today* i saw two babies born! not five minutes into the clinic this morning and Janice came to find me and haul me into the delivery room. she is a trained midwife in Scotland and — even though i don’t think the people here understand much with her accent — a very welcome presence in that birthing room.

allow me to try and paint an accurate (if somewhat colourful) description of my first impression of an African baby delivery…

there are two beds in the room separated by stiff and tattered clear shower curtains with purple flowers on them. the walls are covered with large posters detailing in handwritten instructions how to deal with each stage of delivery. for some reason, the fact that the handwriting is crooked and almost illegible surprises me. i learn that oxytocin injections in the thigh are used within 1 minute after the birth to induce delivery of the placenta. actually, i learn just about anything i need to know to handle a delivery on those walls. some of the instructions terminate with “refer to hospital”.

the windows are half covered in peeling paint and security bars. on a low table at the foot of the beds, there is a “birthing kit” opened and several blankets and towels are layered on each other, laid out in a way that i can tell the new baby will first be welcomed there. the “birthing kit” is a few stainless steel pans and tools wrapped in what looks like a torn sheet. i learned the day before that the clinic only sterilizes their equipment by boiling them in cooking pots. both the doctor and the nurse wear gloves (Janice wears two pairs), but sanitation of the rest of the room doesn’t seem to be very important. an incubator that looks to be from the 1950s (everything in this room looks to be from that decade) sits unused and unready in the corner.

the soon-to-be mother is lying flat on her back on a high bed that may have once been painted white, but was now more red with rust. a tiny midwife with grey through her fuzzy hair and a white nurse cap pinned securely in place, has hoisted herself onto the bed and is crouched over the mother pushing with all her strength on the top of the stomach. the muscles in her face and arms strain and bulge with the effort. without warning, the doctor cuts a 2″ elongation in the vagina and (though i’m not a squeamish person, this made me coil back more than a little horrified) roughly inserts his fingers under the baby’s head where the new incision was made. the mother-to-be groans quietly and is immediately scolded to “shut your mouth!”

a cell phone rings.

the mother-to-be looks over at her handbag on the next bed and motions for someone to bring it to her. she answers the phone mid-contraction and Janice and i look at each other goggle-eyed.

finally the baby boy is welcomed into the world. Janice scoops him up and cleans him off, handing him swaddled back to the mother. the placenta is delivered, the new mother is roughly “cleaned out” of any more blood by the nurse, and sewn up. there are no painkillers or encouragement or kind words (except from Janice) during the whole thing.

i send a quick text message to Jonathan stating that i will never, in any circumstances under my control, have a baby in Africa with an African doctor. it’s not the culturally-determined silence that bothered me. i could probably even get over the birthing techniques that Janice claims are several decades out-of-date and the complete lack of sterilization. it was the hostile attitude of the doctor and nurse that appalled me most. i worked with many doctors from South Africa in northern BC and the one who attended the complicated birth yesterday had a similar (aka: complete lack of) bedside manner.

a few more details and A Very Close Call…

as noted above, the first woman was having some serious contractions, quite close together, when i arrived in the room around 830am. soon after though, she started to smell ketotic and barely had any energy to push. “ketotic” was described to me as a state (experienced by many diabetics) of too many ketones in the blood. this occurs when your body doesn’t have enough sugar to burn off for energy. so, they hooked her up to a dextrose IV and encouraged her to push when the contractions came. i could see the top of the head for at least an hour before it (he) finally decided to join us.

the contractions and pushing were ineffectual because the baby was coming out face up (instead of the normal face down). as a result, his body wasn’t turned the proper way to slide easily through the birthing canal. his soft skull was squished in an elongated manner and i’m sure he had quite a headache that morning! but he was healthy and squealing and Janice held him up to the mother to show her the sex — she was exhausted but pleased.

while the first woman finished delivering, another woman was brought to the second bed, closer to the door. she undressed and laid on a plastic tarp covered by a threadbare sheet. half a dozen more people (students in lab coats and nurses in aprons) started to crowd into the tiny room. i was standing at the foot of the bed of the second mother-to-be, but moved next to Janice (on the other side of the room) so i wouldn’t be in the way.

literally (literally!) less than a minute after i moved, the second mother-to-be’s membrane ruptured (water broke) and shot an enormous amount of liquid across the room (think projectile vomit) — right where i had been standing. the room cleared of its extra occupants VERY quickly and several nurses were fully covered in the wet.

after i got over the initial shock of the blast, i leaned over and asked Janice if that was at all normal. she shook her head vigorously “no”. apparently the baby was turned breech (head up instead of head down in preparation for delivery) and because there was no head blocking the canal, when her water broke, it broke with force and nothing to stop it. also, the “water” was not a normal colour. it was greyish-brown and filled with waste the baby had dispelled because it had been in distress. we learned shortly after that she hadn’t felt the baby move for three days and she was referred to the hospital because the baby had died.

i couldn’t help but compare and contrast in my mind how different this situation would have been in North America. not only would the medical response have differed, but the woman’s blank expression and completely unemotional state at having just learned her baby was dead would be extremely rare in the West. then again, a lot of these women get pregnant 8, 9, 10 times in their life and only a couple of their children survive.

if the first woman was the most complicated (and longest) vaginal delivery i have seen, then the third woman was definitely the shortest and easiest. she was very young (15-ish? but so hard to tell) and delivered a healthy baby boy within minutes of climbing on the delivery bed. the process was drawn out a bit as the midwife got tangled in the suture she was trying to sew a vaginal tear up with. in the time it took her to get untangled, she delivered a harsh-sounding lecture to the new mother. the few English words i caught had something to do with respecting the methods and advice of other people if you seek help. the incident that brought on the lecture was a squirm and squeal as alcohol was poured onto her open vaginal tear.

Janice now figures i must be the luckiest person she knows, barely missing that close call. i thank Baby Jesus that he kept my pants clean. but what a great morning.

my next adventure is in the antenatal (aka: pre-natal) clinic for women in any stage of pregnancy.

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*the difference between the day i write this compared to the day i post it compared to the day you read it is so mixed up. i have no idea what “today” means anymore!

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