The Unexpected Midwife

Irene, moments after delivering her second baby

I have been present at four births in my life. Three were my own sons, and one was a few days ago. December 20, 2016, in a small village – ten minutes drive from the hospital.

9:43pm

“Hello, Madam please can you help my sister Irene? She is in labor and we need transport to the hospital?” Thoko’s voice was urgent.

“I’m coming Thoko. Becky and I will be there in ten minutes.” I assured her as I simultaneously grabbed the car keys, a chitengi and my bag.

Becky – my cousin - had recently arrived to spend the Christmas holidays with our family. She’s a Nurse Practitioner in Australia and had spent 2012 with us volunteering at Malamulo.

We sped along the road – through a sleepy Makwasa town – down the muddy tracks passing through the tea – over the rocks that sporadically dotted the road - to Thoko’s village.

Thoko met our car outside her Aunty’s home. Becky flicked on her headlight and raced with Thoko towards Irene. I dawdled around the Rav4, opening the doors and adjusting the seats, trying to configure the car in the most comfortable way for a woman in labor.

A few minutes passed, and no one was rushing to the Rav4 for transport. Where was Irene?

9:56pm

I followed the glow emanating from Becky’s headlight and found a gathering of women spilling out of Aunty’s kitchen shed. Inside the shed, laying on the cold earth, was Irene. Her arms were stretched towards the walls, as if tied to a cross. She was wearing her day clothes, with a chitengi bunched above her waist. Her legs were open and her body was ready to birth a baby. Thoko was backed up in the corner, holding her sister’s hand. Maggie, the older sister was at Irene’s feet, and the Grandmas of the village were there to counsel on labor, and ‘deliver’ the baby.

“Becky – should we transport Irene?” I inquired.

“There’s no time. She’s going to deliver right here.” Becky surmised as she began placing Irene’s legs in the ‘stirrup’ position for effective pushing.  

“Deliver here?” I said, trying not to sound shocked or surprised, as I looked around the empty kitchen, the black plastic bag that was placed below Irene’s hips, the dim light, the piles of chitengis in the basket by the door.

“Yes, Shar – she’s ready.” Becky responded.

9:59pm

“Come on Irene! I can see the head! Give another push, you’re doing really well!” Becky encouraged Irene as she and Thoko held her feet in the stirrup position.

Silently, with barely a deepened huff, Irene pushed and the baby’s head emerged. In the village, there’s a time in a girl’s life when a meeting is called and she is told, “no screaming in labor. Screaming makes you weak and you will suffer longer because you can’t control your pain.” Irene didn’t scream.

Village chiefs are incentivizing women to have their baby at the hospital by imposing a fine on the woman if she chooses to deliver in the village. In this way, Becky was saving the older women in more ways than one. Firstly, she immediately assessed Irene and took charge of the delivery, and secondly, because she’s a professional, there would be no fine imposed on the family for a village delivery.

“Shar, bring your light here and shine right there.” Becky directed me to a position beside Irene’s arms and head.

I had done this 3 times myself, but now I was worried. The baby’s head was out but it didn’t make a sound. I squinted to see Becky’s eyes – wondering if I should be anxious or if this was ‘normal’.

Becky was calm. She was focused.

“One more push Irene and the baby will be here. Let’s go! Give it a good one Irene!” Becky was cheering her on, while fastening her grip on the baby’s head.

10:00pm

Another quiet push and Irene’s baby girl was out. Becky caught her amid gushing fluids, and administered the baby’s first examination of life. The solar light held by Thoko’s neice provided a faint glow near the doorway, but Becky’s headlight gave a beautiful view of Irene’s baby girl. The baby began to cry, and I’m sure I wasn’t the only one relieved to hear her voice.

“What’s the time Shar?” Becky queried.

Fiddling around in my chitengi wrap for my iphone, I responded after finding it, “Ten O’clock.”

The kitchen shed where Irene delivered her baby

I was holding Irene’s hand, telling her how proud I was of her and the very ‘silent’ delivery. I was thinking of my own experience when an epidural had numbed my pain and I had delivered with ‘ease’ – yet still not quietly.

I was rubbing the baby’s back as she lay on Irene’s chest. I was verbalizing to the women that a beautiful baby had just been born and they must all be congratulated.

Becky was a few steps ahead of us all.

“Time, Shar?” she raised her eyebrows as she connected with my gaze.

“10:04pm” I responded.

“Irene, we’re going to deliver your placenta now.” Becky instructed Irene on how to push and what to expect.

She pushed again, and a fat, healthy placenta with 4 lobes intact plopped out onto the plastic ground covering. Becky had coaxed the placenta by pulling on the cord and matter of factly counted each lobe to ensure there was no retained placenta.

“Thoko – what can we clamp the cord with? String, a piece of chitengi cloth, dental floss?”

“Dental floss?” Thoko held back her snickers.... “we have sharp stones…. Because usually we use a razor blade, but we don’t have any right now.”

“Oh no, we’re not using ‘sharp stones’…” Becky gently dissuaded the women. 

“Let’s just wrap up the placenta and take it with the baby to the hospital.” She made a plan and the placenta was bundled with the baby.

The hospital ambulance arrived just after the placenta had passed, and Irene shakily got to her legs and walked next door for a bath before taking the ambulance to the hospital.

The Gobbles called for the ambulance and here they are leaving for the hospital 

Aunty, Thoko, Maggie, Irene, and baby girl all filtered into the Landcruiser ambulance and trundled along the sludgy track to Malamulo.  Becky and I followed them in the Rav4.

Aunty, Becky, Maggie, Thoko celebrating a new arrival

Irene was admitted to Malamulo with her baby girl. The nurses were diligent in examining Irene and the baby. Becky provided the birth details, including an ‘APGAR score’, and then Irene and her family were escorted to a ward for the night.

Becky, Thoko, Irene and baby at the hospital

Maggie, Aunty, Thoko, baby and Shar at the hospital

I gave Irene one more hug and told her “well done, Irene, very strong. You did it so well.”

Then I walked up the arched pathway with Becky in stride beside me.

I glanced over at my cousin. I was so proud of her composure, her focus, her knowledge and her willingness to help.

The wind caught my hair as we exited the hospital and I imagined a cape flying behind Becky's back, a large "S" emblazoned on her shirt.

Superwoman. There were two tonight.

Irene – the ‘silent’, strong Mom.

And Becky – the unexpected midwife.

Taking Mom and baby home to the village after a few days in the hospital

In the home village of Irene

Zahara meets her baby sister for the first time

Happy, Irene, Zahara, and baby - their first family portrait