Senegalese Doula!

I finally got to be a doula in Senegal!

It was so wonderful to attend/help with a birth that wasn’t on the side of the road, and that was carried out under the supervision of skilled medical professionals. There was so much less pressure on me, and so much less anxiety.

One of the women from my mother’s group, Hawa, was very pregnant at our last meeting. She stuck around after the lesson was over and we talked about her upcoming birth and my sister brought up the fact that I had been a doula in America. Hawa’s eyes lit up and she asked me somewhat jokingly if I’d be willing to help her through her birth when the time came. I said of course and told her very seriously that she MUST call me, at any hour of day or night and I would come running and escort her to the health post and stay with her throughout the entire birth. I wasn’t sure if she would call, but I really hoped that she would.

6am on one of the 3 days that my visitor was in my town, I got the call.

The two of us threw on clothes and sprinted out the door to her house. We met her on the road to the health post. She told me she had been having labor pains for roughly three days but they were now getting much more intense and she knew the baby was coming soon. (This was her 4th). She and I and Amanda (my guest from home) and Hawa’s friend and fellow group member, Mairam, all walked the 10 minutes along the dirt path to the health post in total silence with her. I held her hand and offered my arm as support when the contractions came and she had to stop and breath or lean against a wall.

Now in Pulaar culture (not sure if this is true of all of Senegal) women are expected to give birth silently. Crying, or yelling is seen as a sign of weakness.

So the majority of the walk we spent in silence, Amanda and I flanking Hawa with Mairam walking alongside, silently mumbling her morning prayers. Not once did Hawa cry out, she just whimpered softly to herself. I mentally timed the frequency of her contractions by noticing her face and the few times when she paused to rest because the pain was too intense to walk through.

What struck me most was the power and the intensity of the intimacy I felt among these women. I was reminded of the book The Red Tent (see PC reading list) and the cherished moments, and secrets the women shared under the tent.

I thought about this shared bond, the work ahead of us, and the strength of this courageous woman who was about to bring her baby into the world. I felt reverence for Hawa, for all mothers, for women, for the gift of a womb, and for that private moment that the four of us shared-two young single American women, and two older, Senegalese, Pulaar mothers, walking silently, arm in arm down the quiet sandy streets in the early morning light, before the heat of the day. Them in their traditional Senegalese dress and head scarves, and us in our t-shirts and long skirts.

I don’t remember feeling anxious. I felt secure, confident, slightly hurried, but mostly honored. I was honored that she trusted me so openly to accompany her and attend to her through this difficult and frightening journey.

I was pleased to find that the midwife on duty was my friend. One of the ones I liked the most. She had helped my counterpart give birth and I knew we were in capable hands (as capable as can be for such a basic maternity ward).

My thoughts were going a mile a minute. I was trying to notice every detail but simultaneously give Hawa all of my attention. Here I was finally getting a glimpse into the “quality of care” that I had studied at LSE in my reproductive health course. I didn’t want to miss anything. Granted I’ve seen quite a lot just by hanging around the health post, but this was the first time I would have the chance to see the whole process up close.

I remember feeling relieved that it was so early and that it wasn’t a busy vaccination day. The health post was practically empty which would mean some privacy. The midwife, Nabou, told Hawa to get up on the exam table (in the first room where the registration desk is). She sat at the desk and filled out some paperwork while I helped Hawa lay down. Nabou examined her briefly, and felt her belly, which was visibly pulsating with every contration. To hear the baby’s heartbeat Nabou used a funnel pressed flush up against Hawa’s belly and her ear at the other end. She asked how long Hawa had been in labor and when Hawa said three days, Nabou scoffed and asked her why she hadn’t already stopped by for treatment. Hawa corrected her saying that she had and that they had given her a prescription (for what I’m not sure) and had told her to come back when the contractions were closer together. Then we moved her into the delivery room.

It’s a dirty, stifling hot room with a back door, a sink, and two very basic, very dusty padded, metal tables with stirrups. Mairam was sent to the pharmacy with a list of things that she had to buy for Hawa: gloves, tubing, a syringe, a bag of glucose for an IV drip, gauze pads, and various medicines that I did not recognize. I learned that you really have to have someone, often several people to accompany you and help you at the health post. I learned that if you don’t have the money for the necessary supplies, the health post will pay for the medicines and you just have to pay them back. I was actually pleasantly surprised by that.

To get the money Mairam first had to go back to Hawa’s house and then to the pharmacy. I practically had to bite my lips off to keep from offering to pay for everything. I knew that she could get the money, I just had to be patient. Also, that would start a terrible trend and I could envision the line of women coming to me for money when they had to go to the health post. I told myself that it was enough that I was there with her, and that if I hadn’t been no one else would be. I discovered later that typically they don’t allow anyone else in the delivery room and that they made an exception because, well….I’m a toubak, and they knew I had had some experience, and mostly because the midwife was a friend of mine. That and I’m sure they knew me well enough by now to know that if they had tried to kick me out, I would have pitched a fit and stayed anyway.

Mairam was gone for about thirty minutes during which time Nabou was getting terribly impatient and kept yelling at Hawa for Mairam’s slow pace. I went outside and told Hawa’s aunt and my sister (who had both showed up at that point) to bring cloths and fabric to wrap her and the baby up in afterwards, and sheets to lay on the post-partum bed. Meanwhile Nabou was getting things ready in the delivery room. Washing up, setting up the IV drip, etc. I was focused on Hawa and helping her through each contraction which were getting more and more severe and coming about every minute by that point. She vomited once, and luckily I was there because I got her the trashcan in time. (I’m sure she would have been yelled at had she vomited on the ground). I mostly just stood by her, holding her hands, giving her my body to hold onto, cooing to her that her body was strong, her baby would soon be in her arms, and that even though she was tired it would all soon be over and she would be able to rest. The only thing I could think to do to make her more comfortable was to wet a packet of tissues from my purse with the ice water Amanda and I brought with us and hold it on Hawa’s forehead. She kept telling me how tired she was. She never complained about the pain, only how tired her body was. She continued to let out long sighs and whimpers, calling quietly to “Nenam” meaning, “my mother.” It surprised me that she did not call out to Allah, but to some other grand feminine force. I remember thinking how beautiful that was and realizing that birth really does connect all women.

It was definitely a challenge to try and coach and soothe her in Pulaar, but I did my best and I remembered that it didn’t really matter what I said as long as it was soothing and repetitive. I settled on telling her that she was strong, she could do this, to breathe and that soon her baby would be in her arms.

(I also realized in that moment that this was now the fourth birth I had ever attended, and that none of them had been in my native language! The two in the states were in Spanish, and then these two in Pulaar. I sighed to myself and thought about what a relief it would finally be when I could be a doula in English!)

Nabou set up the IV and now there were roughly three other midwives bustling about, chatting amongst themselves and getting things ready. There was a lot of activity for such a tiny room and it was a struggle to keep Hawa focused and for myself to try and ignore the midwives and focus only on Hawa.

As the contractions came closer together and more severe, Hawa did start to cry out some. I didn’t even think anything of it, but one of the midwives came over and scolded her. Saying that she needed to stop crying because people outside could hear her! I was appalled. But I kept my mouth shut because I didn’t want to risk being asked to leave. The midwives explained to me that they gave Hawa Pitocin to increase the contractions, saying that the baby was tired and so was she and they needed to get the baby out right away. The baby was nearly crowning when one of the assistants starting violently shoving on Hawa’s stomach. Now I’ve heard of this before when the mother is tired, but it looked incredibly painful and they certainly weren’t timing the pushes with the contractions. They kept yelling at her to push even in between contractions, and Nabou was scolding her for not keeping her legs open enough. I felt so helpless and wanted to be in 3 places at once, to hold her legs, and simultaneously be at her head to hold her hands. Nabou kept yelling at her to push even between the contractions (which is pretty much counterproductive and a waste of energy). Hawa was definitely crying out at this point and so overwhelmed by all the different directions and things happening to her. Finally the baby was crowning and instead of having the head come out in one contraction and then waiting for the next one to ease the body out, Nabou pulled him out in one go, with one massive yell from Hawa.

The moment he was born and I saw him I burst into tears. I looked over at Amanda (who had come in to watch during the last few minutes, her first birth ever!) and we were both teary eyed, she was trying so hard not to cry because I had told her it was culturally unacceptable, but I definitely couldn’t help it. With tears streaming down my cheeks I told Hawa it was all over, she had a healthy baby boy, that she did it, praise be to God, may her son be in health etc etc. Nabou smiled at my tears. She wrapped him up in a cloth and laid him on the next table over! Hawa didn’t even get to look at him! She put the vitamin K drops in his eyes to avoid infection, and then just left him there, alone on the table wrapped in a dirty cloth, with the hot sandy air and flies coming in the door. I asked if I could give the baby to Hawa and Nabou said no, that she knew that in America we put the baby immediately on the stomach, but here they waited until the mother was in the other room and cleaned up and resting. I couldn’t help but be angry and confused, with how nicely Nabou was speaking to me throughout the birth, and how mean and impatient she was with Hawa. As she worked to get the afterbirth out, Nabou yelled at Hawa repeatedly to open her legs and scoffed “oh come on, how many births is this for you? Open your legs, so I can finish.”

Hawa lost a lot of blood and was pretty disoriented. Nabou had to kneed her uterus to get the excess blood out and to get it to contract back up. I pointed out that getting her to breastfeed right away would help with that, and again offered to bring the baby over, but she refused. After Nabou finished cleaning her up, the other midwives came in and wrapped her up in cloths, scolding her (yet again) for not bringing a pair of red underwear (or any at all) to act as a diaper to stuff the fabric into. They made do with the fabric she had brought and tied it in a diaper-like fashion around her, changed her clothes and we moved her into the next room to lay on the bed. Her aunt still hadn’t showed up with the sheets for the new bed, so she was yelled at again. At that point I had been over to pat the new baby boy and coo at him, and Amanda and I were the first ones he saw when he did finally open his eyes.

I helped lay Hawa down in the next room. And realizing that the baby was now ALONE in the delivery room and no one seemed to care, I yelled to the new midwife on duty (Nabou’s shift had ended by then, and she practically ran out of there) that I was bringing the baby to Hawa. She said fine and so I carried the little baby boy to her and laid him next to her to let her look at him for the first time, roughly 30 minutes after giving birth. She was so tired, and initially refused to, but I insisted that she breastfeed him and told the midwife to encourage her to also. I sat with her on the bed, watching and making sure he was latched on correctly, which he did almost instantly, with gusto! Amanda sat across from us on the next bed and we smiled at each other, both of us totally unable to process all that had just happened. Hawa’s aunt brought Hawa a steaming hot cup of coffee. I rolled my eyes and told her that she should also drink water if possible. (I know now that arguing over coffee is useless even though it’s crazy to me to want coffee over water after being so dehydrated, but that’s how it is here). At least she was breast feeding and was healthy. I sent Hawa’s aunt out to get her some ice water, to which she asked if it was okay that she drink cold water. I said of course, and then explained to her the importance of getting her hydrated (hence the IV drip) and why immediate breast-feeding was so crucial. She nodded her head and seemed enthusiastic about my help.

I asked Hawa what she was going to name him and she said she was disappointed it was not a girl because she would have named her Binta, but that she wanted to name him after my dad! Again I nearly cried and thought that perhaps Shel might be a difficult name for a Senegalese kid, so I settled on Barry. Senegalifrenchified it sounds like (MbaarY). She seemed happy with that so I’m expecting that will be the little guy’s second name. Children here are given several names so it will probably be used as a nickname mostly just by his mom. But now both my mom and dad have infant namesakes! Cool huh? I keep telling them that now they HAVE to come visit.

We sat with Hawa for another 20 minutes or so and at her urging left to go home and have our own breakfast. It was about 10am by that point and Amanda and I were both starting to feel pretty exhausted and dehydrated. So we made the windy, sandy, hot trek back to my house and sat down for coffee and muesli. My family was thrilled that we had both been there and gave us both all sorts of praise.

Around 11am I called my sister and asked if she had gone back to the health post. She said that no she hadn’t and that Hawa had been transported by ambulance to the next hospital and that there had been complications! I was so upset, and of course in Pulaar there aren’t sophisticated medical terms so all I knew was that she was “tired and missing blood.” I took that to mean that she hadn’t clotted properly and was still bleeding. Her whole family had raced to the next town to be with her so there was nothing Amanda and I could do but wait. We said we would call back in the afternoon and see how she was.

I fretted the entire time. We spent the day making doughnuts with my family for the little soirée we had planned that afternoon for Amanda’s last day, as a thank you for having her. But I was so distracted and anxiously awaited my sister’s phone call. Finally around 2pm I called and talked to Hawa’s husband who said that she was indeed better, but that she had to stay overnight and would be back tomorrow. I was relieved, but still anxious.

I told my Yaaye and she said something that almost made me cry. I told her how relieved and happy I was and how anxious I had been all day, and she just looked at me and said, “Binta I know. I could see it in your face all day. I knew you were scared and worried. I was watching you make doughnuts and you were so distracted and your face was pained. It’s because you are so good and you care so much about your family and your Senegalese family. I spoke to Binta earlier about how upset you were. We were all worried and now we can all be relieved together.” I almost hugged her. How wonderful that she knows me well enough to know what I’m feeling even better than I do!

So Hawa came home the next afternoon and is now healthy and happy. I am so disappointed though because I had to miss the baby’s baptism because I am sick with amoebas + some other horrible bacterial stomach infection + a head cold at the regional house. I could not even travel home and instead spent a week holed up at the house feverish, watching movies, eating soup, and running to the loo every 30 minutes. Yuck. I’m so bummed. I of course called to explain why I couldn’t be there, but it was really a big deal to me to be there, and if I possibly could have made the drive I would have, but it was out of the question to be away from a bathroom and on public transport for 4 hours. I plan on showering her with gifts when I do get back though.

But, my good friend Mairam, who is part of another family totally unrelated to me, and who are my dear dear friends, just called me to tell me that one of the women in her family gave birth to twin girls yesterday!! She was HUGE and I told her that she was having twins. Everyone thought I was crazy, but I insisted. Mairam told me that she is naming one of her girls after me! Hooray! My very first namesake. I’m so honored. But I’m irritated because I have to be down helping with the training for the new volunteers, and am AGAIN going to miss the baptism, but Mairam said that they would postpone it until I came back because they couldn’t imagine me missing it and they didn’t want to have it without me. What an honor. Especially, because it is so important in their culture to hold the Baptism on the seventh day.

These births (and my interaction with the breastfeeding mommy-see previous entry) have absolutely refueled me and helped me out of my mid-service slump. They’ve reminded me of the connections I’ve made in this community and that my work and my presence is valued and respected and needed.
And what an honor.
What an honor to be included and trusted in some of the most important moments of people’s lives.
I am so lucky.