Giving to the World

With every push, the woman’s veins bulged out of her chest and incredibly muscular arms. Her eyes were squeezed shut and her teeth gritted together as she employed all the oxygen she’d inhaled to contract every muscle in effort to expel her baby from her uterus. Lying supine on flat, hard, tile-covered table, she clutched its sides, her legs bent with her feet flat on the surface, and her back raising ever so slightly off the table as she pushed. Her bulbous bellybutton protruded even further from her enormous belly as she pushed with all of her might. Sweat streamed from her naked body, soaking the single crumpled pagne (wax-print cloth) on which she was lying. With an exasperated cry she finally relaxed and gasped for air, her eyes opening and tearing from the pain. She had been pushing for nearly 3 hours now and it had gotten her nowhere. As her chest heaved in effort to help her catch her breath, she looked up towards the ceiling and whispered an exhausted plea: “Essosinam” – “God help me”.

While I have never actually seen a live birth in the States, I’m quite sure that the conditions are fairly different compared to births here in Togo. I’ve never been to hospitals in bigger cities here to see births, but I hear they’re fairly “modern” – and therefore more expensive. Women may pay up to 25,000 cFA (more than $50) to get better care in a large city hospital during deliveries, but in smaller villages like mine, 25,000 cFA is more than most people earn in a month. The delivery fee at my dispensaire (local health clinic) is 500 cFA (just over a dollar) – and even that sum keeps villagers away as they complain, “lidiye fei” – Kabiye for, “there is no money”. Against specific direction to come to the dispensaire to give birth, many women end up giving birth at home – a practice which leads to many deaths and/or health complications among both babies and mothers.

My only experience is what I’ve witnessed in my own dispensaire, although it seems that these expectations exist nearly everywhere – at least in village clinics: Women who show up to give birth at the dispensaire are expected to bring with them family members, a little plastic chamber pot with a cover (used for storing the placenta which they ultimately bury in a ritualistic procedure), Vaseline (used to wipe the baby down after it is born), and numerous pagnes (used for soaking up blood, cleaning off the table and floor at the end, and wrapping the baby after it’s born). Family members are important because they will clean and wipe down the area after the delivery is finished. They also cook and bring food to the new mother who is expected to stay in the dispensaire for up to 3 days in a room that is barren except for plastic-covered foam mats on the ground. If no family members come, the new mother herself is the one who cleans up the mess immediately after having given birth, and she may go hungry. It sounds appalling but it actually happens from time to time.

During the actual delivery itself, women lay on a hard, flat table. They are given nothing for the pain – there just is no medication available (or affordable) to give. Crying out too much from pain may elicit a slap from the midwife who may then proceed to yell at them for being weak. Women also get slaps and yelled out for not following the midwife’s directions or simply for not spreading their legs wide enough. If the woman tears over the course of the birth, she is sutured with a fish-hook without any local anesthetic and is chastised if she even winces. Once the baby actually comes out, the midwife cuts the cord and carries the baby to the opposite end of the table, above the woman’s head, cleans it off with the Vaseline and wraps it in a pagne where she then leaves it wailing. In all the births that I’ve seen since coming here, I have sadly never seen a woman excited about the baby immediately after it comes out. Often, after the placenta is removed, she’ll limp out of the room without even a single glance at the child. No one seems eager to know (right away anyways) if it’s a boy or a girl (contrary to Americans), and many women even have to be forced to breastfeed immediately afterwards (a necessity if the baby is to get the most out of the yellow, nutrient-rich colostrum that comes out of breasts immediately after the woman has given birth) because they don’t want to put the still “dirty” child close to them yet. It’s hard to say whether or not a lot of this seeming apathy is a result of the sheer exhaustion from giving birth, or if it’s just a result of the fact that, to these women, “it’s just another child”. It is common for women to have up to 9 children, partly because many children are a sign of honor, and partly because (and these are words I’ve heard verbatim from their mouths), “that way if some of them die, there are still some left over.” It is unfortunately very common for women to have some of their children die. But it’s surprisingly difficult to convince them to have fewer children so that they can have the means of supporting their survival. The fact of the matter is: big families mean everything to them. But a child tends to represent less an individual than simply a number to add to the family. Other times (too often, in fact), the pregnancy is unexpected or unwanted, so the baby only represents the start of more difficult times. And thus, births don’t tend to be extraordinary events. It is largely for this reason that even months after the baby is born, you can ask a woman what her child’s name is and she’ll look bewildered and then just shrug.

But, my goodness, these women are strong.

To get back to the woman from the beginning of my story…
She had been pushing, and though the baby was fully crowned (the head had fully dilated the cervix; the midwife let me put on gloves and feel for myself), something was obstructing its exit out of the uterus. My midwife was getting worried that even if the baby finally came out, it wouldn’t even be alive after being in that position for so long. “Son basin – c’est trop petit!” she reasoned, pointing out the skinny woman’s small waist; the woman’s hips were too small to permit the baby to pass through. She needed a C-section, meaning she needed to be evacuated to the hospital up in the village 15 km north of me. Hearing that news, the woman sobbed and pleaded for the midwife to do anything so that that didn’t have to be the only option. But there was nothing more that could be done. And so, wrapped in a single pagne, at that stage in her labor, the woman was helped onto the back of a motorcycle that would take her on the 30 minute ride across a bumpy, unpaved dirt road to the hospital, where she could get help. We later found out that the baby was miraculously born alive and healthy.

Another time, I was in the dispensaire helping the midwife finish up paperwork before we left to go eat lunch. There were no other patients and we were almost ready to leave when a very pregnant woman showed up at the front entrance and collapsed on the floor. She was helped to the birthing table and my midwife quickly put on gloves to see how far dilated the woman was. With one hand on the woman’s knee and another in her vagina, I saw the midwife’s eyes widen. She pulled her fingers out and ran into the adjacent room to change into her delivery smock, saying that the baby was coming – that very second. I was standing in the doorway between the two rooms and when the midwife was down to her undergarments I turned and saw that the head of the baby had fully emerged between the young woman’s legs. “Emma! It’s coming, it’s coming!” I alerted the midwife, but then just as suddenly, the whole baby popped out, luckily not slipping off the table. We later found out that this woman was from a village even tinier than mine, 8km further “into the bush”, as we say, and she was getting ready to come to the market in my village that day when her water broke. Being from such a remote village, there were only two men with motorcycles available to take people into my village, but when she asked, they refused because they had already been “rented” to load their motorcycles with yams to bring to the market. So this woman had no choice but to walk in the heat, while in labor, the 8 km on the rough, tiny path that connects her village to mine to get to the dispensaire, where she arrived just in time.

Yet another time, I walked into work to see a woman who I’d known had been pregnant for a long time walking around with a ‘deflated’ stomach. I congratulated her on what ended up being a new baby girl, who was lying wrapped up on a mat in the recovery room. But when I looked in the woman’s carnet de sante (health book) to find out what the baby’s weight was at birth, I found that section to be empty – meaning that the woman had not given birth at the dispensaire, even though I’d counseled her to do so for months. Disappointed in her, I scolded her and asked why she had given birth at home instead. “You don’t understand,” she explained to me, “I didn’t even give birth at home – I was in the fields”. It turns out that one morning, 9 months pregnant, she left to go work in her fields by herself and went into labor. Five kilometers away from home and with no one around to help, she lay down on a pagne, gave birth to her 6th child, and then walked home. My mouth was hanging open by the end of her story. “You mean to say that you gave birth to your baby by yourself in a field?” I asked. “That’s incredible!” My soft-spoken, humble friend just lightly smiled, looked at the ground and shrugged. “What other choice did I have?” she said.

A common expression Togolese women use when they talk about giving birth is mettre au monde, which translates to “giving to the world”. Their stories and that which I witness continue to astound me when I realize what “giving” can really mean for them.