Normal?

Her contractions were strong and frequent when I first met her. She lay on the bed and her mother held her hand.

The pain contorted her face and forced the occasional groan, but she didn't seem to notice it much. For the most part, she was surprisingly quiet.

So quiet in fact, that I didn't think she was even close.

As a 17 year old G1 (aka: primigravida or woman pregnant for the first time), I expected things to go a little slower. But her body had other plans.

Shortly after we arrived, her waters broke and she started getting grunty. One of the students informed the head nurse, who started setting up the room.

She started pushing before the nurse was ready, so I encouraged her to breathe through contractions and taught her how to push effectively.

The grandmother, looking a mixture of exhausted-relief, excused herself to the corner of the room and said nothing. Absolutely nothing.

The mother pushed effectively despite the five extra medical student faces huddled around her bed. She didn't seem to notice or care in all the pain.

The nurse on duty expedited the birth by doing perineal stretching and the mother remained silent. She pushed only a handful of times before the head was born. The nurse didn't wait for the next contraction, she just reached inside and wrenched the shoulders free. Again, the mother made no noise.

The baby was out less than a minute when the cord was cut. She too made not a sound. Just like her mama.

The nurse grabbed the child by both feet and swung her in the air, presenting her upside down for the mother to see. The mother smiled when she saw it was a girl, then dropped her head back on the bed in a rush of exhaustion.

The nurse lay the child on her breast and it mewed quietly.

Within 3 minutes after the birth, the nurse aggressively massaged the mother's uterus and applied traction on the cord. The placenta wasn't budging. She forced it harder and massaged even more aggressively.

This continued until the nurse found herself with a torn placenta (only 5 minutes postpartum) and decided to do a manual extraction. Reaching her right hand in up to her elbow, the nurse extracted chunk after chunk of the placenta from the uterine wall. Each time she reached in, she came out with chunks, clots and membranes.

The mother made not a sound. 

Afterward, the nurse reached in repeatedly with non-sterile gauze to evacuate the uterus and vaginal canal of any remaining blood. But still the young, new mother remained silent.

Inside, I screamed for her. Inside, I cried out in pain.

For her.

How she remained so stoic... so quiet, I'm still not sure.

As I looked through the nurses' bloodied hands, several baffled expressions caught my eye. "What must these medical students be thinking?"

For many of them, this was their very first experience with birth. I shuddered to think that this was considered 'normal' in Mozambique.

Perhaps... it is normal.