Monday 3 June 2019

Policing Childbirth and Risking Women’s Lives

Woman breastfeeding her newborn
Image: Feature Shoot
My first experience with childbirth was when my youngest sister – Sadiya – was born. I was seven years old then. I remember my mum trying to put on a brave face as she was aided to the car. In all honesty, I didn't understand what was going on, but my aunts and uncles seemed to be in a panic. I can't remember what my father's demeanor was, but I know we didn't see our mother until the next day when we were introduced to our newborn sister. There was happiness, excitement and an air of love all around. If my mother was frazzled after the birth, she didn’t show it or…I didn't notice.
I gradually began to see women around me give birth to babies and carry on with their lives. They didn’t pause to take a break or stop taking care of their families. Life just went on. 

Then sometime in 2013, I went to visit a friend in Garkida, Adamawa State. I was a serving corps member then and my friend – a doctor – had been posted to that community for his service to the nation.
I went on his ward rounds with him and as usual, was depressed by the smell of the sick mixed with pungent anti-bacterial detergents and caped off by the stinky attitudes of nurses. But the most unnerving thing I saw was the sad look of dejection on the face of a frail woman who was carrying a child on her back, with a branch of leaves hanging from the side of the baby.
Without being told, I knew something was wrong.
I asked my friend if carrying her baby with the leaves like that was healthy, and if he could do something about it.
'The baby is dead. The leaves is to let everyone know.'
I looked at the woman again and felt a wave of sadness wash over me.
It wasn't that she was crying; because she wasn't. Beyond the air of brokenness around her, she seemed so stoic in her resolve as she walked out of the hospital and into the surrounding hills.
When I asked my friend what was wrong, he explained.
'She is a nomadic Fulani woman. From my experience with them, their culture demands that they give birth with the least fuss possible. When they go into labor, they usually look for a corner and squat. They then begin to push as quietly as possible until the baby comes. Many of them are so weak by the time the baby comes and it is not unheard of that a great number of them die in the process. And in many cases, the children do not survive either. In that woman's case, the baby came out sickly; jaundice. If she had given birth in the hospital or had come in as soon as the baby was born, something may have been done to save the child. But they wait until almost nothing can be done and by the time they make the long trek to this hospital – which is the only healthcare facility that is in this town – the baby would have died.'
I was heartbroken. Not only did the baby not have a fighting the chance, the mother also had to trek a long distance after newly giving birth; when she herself had not even healed from the traumatic experience that she had gone through. And what was the cause? A culture that said Fulani women were strong; that these women should give birth at home; that giving birth should be done silently; and one that only sought the hospital when things had gone awry.
The memory of that woman walking into the hills with her dead baby strapped on her back stayed with me for a while. Soon though, the thought of childbirth went to the far recesses of my mind.
A few month later, I fell ill and had to be admitted to the hospital. It was a private hospital and by the time they were ready to give me a bed, there was only one space left; the maternity ward. Two incidences happened in my brief stay in the hospital that brought the childbirth conversation back to my radar.
One woman came in about ready to pop. She kept pacing up and down with barely any sign of the contractions wracking her body beyond the occasional wince. Soon, she was called into the delivery room where she had the most quiet delivery possible. When I say quiet, I mean she didn’t scream, didn’t shout, and barely even moaned. The only time she cried out was when – in my opinion – she was being stitched up after the delivery. The nurse kept saying she was such a strong woman. Less than an hour after she gave birth, she was dressed and ready to go. As soon as she entered the ward, everyone started praising her; ‘strong woman’, ‘Hebrew woman’, ‘real woman’. Even though I was weak from the receding plasmodium in my system, I couldn’t help but give a small clap when everyone did. She smiled slightly, basking in what I had come to see was the ultimate praise. Hours after she left the hospital, people were still talking about her and how ‘strong’ a woman she was.

But we didn’t stay on her case for long.

Another woman came in to deliver her baby and she cried like hell. She shouted, screamed, yelled and any other word that connotes expressing agony. The nurse – same one who delivered the first baby – screamed right back at her. ‘Abeg no disturb us with shout here. When you dey fuck, you no shout. Now, you wan tear our ear. Abeg! No shout for us here. Na we cause am?’

I was desperately shocked.

Why the hell was it okay to shout at that woman?! Why was it okay to insult her?! Did the nurse understand that she was a care giver?! I wanted to get up and rain curses on the nurse, but I couldn’t find the courage to do that. When the delivery was done – and by God, it felt like it went on forever – the woman was brought into the ward and given a bed. She was not welcomed with any clap. No one called her a ‘strong woman’. Most people averted their eyes as she settled into her bed. I wanted to clap; after all, this woman had just gone through a painful ordeal. But I didn’t want to draw attention to myself. So, I laid back in bed.

It was at this moment that the woman right opposite me turned to her baby and called out for help. Before I describe the situation, let me talk about the woman. She was frail, and obviously very sick. She looked like a bag of bones and had a bad smell coming from her. I could tell she was very poor. Her daughter – someone not more than 10 years old – was helping her in the hospital. Because she was just a child herself, she didn’t know how to behave and how to be of any help at all. The husband came in and out and it was during one of his visits that I learned what had happened.

They were poor alright; extremely poor. The woman barely had any food to eat and the pregnancy had overwhelmed her body. Due to complications during her labor, the doctor had to do a caesarian section to get the baby. The mother lost a lot of blood and the father raised some money to get some transfused into her. In fact, it was because she had been given some blood that she looked better. Remember I said she looked frail, right? Well, that was her looking way better than she did when she first came to the hospital.

Anyway, when the nurse got to her, it was to find out that her baby died. The woman couldn’t even cry. She just began to make these wracking sounds that didn’t seem to want to come out. The husband went out, took a carton, placed the baby in it and left.

He never came back.

By the time I was discharged, the doctors had been told the man had run away. He couldn’t pay the bills. The woman just lay there, making these wracking sounds and looking at where she once cradled her baby. I think she lost her mind. Yet… the only thing that seemed to matter to the hospital was the fact that she wouldn’t be able to pay her bills. The willingness to check her faded out and I am guessing that is why the woman smelled a bit.

I don’t know what happened to her afterwards because I was discharged the very next day. But when I think of childbirth, I think of that woman, wrapped in her pain, unable to cry out loud or grieve properly, abandoned by her husband and still managing to keep her other child in check because…appearances.

That image – and the other cases of childbirth I had witnessed – started the flame for what became my desire to contribute to ending maternal and childbirth mortality among African women.

Here are some facts about child and maternal mortality in the world.

·       An estimated 6.3 million children under the age of 15 years died in 2017. 5.4 million of them were under the age of 5 and 2.5 million of those children died within the first month of life. This translates into 15,000 under-five deaths per day.
·       Children in sub-Saharan Africa are more than 15 times more likely to die before the age of 5 than children in high income countries.
·       Every day in 2015, about 830 women died due to complications of pregnancy and child birth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented.
·       Of the 830 daily maternal deaths, 550 occurred in sub-Saharan Africa and 180 in Southern Asia, compared to 5 in developed countries.
·       The risk of a woman in a developing country dying from a maternal-related cause during her lifetime is about 33 times higher compared to a woman living in a developed country.

Source: World Health Organization (Children: Reducing Mortality, Maternal Mortality)

These statistics are gloomy. They tell a story of poverty, underdevelopment and an abysmal (or in many cases, lack of) government investment in healthcare generally, and Maternal, Newborn, and Child Health specifically. This is more of an African problem than it is for the rest of the world. This is why I commend all the individuals and non-governmental organizations working overtime to try and overturn this preventable loss of lives. But…there is still so much to be done!

Which is why a new trend that is happening in different parts of Nigeria (for example) has me worried.

So… a friend of mine was talking about her child when, for some reason, she decided to confide in me about her birthing process. She had gone to the hospital ready to give birth ‘normally’ when the doctors noticed her crashing health. She was having problems with high blood pressure and natural delivery was no longer an option. She told me that she kept insisting that she wanted to give birth naturally. The doctor told her that was not possible, especially if she wanted to survive. They kept going back and forth until, seeing that she could barely stay conscious, she signed the consent form and lost consciousness. A caesarean section was done and mother and baby were saved. That is, until her own mother went to the hospital.

To paraphrase her, ‘My mother doesn’t think I am a real woman. In fact, when my other sisters are talking about their childbirth and I try to talk about mine, my mother would tell me to shut up and let ‘real women talk’.

I was genuinely shocked! What the hell was that?!

She tried to brush it off like it was a joke, but I wasn’t having none of that. I asked for more information and I learned that is very common place for women to be shamed for having caesarean sections. Remember when I mentioned the ‘Hebrew woman’? Well, some group of women came together and determined that was the standard for childbirth and any woman who didn’t act accordingly was a disgrace to her family and community. Still don’t know what the Hebrew woman thing is? Well, Exodus 1:6-19 may give you context. For those who may not read it, Hebrew women were reported to give birth so quickly that the midwives couldn’t carry out Pharaoh’s directives to kill all the male children. It is funny that the Hebrew women may not actually have given birth that way. Verse 17 says, The midwives, however, feared God and did not do what the king of Egypt had told them to do; they let the boys live.” So when they said, “Hebrew women are not like Egyptian women; they are vigorous and give birth before the midwives arrive.”, they were lying. But…I don’t want to be one that bursts the religious bubble. Who am I kidding? I want to burst these bubbles that affect our lives!

Anyway, in spite of the fact that the Hebrew women’s childbirth was a fable, many Africans, especially those who practice Christianity, take the statement as the gold seal for childbirth. This has led to many deaths of both mother and child, and a maternal and child health crisis today.

To make matters worse, one thing that helps women ease their pain during labor – the epidural anesthesia – has come under heavy criticism by people who are mostly ignorant of the procedures, the benefits and the associated risks. Like a radio show host I heard recently.

The man – known for being an uncouth, unprofessional and ignorant dolt – said the World Health Organization has a plan to sterilize African women so that we cannot give birth anymore. He went further to stress that ‘our population was a threat to the world and they are afraid that we would take over soon’. I know; delusional. if he had any sense, he would have know that 'epidurals' are not contraceptives. What got me so angry was when he told his listeners – numbering in the millions – that ‘women of these days are lazy. Our mother that gave birth naturally, did they do it with two heads?’ or something equally disgusting. Our fathers farmed under extreme weather and trekked long distances to get anywhere. I don’t see him doing the same. Dolts like him constantly try to police women’s advancements with retarded arguments that they are unwilling to apply to themselves. It would be tiring if it didn’t affect our lives so.

I genuinely think men should shut their mouths when issues surrounding pregnancy and childbirth are on the front burner; unless of course, they are medical professionals who have sense. Men who are not doctors usually do not have the range. Second, they do not understand the female form, its physiological responses and why every little help counts. I mean, men still believe women are exaggerating their menstrual cramps so why wouldn’t they insist that all women must give birth naturally, without anesthesia, and many times, at the risk of their lives?

But men are not the only problem. Women are major gatekeepers of the misogyny that threatens our very existence. It is women who are constantly insisting that another woman who has given birth through surgery is ‘not a real woman’. It is women who are pushing the ‘Hebrew women’ or ‘Fulani women’ theory. It is women who clap for women who give birth in silence and shame those who scream. It is still women that negate post-partum depression because 'their mothers didn't have it'. And post-partum depression is whole topic on its own! Again, it is still women who actively contribute to keeping the status quo that is a threat to our lives and existence.

So how do we deal with this constant policing of women’s bodies, sexuality, reproductive health and rights and general wellbeing?

I know this is an idealistic solution but I think we need to keep campaigning for quality education for everyone. Education, in its real sense, clears the cobwebs of ignorance and gives clarity to life’s issues. It broadens the mind and opens one to new ideals and concepts. It allows women understand their sexual and reproductive health and rights issues, so they can make the best decisions for themselves and for their babies. Quality education clears myths and misconceptions that would otherwise keep us stifled. It allows mothers to trust medical personnel because they understand procedures that are about to be done to them. It also helps a woman to choose herself first, so that she is able to be the best person that she can be.

We still have a long way to go…but I believe that we can achieve great things if we keep chiseling the huge glass ceiling that constantly tries to negate the very fullness of our being.