Better than beans

I heard a taxi pull up in front of the clinic. It was 5 in the morning and the driver laid on his horn a few times before coming to a complete stop. I jumped up to peer out the shutters, half asleep, but hoping it was a case for maternity. The last few dramatic drop offs were mostly for the health clinic, some boy who had a skirmish with his best friend and got slingshotted in the head with a rock, a sick grandmother who couldn't walk, and a teenage child with cerebral malaria whose neck was convulsing sideways. I wasn't in the mood for any of that, I wanted a birth. No better way to start your day.

I kept my eyes focused in on the back seat, where one woman was scooching across and pulling herself out and the other was gathering together a bag of items.

Simone, somewhere between dream state and semi-consciousness asked "is it one?" and then buried her head in the pillow.

I could confidently answer 'yes' after i saw how the woman's sarong jutted out in front and hung down over her globe-like midsection. i went out to greet and invite them in.

"You can go back there." i said in English, too early to think in Twi. She stared at me, perplexed. I tried again. "Ko, ho."

She walked back to the labor ward just as i heard someone else come in. It was Efreeyeh. "Have you already checked her?" She asked.

"No, she just came."

"Then check her Akua."

"Okay, I'll go then-"

"I will go." She said, finishing my sentence. It was our method of learning. We would check how far a woman has dilated, keep it a secret until we both had our conclusions, then tell each other what we found at the same time. This is a tricky part of midwifery for me, considering how different every woman's interior is and not having a lot of instruction while I'm doing it, I literally have to feel my way through this.

We both had our idea and were looking at one another's eyes. "Go." i said.

"6" she said.
"9" i said.

"EI! Akua! 9! You say 9? It isn't 9. She is only 6. Maybe 6 to 7."

I was the first to admit if there was fault it was probably mine. "Okay, 6, sounds good." I made a mental note that 6 cm should feel similar to that.

"No but you say 9."

"Yeah but I don't really know. You've been doing this full time for 2 years. I trust you."

Ma the midwife came in shortly. I asked her to check and she said "AH! Why? But you and Efreeyeh are perfect!" I told her that I thought there was meconium (a child's first stool, and generally not a great sign) and I needed her opinion. "But can't you tell?" She queried.

"Yes, but I want you to check too."

"Hand me some gloves."

I gave her the only ones available, small tight bright purple gloves. She is a large woman with hands as plump as fresh baked muffins.

"Kaisy! Ah! How am I supposed to see what is going on when you give me the purple color? And what size are these? AH! Can I see meconium if I wear these?! Ah! Where is Efreeyeh? Go find me some white color."

I ran over to the injection room on the other side of the clinic and brought back white gloves. She put them on and confidently thrust her fingers into the mother. "6", she said pulling them out and ridding herself of the gloves. She plopped down in the chair. There was no mention of the meconium, so I asked. She seemed a little annoyed this morning. I tried to tread lightly with my inquisitiveness.

"There is meconium, so we will monitor the baby every 30 minutes with the fetalscope to assure it isn't distressed. If it is distressed I will refer her to the hospital."

A few hours passed and before long it was 10 o'clock. Still not a lot had changed. The mother's contractions weren't strong, not a lot of progression was being made, and I was getting hungry. But I didn't want to miss a thing so I asked Simone if she would sacrifice missing the birth to go and buy us food from town.

Suddenly some heavy groans were heard and both Simone and I decided to abandon the food.

Ma bellowed out at us "Won't you take your breakfast! Go buy food! Don't wait here it will be some time before this woman delivers. Won't you go and buy your food? If not, all the food will finish."

It didn't seem like it was going to be that long, and looking at my friend we both couldn't help but laugh. The food in the village is limited, and the best breakfast they have, beans, sells out by 10:30. If you don't make it in time for that, you are lucky if you get anything. Lunch is not any more exciting, with plain white rice being the only food available.

What to do?

"Beans" Simone said, raising her left hand up like one half of a scale "or birth." She brought her other hand up, and balanced out the two. "Beans or birth, beans or birth?"

"Beans." I said.

"Yes, beans." Ma said. "And buy me coco (sour porridge) while you are out. Tell them no sugar in my coco."

I wrote on a piece of paper how to say "I want coco with no sugar" and drew out a little map of where to find the coco lady. We laughed considering the 'downtown' can be traversed in 15 seconds, yet the lady selling coco had remained a mystery. She was the one dipping a plastic cup into a huge metal bowl, pouring the contents into little plastic bags, and sometimes i mentioned, she sold peanuts.

Simone returned having successfully completed her first solo mission: operation buy us breakfast and get back before baby arrives.

We had time to eat, wash our hands, and get back in the ward only to find the woman had vomited quite a bit and was being set up to receive fluids intravenously. Ma was close to referring her when we heard the magic words escape her panting, dry mouth. Translated into English they are- "I have to go poop." Every time I hear a woman say these words, and 95% of laboring mothers say this, it is a good sign the head at the end of the tunnel is soon to come. Pressure of her child's cranium creates a sensation that is similar to the feeling of having to use the restroom. It is a delightful phrase, as sweet to the ears as honey is to the tongue.

Ma sat down while Efreeyeh and I stood on both sides of the mother's legs. This was her 5th child, but she was pushing as if it was her first. She was extremely skinny, and exhausted. "Continue to move your fingers like this" Ma said, watching me from her chair. Efreeyeh chanted "Chim chim!" and one of the nurse's assistants came in to support the woman from the back, hoisting her up into a semi-reclined position. Simone was standing to the side of Efreeyeh with her neck poking out and her jaw slacked, staring at the head wedged deep in the birth canal. She looked stunned. Later she admitted that she almost passed out and had to bend over and breathe. "I just kept thinking, how is that thing gonna come out of there! How?!" Last month at work she tried to revive a woman who was on the edge of death. But, she is unaccustomed to birth, and it was a lot to process, considering she hadn't only seen one and it was during nursing school years and years ago. "But I don't remember having that feeling, like, how is it going to come out of there? At first the head looked really small, and i thought, oh that's a small head, but when it all came out, i thought, oh my God that is huge. She just pushed that thing out."

I was thinking the same thing at a certain point. Ma let me do this delivery, but all the pushing and all my guiding and pulling and stretching weren't doing much. Or at least that's how it felt at a certain point. "Ma" i said after a lot of hard work "I need your help." She stood up and walked over, she grabbed a hold of the child and pulled really hard, the lady winced and arched up and said something in the ancient language of childbirth, and the child, along with a lot of thick goopy meconium, was out.

I am always fascinated by meconium, it's texture, it's darkness, it's ability to stick together in a shape like a baby slug. "Look" i wanted Simone to see it. She nodded, but I think she was processing what had just happened and could care less about a newborn's feces. She watched Efreeyeh scrub down the child's thick head of hair, I stepped to the side when the mother said she was having sharp pains, and observed the delivery of the placenta. After it came, Ma and the others broke into a sponatneous song of thanksgiving. They sang to God, thanking Him for watching over everything, and then Ma somehow segued it into gratitude for food as well.

Generally after a delivery, when I go to take the bundled baby to it's mother, who is still recuperating on the flat black padded exam table she just pushed it out on, the mother gives a faint smile lays back down. Efreeyeh scurries around her, wiping the blood off her legs and buttocks. I always expected more, like a yelp of jubilation, or her to sit upright and demand the infant. But I soon became used to this, realizing the work of labor has drained them of any outward expression towards the deep love they must feel for this new being. But it was different with this woman, as I should assume, it will be different with every person and their baby. This mother broke into a huge smile, but more, her face changed completely. She went from a fatigued skinny woman in pain, crying out "why? why God why?" to a confidant radiant life giving mother connecting with her daughter. The transformation was palpable. Even though her little girls eyes were closed they were communicating on the deepest level.

Later Simone noted "I almost, well I did, cry a little bit when- did you see that- when the mom looked at her baby? Wasn't that the most beautiful thing you've ever seen?" She sighed and held her hand to her chest.