A Birth

Now I am a person who has alwasy been horrified by the concept of child birth and everything that goes along with it (especially having four older sisters who have all had kids), but after a few days at the hospital and getting to be a part of all of the gross/interesting/extraordinary things going on there, it became my secret wish to be able to see how the Kenyan women deliver babies.

Ruth, a woman who works at the seminary and runsthe duka (shop) right across the street where I alwasy bought my mandazi was very pregnant with twins while I was there. She was having her babies by c-section, and her estimated due date was about a week after I arrived, so I expected that if anything, I would get to see Ruth's c-section. She and I became good friends while I was there, and we spent a lot of time talking about labor and delivery since my mother had herself had twins and also a baby who died not long after birth. Ruth had a four-year-old daughter (named Nancy after the American seminary director) and had lost a son during childbirth after her. The little boy had also been born by c-section, but he was overdue and there were complications that made it difficult to get him out and he died in the process.

Ruth was terrified of losing these two babies. She thought of them as God's way of replacing her lost blessing with two new ones, but as her due date approached and she was continually encouraged to schedule her c-section, she just couldn't do it. In her mind they were safe inside of her, and as strong and realistic as she was about all other aspects of life, she just couldn't bring herself to schedule the point where she lost her baby boy. While they were inside of her she felt like she had some control, but as soon as the procedure to get them out would begin it would be out of her hands. I almost suspect that she was preparing herself to lose them, and wanted to keep them with her in whatever way she could for as long as she could.

I went with Ruth to her doctor appointments and got to see the babies on the little portable sonogram kit the hospital had. They seemed to be good sized by measuring their heads. Instead of encouraging Ruth, I think it made her more nervous. The doctor insisted that she schedule a c-section when she was a week overdue, but under her calm exterior I could see the panic in her eyes and she wouldn't do it. Despite the fact that a big part of the reason her son had died was from being so overdue, she just couldn't do it. Her head told her one thing but her maternal fears were less rational.

So back home we would go, for her to have me tell her again and again how much my twin sisters weighed when they were born and how healthy they were, etc. etc. etc. I fibbed a lot during those conversations because my sisters did spend almost a month in the hospital and could have very easily not made it, and our Kenyan hospital was no where near up to par with the 1973 American hospital my sisters were born in. These facts would only have caused the poor woman more terror in her heart, so I didn't feel bad about my omissions.

Unfortunately for me, Ruth finally scheduled her c-section for the day I left Maseno (about a month after we first thought the babies should be arriving) and I wasn't able to be there with her. But fortunately for Ruth, the story has a happy ending. Victor and Tracy were born on July 18th, a perfectly healthy (though small) boy and girl to round out their family.

Ruth is not your typical Kenyan woman in that she has opinions and willingly and confidently expresses them (and has a husband, the dean of the seminary, who doesn't beat her for it). She told me that three kids is plenty for her. This is pretty much unheard of in a place where people never think about how many kids they will have. Preparation for the next one begins when they get pregnant, which makes trying to plan for a ball park figure a pretty abstract concept.

During my second to last week in Maseno, I did luck out when a woman went into labor during the daytime while I was selling books out on the street corner in front of the hospital, and things progressed quickly enough that everything was over and done by the time we needed to head back for dinner.

To gain a picture in your mind of the setting for this experience, reference this post where I describe the hospital.

I headed over to the maternity ward with my med student friends Chris and Katie when we heard there was a hot one. Neither of them had seen a birth before either and they were practically giddy. The lady who was about to give birth, Susan, was laying writhing on a hospital bed with another woman in a bed a few feet away, waiting for her turn. It was Susan's first birth, and she was quite obviously in a lot of pain. There is no pain medication at this hospital.

When there aren't even basic medications, the concept of an epidural is laughable. All child births are natural. As explained in a previous post, nurses have a tendency to beat the women in labor if they are taking too long to encourage them. It's brutal. There are no husbands to be seen anywhere near the hospital, much less in the delivery room, and if you have a female family member to accompany you, they get to wait outside the wide open windows to listen to you scream for however long it takes as Susan's sister did.

The nurses were smirking and rolling their eyes at Susan because she was making so much noise over her contractions. Obviously it was her first child and not her fifth or sixth. They pretty much ignored her while she was writhing on the bed. Chris rubbed her back and talked her through the contractions. I think that was fairly revolutionary. As Susan struggled and cried, the Kenyan doctor arrived and we turned our attention to the lady in the next bed.

This woman was there to be induced with her eighth child. She was overdue with no signs of labor. To induce her, we and all of the many Kenyan nursing students there gathered round to watch the doctor stick a cathater on up in there (the blood was pouring) and then use a funnel to fill the balloon on the inside of her uterus with water so it would stay put. He then took the other end of the cathater and tied it to her thigh. When he was done with that, he stretched out her leg until it was flat on the bed and remarked that all we had to do now was wait a few hours.

Pardon me while I pull my jaw off the floor.

My two oldest sisters have been induced with all four of their kids and I am darn positive that this is not how it works here. Inducing labor in modern medical settings involves giving drugs to bring on contractions, not inserting a cathater into someones uterus and then using the weight of their own leg to stretch it out so they dialate. Necessity breeds creativity. It was horrible and really, really cool to watch all at the same time.

Of course while the doctor was performing this "procedure" not one of the Kenyan staff ever acknowledged the presence of the woman whose vaginal area they were messing with, and the doctor proceeded to tell Med Student Katie that she was a bad woman because she had been married three years and hadn't produced any children. It is her role in life after all. I asked him how many kids he had and he said one with his wife, and (shrug of the shoulders)maybe some others. This is one of the stories I now use to describe African male machismo. Women are there to spread their legs and be "productive" and the men are just there to enjoy it.

The doctor disappeared and we turned our attention back to Susan, who was making more and more noise by the minute. She started shouting "nimetoka, NIMETOKA" over and over again. This made me giggle because I actually understood what she was saying. In Swahili, to say that you are American you say "nimetoka Marekani" or that you come out of America. In this situation, Susan was simply screaming "come out, COME OUT!"

After all the nimetokas, she actually started screaming my name. Now you might find this strange since I am not the baby's daddy, nor had I ever met Susan before, but kali in Swahili means fierce or severe and is used to describe pain.

Pretty, I know.

Chris kept cracking up and giving me looks across the room every time she shouted it as he was vigorously rubbing her back.

Not long after, I pointed out that some stuff was starting to ooze out from between her legs. Chris and Katie and I stayed put, with hearts pounding and eyes as big as saucers. All of a sudden, the big scream came and the nurses ran into the room. I guess we in our inexperience thought that all the screams were important, but they knew what they were listening for.

All at once the top of a head was poking out. The nurses flew into action, grabbing the little tool table with the scissor and all the other instruments on it and throwing an apron on the first year nursing student who performed the delivery. No need to call a doctor. It happened so quickly you could tell that even the seasoned veterans in the room were surprised. The baby was already coming out before they had the nursing student in charge geared up.

I stepped aside to get as out of the way as possible and with one big push the baby was halfway out. Susan, in the heat of the pain, reached her hand down and tried to start shoving the baby back in. This was the only time the many nurses actually seemed startled or all that engaged in anything they were doing. The grabbed her arms and held them down until the baby was safely out about a second later.

The baby girl was a tiny thing and all gray and slimey. They wiped her off and wrapped her up and weighed her before putting her in a basinette in the corner and completely ignoring her. The basinette was behind Susan's head so it was not in her line of vision and they never once bothered to show her the baby. I had been fine during the birth, but this is when I became sooooo uncomfortable. The woman just gave birth for heaven's sake and you're not even going to hold up the baby in front of her so she can see it for a second or two?! It just felt so wrong.

All the focus was brought back to Susan as they stuffed big guaze pads up between her legs to stop the bleeding after the placenta came. Most of the nurses headed off into another corner to watch it be disected, which I admit I also watched with interest. The others called in Susan's sister who brought a bag with a change of clothes for Susan and two brand new, beautiful khangas to wrap the baby in. As soon as the bleeding had slowed, they had Susan sitting up and were changing her out of the hospital gown into her street clothes. About 20 minutes after giving birth.

When she sat up, Susan turned her attention to us and gave us tired but friendly smiles as she asked how she did and apologized for yelling so much. 20 minutes after giving birth. This is when Chris finally asked if she wanted to see her baby. She seemed to be pleasantly surprised that we offered and wheeled the basinette over to her. That also made me very, very uncomfortable. This was an educated woman who worked at Maseno University, and she didn't even feel that she had the right to ask to see her own newborn infant, despite the fact that the baby was about two feet away from her in that cramped room, just behind her so she couldn't see it.

She grinned from ear to ear when she first saw her little girl and she and her sister admired her but immediately started saying that she was much too small. The baby was 2.4kgs, and 2.5 is the bottom level for a healthy birth weight. This meant that the little girl would have to stay tightly wrapped in her basinette for warmth until she gained the extra tenth of a kg.

At about 30 minutes after giving birth, Susan was forced to stand and move herself into a wheel chair so she could be brought to the wing where the new mothers recuperate. Blood dripped from between her legs onto the floor as soon as she stood. No big deal, getting her out of there so their job could be done was the only important thing.

And what was the other pregnant lady who was working on dialating in the same room doing all this time? Turning her head as much as she could without having to shift the rest of her body and mess with leg/uterus contraption, watching the whole dang thing and taking in every scream. Poor woman had to sit and watch what she was going to have to go through in a matter of hours. I know she had been through it seven times before, but that still can't be pleasant to watch under the circumstances. That woman never made a single sound while she was being dialated or during Susan's labor, and she kept a very blank and untouchable facial expression, but I (and only I since no one else paid the least bit of attention to her) saw the look in her eyes as she watched the woman in the bed next to her struggle. If she could have, she would have run.

I was honored to take these two pictures, the very first pictures of this child's life, about 40 minutes after she was born. At this point the mother had already been wiped down, uncomfortably shoved into her dress, and forced to stand and walk a few steps between her beds and the wheel chair. And as soon as the initial shock of labor wore off, Susan was chatting and entertaining everyone else like it was any other day. It blew my mind.

I asked her what her baby's name was at the point when I offered to take the pictures, and Susan just looked at me like I was crazy. Who would know a thing like that already? I guess Kenyan women don't spend nine months pooring over baby name books in anxious expectation.

It wasn't until after I got home and was able to e-mail Susan's sister these pictures (which they were thrilled to receive) that I found out her name.

Meet Eleanor Chebet.