CHIM!!

August 21, 2010

Last night, I went with Catherine to the labor ward. She has been desperately trying to catch a baby (I absolutely can’t stand that phrase. They ooze out, they don’t shoot out like cannonballs). I won’t go into all the details of seeing my first birth, thinking about all the incredible physiological changes that need to happen at the right time for the baby to be born and healthy, imagining the agony that my mom went through, knowing that some of the women have had 5 or 10 kids and don’t know about, don’t want to use, or are prevented from using contraceptives. Any of those topics could fill up 15 pages of blogging but I think I can reflect on that later—those are all things that are universal. The one that I want to think about is the fact that the women aren’t allowed to have anyone else in the delivery room. Kwadwo supplemented my knowledge today in the van on the way back from Koforidua but I think I have a lot of reading to do if I want to understand the culture surrounding pregnancy.

(Aside: The trip is a 2.5 hour drive and I really wish he was more talkative because I could have talked about it for hours. I’m usually pretty good at figuring out how to get people to talk but Kwadwo is kind of an enigma. Maybe my human radar only works on Americans.)

I’m very glad that I went to the labor ward so that I could see what I’ve been researching, but it did not seem as relevant to my research as I thought it would. I really just can’t believe that the women can’t have someone with them. I felt AWFUL standing in my scrubs with my privileged white self just staring at women screaming. I couldn’t even talk to them because most of them didn’t really speak English. One woman only spoke Ga and the staff had a hard time communicating with her.

(Aside: I would have expected that in Kumasi because that region is mostly Twi-speaking, but here in Accra, many people speak Ga… it’s almost like Twi is the second language here and English is the third. School is taught in English, but that is a disaster that I’ll think about later.)

So I just felt awful. I think I would have felt almost fine if I could have communicated with the women but I felt like they were thinking that I was really judgmental or something because I just stood silently in the corner of a room. I stood with Catherine and 3 other medical students (they are all required to catch 13 babies and see about 20 deliveries during their 5^th year), and there were times when we just stared at the naked woman’s exposed vagina.

So Kwadwo said that the traditional culture was/is very strict about women and their vaginas. Women aren’t supposed to cook or be around other people when they have their period. Periods are messy and I understand why they have been historically associated with uncleanliness. He also said that it was typical that the man would go out of town when his wife was giving birth. The woman was supposed to go to her mother’s house and stay there for the end of her pregnancy, giving birth at her mother’s home. The husband shouldn’t see the woman in labor for a few reasons: don’t want to see their wife in pain, or at least in a pain that they can’t control or ease, the husband might not get turned on again if he sees the woman giving birth, and sometimes the husband hasn’t seen the woman fully naked and that would be inappropriate.

Also, Kwadwo mentioned that the labor ward is not set up for individual births, it’s set up for community births, but not community as in, “it takes a village”. More community as in, “you don’t have a right to privacy and you should deliver the baby soon”. So I guess I’ll just go from the beginning:

The women enter with their personal belongings and sometimes a friend/family member. They arrive moaning. About half of them were in wheelchairs. The doors are VERY heavy and I saw two people get totally pegged with the doors as they were wheeling in laboring women. Talk about the potential for lawsuits… They are told to put their things on the shelves and that the companion is not allowed to go any further. Then they stand there while the nurses talk between themselves and, in one case, argue whether her labor should be induced or whether she could stay on that floor with the uncomplicated pregnancies. During this time, they are standing and moaning or rocking from side to side. A nurse leads the way to a room, and the woman is forced to waddle as fast as she can to follow the nurse. Then, I think they just check her BP, HR, dilation, temp, etc. They are either led to a room or the hallway—not sure what the difference is, and then they are told to get on the bed. The “beds” are about 2.5 feet off the ground and they need to use a wobbly wooden stool with legs like this /---/. The nurses do not help them get up. The women then labor right there, in the hallway. They roll around in pain on the “beds”, which are like the black cushioned examining tables that we have in the USA. The stirrup-like feet-holders were broken, and when the women tried to put their feet in them, they would spin around and her leg would kick out and off the table. There aren’t any side rails and I pulled a Karen Gardstrom when I gasped and reached out my arm every time a woman decided she would thrash into a new position. So then when they start actually delivering, they are made to get off the (very tall!) table (using the faulty stool) and walk to a bed in a room. They lay on the bed and then they are forced to get up again and go into a similar black-cushioned thing; this time it’s more of an upright chair than a table. One woman I saw last night was using the bed on wheels to get up on the really tall chair. The nurses didn’t really help her except for holding her IV bag and yelling what I’m assuming could be translated to, “you NEED to get on this chair. Just do it. STAND UP.”

Actually, I know they said “stand up” because I know Twi!! It is pronounced like, “sahr – rie” (or “sorry”—appropriate!).

I know our midwife teacher told us that we should be moving around while we’re in labor and stuff, but this just doesn’t seem safe. It’s not like the baby fell out of her on the way over but the head was definitely ready to pop out while she moved. And there was no assistance!!

So that is the thing with the beds. Now for the partners. They are not allowed. No one except the mother-to-be. I couldn’t tell how the women felt about it. I think they probably were in so much pain that they didn’t have the energy to be angry at us. Now I understand why the doctor with the super nice practice isn’t coming on Wednesday. Oh wow. I have no idea where that came from. I just fell asleep and kept typing. Anyway, what I meant was Now I understand why the doctor with the super nice practice was talking about introducing the concept of a doula. They wouldn’t be with the woman for the medical stuff, but they would know the woman well enough to know the normal parameters of skin color, actions, feelings, etc. Kwadwo said that most people ignore the women’s screaming, but he tries to pick up on how it sounds at the beginning and stay finely tuned to any changes. Other than that, the women labor alone, with very little encouragement from the nurses or doctors.

I guess it is understood that pain always accompanies labor and childbirth. The process is what makes you a real woman and apparently women who have had C-sections are not considered real women. I’m pretty sure it’s not as harsh as that sounds, but that’s the way he explained it to me. I’ve heard this before and Kwadwo repeated it: the nurses and doctors will say, “Be quiet. Who are you screaming for? There’s no one here to help you.” That was not more harsh than it actually is. Apparently the women obstetricians are more dismissive than the men when it comes to pain management. Only people who have been exposed to Western culture will ask for pain relief or permission for their husband’s company. (I get the sense that the only people who would ask pain relief are the ones who are wealthy and have a high enough social status that they have husbands and not boyfriends or ‘partners’.)

Anyway, this is scattered but the bottom line is that I can’t imagine going through so much pain without anyone there with me. Some people say the birthing process is beautiful and I’m not sure that’s the adjective I would use. I think it’s absolutely miraculous, but I think the first part of giving birth is really about the mother. Since the father is not physically involved in the whole process, I think it is so important that he is there to support the mother. Also, speaking of relationships and stuff like that, after the babies are born, they are put in those portable cribs instead of with the mother. I am definitely not up to date on my maternal-natal bonding within the first hours of life, but I think that the research really supports physical contact as soon as possible. It’s interesting because at Komfo-Anokye, all the women were lying with their babies. I assume that’s similar in the postpartum ward at Korle Bu, just not for the first hours? Not sure. All the kids in Ghana haven’t died, though, so I’m pretty sure that it is okay that they are not with their mothers right away. Oh, and the title of the post refers to what the nurses say. ‘Chim’ means ‘push’.

Ghanaian proverb of the day: It is a child who has never traveled who says that only his mother prepares tasty meals.