anything else go wrong right now?! What is the matter with these people! Don't they do this all the time?

Knowing we couldn't keep the pieces of placenta in there, I washed my hands and reached up her again, sweeping the inside of her uterus carefully with my hands, pulling out large bloody pieces. Deciding I'd done as much as I could, I rinsed off and stepped back, trying one last time to convince the family to take her in to get blood and antibiotics. I wished I was strong enough to just throw the woman on my back and carry her to the hospital! They responded the same as before, so after sticking a piece of fabric partway up her to hopefully stem any more bleeding, I turned dejectedly away and left. As Jesus says to his disciples, "If anyone will not welcome you or listen to your words, shake the dust off your feet when you leave that home."

Back at home, I changed out of my soiled skirt and repeatedly rinsed out my mouth to get all remnants of bloody mucous gone from my taste. For hours after lying down to sleep under the stars, I lay awake, unable to keep the days events from my mind. Did I do everything I could have? Should I not have helped at all? I am not a doctor or a midwife! I'm not even a nurse like they think I am.....but I work under the guidance of the Great Physician. By his wisdom and power, that baby is alive.

(The woman died this afternoon and now the family is spending tons of money, giving the proper funeral and entertaining guests with tea)