11 September 2013
I woke up on September 11th with a lot of energy. When a labor call came in from Okidi, I had a feeling that I should go with the driver. I packed up some birth supplies (just in case), got Eugenia, and got in the car.
We drove to Okidi on the unpaved red-dirt road that disappears into the tall grass the farther out you go. There are lots of bumps and potholes — and not a few muddy patches. We made it to our destination, a school in Okidi, before the truck got stuck in a boggy place.
It’s no fun to be stuck.
People were nearby who offered to help our driver, and meanwhile, a young man on a bike came to tell Eugenia and me that his family was the one who had called us. Where was the woman? She was supposed to meet us there at the school buildings, which the truck could get to, and not wait at her family’s compound – which could only be reached by walking a dirt footpath.
I asked the young man if the mother was pushing. He said yes. Assuming the baby would be born by the time we got there, I said to Eugenia we should get our things and go check on the situation. So we started walking.
It turned out to be a half hour walk into the bush. We reached the family compound and found the woman sitting on a mat outside a hut. Her contractions were spaced out. Eugenia said it seemed that she was at the beginning of labor. “That — or the end of it,” I said. Meanwhile, the family said there was another woman in labor nearby. Two laboring mothers? I went to go check on the second mama.
She was only about five minutes away, and she was walking slowly and painfully in my direction, so I helped her the rest of the way to the compound of the family where the first mama was. I did a quick assessment of her fundal height: only four fingers above the umbilicus, suggesting she was only about 6 months along – and that the baby was not ready to come. With the translating skill of an elder in the compound, George, who is also the VHT (Village Health Team) worker, we learned that the woman wasn’t expecting her baby for another three months.
A few more questions revealed the woman was probably badly dehydrated and had a severe UTI. This had brought on contractions and preterm labor. I poured some vitamin C powder into a cup of water and asked her to drink it, but she refused. I was surprised! Eventually I poured out the Emergen-C and gave her clear water, and with a lot of help from George, finally persuaded her to drink.
Meanwhile, Eugenia and I were discussing whether we should try to walk back to the truck with these mamas, whether the truck would be out of the mud, and if we would have 45 minutes to get to the birth center before the first mama gave birth. The answer to that last question was … no! She started pushing as we were talking.
So we put on our gloves. Eugenia was seated in front of the mama to catch, and I was at the mama’s side to assist. The baby’s head emerged completely and started to restitute. Then the baby’s head stopped restituting. Color was still good … still good … and then the baby’s face started turning dark blue. I reached in with two hands to help the baby’s head continue restituting. As I did this, I urged the mama to push. Chol matek! She did, the baby’s shoulders came out, and Eugenia caught her. She cried her birth cry to open her lungs and started pinking up immediately on her mother’s belly. A great relief! A beautiful moment.
We turned around and looked up only to discover Akwero Katherine was there! She is one of the three main TBAs who helps us at the Ot Nywal Me Kuc birth center. She actually lives in a hut very close by, but she had not been there earlier. Now she helped us with the postpartum details.
There was minimal bleeding after the placenta delivered, and the fundus was firm. We had the mom cleaned up, lying down in a hut, and skin-to-skin breastfeeding her baby in less than ten minutes. Whew!
After checking on the mama and baby over the next two hours, we decided the best thing to do would be to leave them in the care of her family as a half hour walk to a truck that might not be going anywhere didn’t seem wise. (We didn’t want to exhaust the mama, dehydrate her or cause a post-partum hemorrhage). The family gave us a rooster for helping with the birth, which is a traditional gift to midwives (this was our second bird of the week, actually), and Eugenia named the baby Aloyo Aracely. Meanwhile, George told Eugenia that his mother’s name is Eugenia, too!
And then Katherine explained to us why she had not been nearby at the time of this birth even though her hut was so close: she had been at the funeral of her niece.
The girl, only in primary school grade 4 (about eleven years old), had been walking back from the fields where she was collecting sweet potato leaves. They were in a basket on her head, which she was holding. When she passed under a tree, she brushed against a branch, and a snake was in the tree and bit her, so she was poisoned. The family wanted to take her to the hospital, but she died before they could.
The hospital is very far away from Okidi.
Katherine and I then walked to her hut together to get a hanging scale to weigh the baby. On the way back, she called out to her neighbor in Acholi the good news of the new baby being born. Then, in English, she said to me that she had dreamed last night that she was catching a small baby. “It is this baby!” she said. When we weighed Aracely back at the family compound, it turned out that she was 3700 grams: a very good size for an Acholi newborn!
We still had the second mama with the UTI to transport back to get treated with antibiotics. We walked through the grass to the truck at her pace, all of us following in a line behind her: her sister-in-law with a baby on her back and firewood on her head, I with our supplies, the husband with his bicycle, and Eugenia with the rooster. Following advice from my friend Laker Christine a few days earlier (who had said I really ought to learn how to carry things on my head to keep my back straight and neck strong), I decided to carry our bowl of medical supplies on my head to free my hands. I only dropped it once when the rooster went crazy and tried to fly away from Eugenia despite its feet being tied. Ay!
Eugenia with a chicken given
earlier in the week
To make a long story short … The truck was out of the mud when we got back, which was great. But it got stuck a second time on the road, and getting it out that time took hours. The truck overheated once we re-started our drive, and the radiator spouted steam and water – five feet in the air when the driver opened the hood and uncapped the radiator – and by the time we finally got back to the birth center, the engine block was cracked. So we need a new ambulance for sure.
Kate makes the international sign for
“this truck is kaput”
But we made it back at last, and the mama with the UTI is recovering.