10 August 2013
On Saturday, a nineteen-year-old young woman came into our birth center from Okidi reporting that she had been in labor since Thursday. She arrived by boda-boda (i.e., motorcycle). We checked her: she was fully dilated and ready to push. But she was also clearly dehydrated, faint, and exhausted. We gave her water with vitamin C and porridge, and her eyes became clearer and more focused. Her energy revived.
She had a low transverse incision on her belly, and she reported that she’d had a c-section with her first baby. Why? According to her, doctors had told her that, after being in labor for two weeks, it was time for surgery.
For the first two hours, she was unable to make effective pushing efforts. The baby was not descending. She said she wasn’t sure her hips were big enough to let the baby pass through. And then the baby started showing some signs of distress (late decels and meconium after the bag of waters was broken). Finally, we told her that another c-section might be necessary if she could not push the baby out.
All of a sudden, this amazing Acholi woman turned into a lioness! She was absolutely ready to push with all of her might, and she started ordering the midwives around, telling this one to sit here, the other to do this, and she hunkered down and pushed. She was not one bit interested in having surgery again.
I was holding a mirror for her, which she watched carefully as she pushed, and when she could see her baby’s head as she pushed, tears came to her eyes. It was so beautifully touching. She pushed her baby out with all her nineteen-year-old might: a boy whose significant caput and head-molding told us that he had been in an asynclitic position, which makes baby much harder to push through, but she did it! A victorious VBAC. And the baby made the transition to life outside the womb very well, needing no resuscitation.
This woman’s experience got me thinking about how much harder it is to have a c-section in northern Uganda than America. Women here do a lot of carrying of heavy loads—water, firewood, food—usually on their heads with their youngest baby tied to their backs. I seriously doubt that the full, eight-week recovery time recommended to American women (and rarely adequate for them, either) can be honored easily by families who depend on the mother to do so much, especially when her children are too young to help.
It’s one more reason why the midwifery model of care, which makes every effort to ensure a natural birth, is so vital to supporting women in childbirth here in east Africa.
Give justice to the weak and the fatherless;
maintain the right of the afflicted and the destitute.
Rescue the weak and the needy;
deliver them from the hand of the wicked.
~ Psalm 82: 3-4