Saturday, October 22, 2011

Suffocating Love

Thin, quizzical eyebrows framed her face in an arch. They spoke fear muddled with innocence. They screamed confusion and doubt. They betrayed her age.

Never having met before, I was surprised to learn she’d come to deliver.

-- “Really? You are here to deliver with me?” I asked through my translator.
-- “Yes. If I’m in labor I will stay here at the clinic.”
-- “Okay. Let’s count contractions and see if we need to do a vaginal exam.”

As I assessed her, she tried to look bored but her eyes gave her away. They flashed around the room, taking it in.

What did she see, I wonder.

Did she focus on the plywood walls stained in blood and spit that even bleach won’t touch? Or was it the pink bed sheet I use as a door? Perhaps it was the drawers of mysterious instruments and shelves of neatly lined IV bottles?

-- “You are definitely in labor,” I announced, “But it’s early still. Can you walk around a bit?”

She said she would, then melted back into the day-to-day commotion --morphing into just another big belly-ed teenager with quizzical eyebrows.

When I checked on her throughout the day, I often found her surrounded by friends laughing at her in solidarity. They were trying to cheer her up.

It couldn’t tell if it was working.

She sulked silently, but never left their side. She seemed to want their noise, to need their noise. They represented love --even in the form of playful mocking.

(More and more, I’m learning how woman care for each other here in labor.

They are cheerful doulas with sharp tongues. If encouragement doesn’t work they berate.... but only to help of course. They scream and yell only because they care.

But I get ahead of myself.)

Akutet labored all day, blending in with the sea of screaming toddlers and breastfeeding moms waiting for their turn with the doctors. In their chaos, her slight moans were never heard.

But as the afternoon wore on, there were fewer distractions for her pain; and the last patient left.

Only then did her closest friends rally.

It came in the form of silly banter and mocking. Their laughter bounced about like mag pies bathing, but Akutet never made a sound.

Sensing she needed to hear rather than speak, the flock chattered and chirped incessantly --encircling her with flapping wings of love. They entertained her with stories and ignored her pain.

She was getting active.

Each time I came to check on her they pulled me in to their circle. They loved on me and laughed at my Dinka. They told me stories in their limited English. They spoke of nothing, very loudly, as if noise could drown out contractions.

I think it was working. 

But eventually Akutet decided she needed a break, and wandered off to the birth room to lie down. I followed her in to check her, but she asked for silence and I gave it to her happily, then went to lie down too.

However, a few minutes later her water broke, and a small tsunami splattered across the floor. But before my translator could call for me to come, her friends kicked it into high gear.

I arrived to find one friend supporting her back, two standing on either side yelling for her to push, and a grandmother figure crouched in front with her hands posed for a football punt.

“Blue-42! Blue-42! Hut. Hut!” echoed in my head and I laughed.

Explaining I needed to make sure she was fully first, I asked them to step outside. They obeyed... albeit a bit reluctantly, and I did a quick exam.

Yep. It was time.

So I set up the room, then brought them all back inside. Grandma took her right leg, Maria took her left, and Mary supported her back. But this time, I was the one kneeling in front ready for the football punt!         --Hut! Hut! 

Two more friends stood behind me and watched while my translator bent low to get a better look. He seemed pleased to be a part of the fun (definitely a first!) and even laughed good-naturedly as he translated their banter.

Akutet was pushing like a champ but her friends didn’t think so. They yelled gruff commands with acid voices. Was something wrong?

-- “What are they saying?” I asked my translator, “Are they mad?”
-- “No. No. They say she needs to listen to you. She’s not listening to you. They say, you are helping her. She must push, they say.”
-- “Oh,” I smiled. They had my back.

Once the baby’s head peeked out with each push, Maria took her screaming and threats to a new level --suffocation.

Yep. She decided Akutet would only be able to push if suffocated properly, and subsequently covered her nose and mouth when pushing!

(This is a common practice here. It’s one that I’ve discouraged in the past but decided to roll with  on this occasion.)

Akutet didn’t argue. She recognized it as the ‘right thing to do’ and pushed like mad. Basically it turned her pushes into ‘purple pushing’ and reminded me of the ‘count to ten’ type of pushing sometimes done in the States.

However, as the contractions faded I encouraged her to breath and Maria reluctantly took her hands away from her mouth. She looked at me as if I were not playing by the rules, but did as I asked nevertheless.

-- “You can hold your breath if you like Akutet. But after the contraction, breathe so your baby can breathe, too. Okay?”

Akutet rolled her eyes and shifted one eyebrow up in response, but Maria nodded determinedly.

Then together all eight of us cheered and hooted, hollered and pushed that baby out.
... and a miniature squawking mag pie was born! 

Her birth taught me on a whole new level what it means to be a midwife in Sudan. I realize now that when I was trying to give them privacy, I was actually secluding them from their cheer squad. And what I thought was verbal abuse, is really just Sudanese tough love.

And the pushing... the pushing...

I must say, in Sudan love is a bit suffocating at times! 

I wonder if I will ever suffocate a woman in labor?
     ... to help of course. Only to help.