Yearning for Change

I finished my rotation, at last at Konfo Anokye Teaching Hospital. My Obstretrics and Gyenecology rotation was the final component. I had been looking forward to again being around birthing mothers and newborn babies but in the end I don’t think I can tolerate being witnessing this type of birth much longer.

I am yearning to work in an environment like Holy Family Birth Center. When I was young my mother would occasionally take us to Weslaco to visit a friend of hers who she met in Bolivia years earlier. As a child I did not place any importance on the words “birth center.” When Sister Janice and Sister Angela talked to my mom about their work I listened and let it go. For me it was simply a peaceful stopping point near the Gulf or on our way to Mexico with open flat land, goats and chickens, and many friendly women.

The summer after I qualified as a registered nurse, before my midwifery training, I went back with new eyes. I spent a couple weeks at the birth center volunteering (observing). Sister Angela founded the birth center in the early 80s to serve women who had nowhere else to go – poor uninsured women and illegal immigrant women. She not only gave them a place to deliver but provided excellent care throughout their pregnancy and postnatal period. The grounds include a small clinic, basic housing for the few staff midwives and volunteer nurses, a small chapel, space for chickens and goats, and five free standing suites for deliveries. Each birth suite contains a double bed, a rocking chair, a couple stools, a counter and sink, a bathroom and a small kitchen.

During my three weeks there I witnessed a handful of births. Each was beautiful, peaceful, personal. I loved the births but I also loved that an hour or so after delivery the midwife would wrap the baby’s body and wash his head under running warm water at the sink. The babies would never cry; they would close their eyes and move their heads in a rocking motion clearly enjoying the warm water and gentle massaging touch of the midwife. I loved that after the birth, when the woman was lying comfortably with her family and newborn in the double bed, the midwife or nurse would ask them what they would like to eat and then go to the kitchen and prepare the food herself. I loved that the nurses would visit the women in their homes or trailers for their postnatal checks. I loved that the quality of care given was what we generally believe accessible only to the wealthy but there was given compassionately and lovingly to the poor. And for the babies, their gentle welcome was an appropriate end to their difficult journey and a promise that the world is capable of offering comfort and love.

The births I have witnessed more frequently stand in dramatic contrast to those at Holy Family in Weslaco, Texas. Women are treated as though every cry of pain and every gesture of reaching out to touch a clinician is a personal affront to the nurses and doctors. I can’t understand the language here but I can certainly understand the tone and I do understand “mepakyew” which I hear the women say over and over to whoever yells at them. Mepakyew means please, or to be sorry, or to beg and the literal translation is “I lie at your feet.” No one rubs backs or holds hands; the only touch is the clinical touch. I watched a doctor give a woman a “gentle” slap on the thigh to tell her to spread her legs. I have seen few give a warning before beginning a vaginal exam or give an explanation afterwards. I have seen many give a harsh look or word if she cries during the exam or pulls away. I have seen newborn babies held without tenderness , picked up by two arms or just one, held by the back without supporting the head, placed on a sheet covering a cool metal table, suctioned vigorously so they gag again and again even if they come out pink and crying. I was horrified to see a few newborns scream as they were bathed in cold water (this was not at KATH and not done by nurses and I did inform the charge nurse that it was happening). On one hand after my couple days in the KATH labor ward I appreciated how much change occurred at Bottom during my three year stay, thanks I believe in great part to Dr. Meguid and a handful of motivated clinicians who were also eager to see change. On the other hand I feel so tired and sad. I cannot watch this anymore. I want to provide an alternative not just a hand to hold or a kind look to help make the inhumane treatment a little more bearable. It should not be born.

The morning of my second day in the labor ward at KATH I met Ama. Ama was struggling with a premature urge to push meaning that well before her cervix was completely dilated she desperately wanted to push her baby out. Usually this happens when the baby’s head is very low in the pelvis during early labor. The danger is that if she pushes against a partially closed cervix the cervix will swell, it will not dilate well and may become an obstruction or may tear, generally the mother tires early and her baby may show signs of excessive stress. During the contractions Ama would cry out and push, the vessels in her neck protruding as she strained. Periodically the nurses and doctors would yell at her from across the room and she would tearfully say over and over, “mepakyew”. I stayed with her. I rubbed her back and encouraged her to try different positions that might alleviate the urge. The urge was still strong but she cried out less while I was with her and every now and then she would look intensely into my eyes and say, “God bless you.” When her cervix was finally 9 centimeters I led her to the delivery bed and as she pushed I held pressure on her cervix and soon felt it slip over the baby’s head. I stood so that I blocked the nurse’s view of her perineum and no one yelled at her to push. She did an amazing job. She focused and pushed with each wave of contraction and released and relaxed complete when they passed. I encouraged her to continue following the rhythm of her body and the baby’s head crowned slowly. Luckily the resuscitare was occupied by another baby so I wrapped her newborn and placed him in her arms. She had no tear so I cleaned her and led her back to the bed then helped her breastfeed. The rest of the day anytime I looked in her direction she said, “God bless you. May God really bless you.” At one point she even tried to give me a handful of money. I received so many blessings from Ama that day. It felt great to help her but sadly what I did was nothing beyond basic care and her effusive gratitude was simply because the treatment she received before I stood next to her was really not care at all.

A few times during my three months at KATH while chatting with house officers (the equivalent of American first year interns) they asked me what I enjoyed about being a midwife and said that they really did not like O&G. Now I certainly understand why. If this is the sum total of your experience regarding birth - such an ugly side with only messiness, pain, yelling, and a policing attitude - it would be difficult to imagine beauty. There is a great potential for beauty. While I was on the labor ward, the house officers were often much more gentle than their seniors and I realized that the treatment of the women though most painful to the women themselves, also hurts all who stand by, slowly killing the voice that says quietly, “this is not right.”

Now that I have finished I am supposed to go to Accra to turn in my signed form from the hospital and pay another US$200 to register. I will actually be flying to the States on Sunday for a few months to work and be with family and since Clement will soon be heading to Malawi this is our last week together for some time. I am already dreading our separation. There is a Philippina nurse who became my friend during the rotations who will also be heading to Accra for the same purpose and she offered to take my papers so I could spend a few more days with Clement (and leave on Saturday instead of Thursday). I called the Nurses and Midwives Council to explain my situation and ask if she could hand mine in and whether I could sign the necessary papers on my return. The response I received was, “You need to set your priorities, everyone has husbands and children but if you want to practice as a nurse then you need to follow the rules here. . . Why can’t you come to Accra a day early to turn in your paperwork?!!. . . Maybe you should just stay at home with your husband if that is your priority rather than work as a nurse . . . “ She went on and on for a while chastising me for the effort I was creating for other people. Finally I interrupted and said, “I understand that everyone has husbands and children and that is why I thought you might understand. I am sorry that I am creating so much trouble for you. I am sorry I asked. Please forget it. I will come in person. Have a nice day.” Then I hung up on her. Then I cried (I am really too sensitive). Then I realized that I had just received a small taste of the attitude women in labor here face, which made me feel somehow better and worse.