Friday, April 19, 2013

Let's Have This One at Home!

I was talking to my friend yesterday when she mentioned that her daughter-in-law had been having labor pains since morning.  I asked where she was going to deliver and she said she was going to a TBA (traditional birth attendant)’s house.  “Can I come?? Can I come????”  I know I said that OB was not my thing. And it’s not. But I’ve only seen deliveries in the hospital and was curious to see how the majority of the women do it. (The vast majority still attempt to deliver at home, hence the reason the deliveries we do are usually complicated).  She said it would be no problem and would call us (I have two friends staying with me who also wanted to get in on the action) when the time was closer.
That evening we were getting ready to make dinner when my friend came by and said that he’d been told to direct us to the TBA’s house. The time was here!  We hopped in my car and headed over there.  All four of us.  Yes, I brought a 5 ½ year old to watch a woman giving birth.  That’s what happens when your mom lives thousands of miles away and your neighbors are both out of town.  Sure you don’t want to move over here Mom!?!??!?!  Fortunately Mari quickly found some friends at the house and stayed outside.
I walked into the house with a nervous feeling in my stomach. I hadn’t seen one of these in a house before and was wondering how this was going to turn out. What about the oxygen? How are we going to bag the baby if something goes wrong? What if the woman keeps bleeding?  I was comforted by the fact that this was the woman’s second delivery and the first one had given her no problems. (Incidentally her first child was also born in April….of last year.  I figured it was so close to the last one that things should still be pretty open and maybe this baby will just shoot right out). 
At 5:30pm we walked into the house and saw the woman lying on the bed. As we were invited to sit down with my friend on the foam mattress on the ground, I started watching the laboring woman. She was, for the most part, silent.  She even looked like she was sleeping at times.  What the heck?! This woman is just beginning her labor. We’re going to be here until tomorrow!!  We settled in….for a long wait.
Let the baby borning begin!  We met the TBA (who I realized I’d already met once when she’s brought a woman with a retained twin to the hospital) and mangos were served all around.  Women came and went and I strained to understand the fast talking that seems to happen a lot when a bunch of women get together......apparently in any country!  I was able to catch a little of their gossip but they were talking so fast that I will remain blissfully ignorant about which man sent away which woman, who has a certain witch’s curse on them, etc. 
The time moved.  Slowly.  I’ve seen quite a few women give birth here and I’ve learned the signs.  Sleeping in between contractions and merely sucking in  your breath a bit with each contraction does not mean that the baby is coming quickly.  Usually.  However when the TBA checked her, she said that head was far down and she would give birth before the sun went down.  “Say what?” I asked?  “Oh yes,” said my friend.  “This is what she did with her last one too. She bears the pain very well! This morning she was in labor all day and still did the cooking and the washing.  She’s strong!”  Apparently!!  I told them that if it was me giving birth they would know it!
As the sun started going down, one of my friends asked if they had lights. This got a laugh from the whole room.  One woman said, “the sun isn’t even down yet and this woman is asking if we have light?  She pointed to the lantern and said, “This is our generator.” 
The waiting continued. The sun went down and still no baby.  The room was hot.  The one small window didn’t provide a lot of air circulation and for some reason being in the dark with only the lantern for light just made it seem hotter. To be embarrassingly honest, it felt a bit like I’d stepped back in time (and into a movie) and was in the film “Gone With the Wind” when Scarlett is helping to deliver Melanie’s baby.  Except for the goats. There always seem to be more goats around here. 
After about 3 ½ hours of waiting things started happening. She was still SO quiet. Incredible! But she started moving more. And whimpering a bit.  And then just like that she was ready to push.  She gave a couple valiant efforts, but then said she wanted to eat.  We stopped everything and someone went and hot her some rice to eat.  I was marveling at how different this was than a delivery in the States, or even one in the hospital here. Stopping pushing to eat? Unheard of. J
After she’d eaten her fill she got back down to her pushing.  There was no shouting at her to push. There was no slapping her legs.  A comment might have been made that if she didn’t push well her boyfriend was going to go get another woman pregnant in Freetown.  (Probably not the most encouraging thought….) I was standing at the head of the bed and she kept reaching for me and asking “who’s that.”  When I’d say “it’s Emily” she would say “Hold me Emily!!!” at which time I’d grab onto her hand.  At one point she said, “Emily pray for me!!” I said, “I AM!!!!!”  After a few seconds I looked up and everyone in the room was looking at me.  “Oh you mean out loud?? Ok.”  Oops! J
After about 30 minutes of pushing, out came a beautiful baby boy.  Her first child was a girl so everyone was THRILLED that it was a boy.  They called the father who, interestingly enough they hadn’t even told she was in labor. If the father isn’t around, they don’t tell him until the baby is born.  The TBA delivered her placenta and then washed the baby off.  Within 30 minutes of her delivery we were all piled in my car to drive her home.
The whole thing was just incredible.  I get frustrated when women don’t come to the hospital to deliver here, because although we can’t do a LOT if we have babies in trouble, we can do SOMETHING. After seeing this delivery however, I understand better why women aren’t always eager to go to the hospital right away.  Aside from the fact that it costs more money and is not part of the tradition, it was also a much more relaxed environment than most deliveries at the hospital.  This is keeping in mind of course, that most of our deliveries are more dramatic for the sole reason that they’ve usually already tried to deliver at home and were unable, so the baby and/or mother is often in trouble by the time they get to the hospital. She was surrounded by her friends and family.  And everything went smoothly!!  This is what I was most fearful of. I know that the large majority of deliveries are perfectly fine. But I also know that Sierra Leone has one of the highest maternal mortality rates in the world.  And I didn’t forget that the entire time I was in that dark, sweltering room.  Women die in places like this.  A lot of them.  In fact, this woman had a 1/8 chance of dying while giving birth.  Not something I want to play around with!! But thank God she and baby both did great.  And I had a new experience!!  Good day.

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