Sadness

Yesterday I experienced a sad and frightening evening.  I have a good friend who was 6 – 7 months pregnant.    The beginning of her pregnancy was emotional.  She had gotten pregnant while breastfeeding her 21 month old little boy Mamodi.  Getting pregnant while you are breastfeeding is a HUGE taboo around here.  So, even though her husband was the baby’s father, they wanted to have an abortion so no one would find out that they were sleeping together.  (In this culture, a husband and wife cannot have relations from when she knows that she is pregnant, until the baby is weaned from breastfeeding – at 2 – 3 years of age.)   

They asked me to give them something to help abort the baby.  Obviously, I refused.  We prayed with them and talked with them and showed them a picture of the fetal development at that point, and they decided to keep the baby.  That night, she started weaning Mamodi.  Because they were so ashamed of how she got pregnant, they wanted to keep it a secret, saying that her mom would beat her if she found out.  Since extended family is the one who normally helps the weaning process by taking the child away from mom for a few days, we became the extended family.  Mamodi came and spent time with us – especially when he was crying to nurse.  It was a long few days, but Isatu was strong and everyone survived.

Eventually, the crisis passed and life settled into a routine.  Mamodi was growing stronger and Isatu was slowly beginning to show.  In June, she was at my house one morning and we pulled out the fetal Doppler that I have and listened to the baby’s heartbeat – nice and strong.  Secretly, I was hoping it was a girl, since she only has boys. (She had a little girl a few years back, but it died within a day or two of birth.)  Every mom here wants a little girl to teach how to cook and to help with the work.  In my mind, I was trying to figure out when she was due, and whether or not we would be in town.

A few days ago, she came to me and asked me to check her.  She said that she was having some low belly pain.  No problem, I said.  She came in the afternoon and I pulled out my Doppler.  No heartbeat.  I tried again.  Nothing.  I was beginning to get worried, but didn’t want to her know.  ”Well”, I said, “I can’t hear anything; maybe the baby is in the wrong position.  Come back in a few days and we will try again.”  She agreed and left.  My mind was racing.  If the baby was not alive, and I was sure it wasn’t, what were our options?   Does she have to go to the hospital or do we wait it out?  If she started to miscarry in the village, would she have problems?  Another friend of mine nearly bled to death having a miscarriage.   I got out the sat modem and sent off an email to an OB-GYN friend to ask for advice.

            

    Isatu came back later that evening.  We talked a little.  I promised to try again the next day to find the heartbeat, but told her, “I don’t think your baby is strong and healthy.  I am concerned for you.”  All night, I was overwhelmed with sadness and concern.  Yesterday afternoon, we tried again.  Nothing.  We talked.  I said, “Maybe you need to go to the hospital and have an x-ray (meaning an ultrasound) there.” (I am not actually sure that you can get one done in Faranah.)  I went back to work.  Later in the afternoon, while I was seeing a porch FULL of patients, she called me from the back porch and told me that she was having some pain in her lower belly and had a tiny bit of bleeding. 

 I debated about whether or not to send her to the hospital, but she said she didn’t have a way to get there.  I sent her home with some Gatorade and Tylenol and told her to rest and that I would check on her later.  I pulled out all of my books on women’s health and midwifery.  All seemed to say that most miscarriages pass without incident and gave warning signs of what to watch for.  I was feeling better about her staying in the village.  We ate supper and I was preparing to go and check on her when her husband, Mordeka, showed up, saying that she was having a lot of pain.  I grabbed a back of supplies and headed out. 

               

 When I entered her dark room, I found her lying on a cloth.  The bleeding had increased a lot, as well as the pain.  I check her – sure enough, her cervix was open and I could feel what felt like the baby’s head coming down.  I sat down beside her and waited.  We talked a little, but mostly we were quiet.  Her kids kept popping their heads in, so finally I pushed a chair up against the door.  The pains were getting stronger.  She gave a push out and pooped what I thought was the head still encased in the amniotic sack, but soon discovered was just a sack of fluid.  I was getting nervous.  She was bleeding a lot.  I am still fairly new at all of this midwife stuff, so wasn’t sure if I should break the sack or not, like I do with a normal delivery.  Would it cause her to bleed more?  I called my family on the radio and asked one of the boys to bring down my delivery bag, which they did.  

 We sat and waited.  I was getting scared.  I prayed over her and sang while we waited.  Jim came down then and was sitting outside with Mordeka.  He was praying and the kids were praying.  We were not making progress.  I sent Mordeka to try to find the town midwife, thinking that, if I did break the sack, and she started bleeding, someone would be there to help me.  The midwife was at the mosque praying.   Isatu mentioned her aunt, who helps with deliveries sometimes, so Mordeka went and called for her. She came a short while later.  We began to work together.   

She was helping Isatu push.  The bleeding was increasing, along with my fear.  Were we going to have to take her to the hospital?  How was that even possible in the condition she was in?  Finally, I decided – I broke the sack.  That seemed to help.  Slowly but surely, the pain and contractions increased.  I could now see the baby’s head.  The midwife showed up – she thought that Isatu was in labor because she was at her due date.  We told her that the baby was not living.  Finally the baby was delivered – a good sized little boy - stillborn.  I was filled with sadness.  He couldn’t have died that long ago.  We got Isatu cleaned up and I wasn’t sure what to do next.  I am still learning customs about death.  Amazingly, neither of the ladies seemed to know what to do either.

                 

We cleaned the baby up and wrapped him in a white blanket (bodies always have to be wrapped in white – thankfully I had a white baby blanket with me.)  The midwife told the aunt to go and tell the family.  She said, “What do I tell them?”  In some small way, that was a big encouragement to me.  Many times, in this culture, I feel at a loss for the right thing to say.  Here were 2 women- from the culture – who were trying to figure it out as well.  They thought for a few minutes.  Finally, the midwife said, “Tell them that the baby was born, that it was a little boy, but that he was not saved.”  She left to do that.   

We got Isatu settled in bed, and the 2 women looked like they were ready to leave.  I sat down on the bed beside Isatu, just wanting to be with her for a while.  She looked completely overwhelmed and sad.  I was afraid that she (and others) would believe that she had lost the baby because of how he was conceived.  I shared with them that I had a miscarriage before I got pregnant with the boys.  The midwife said, “This is the third miscarriage in the village in the past few weeks.” 

 That started a long discussion, and it seemed that we were going to be spared the false blame on the conception of this little boy.  I was SO thankful.  Women started to trickle in as the news spread – even at 10 pm.  The room started to fill up with women who came to sit with Isatu.  In the small 4 foot by 6 foot space, I counted 11 people – plus Isatu and Mamodi.  We had some togetherness going on!  Eventually, I walked home to grab some antibiotics that I wanted her to take – just to prevent any infection that could happen.  While at home, I had Ben warm up some rice that was in the fridge and took it back to her to eat.

She is doing okay now.  I went to check on her, but she was sleeping, so I left some food and came home.  Mordeka came and said she was doing better. 

                

 In the sadness of all of it, I found some things to be thankful for.  First, I was in the village when it happened.  Second, she didn’t have to go to the hospital and is doing okay.  Third, there doesn’t seem to be any blame on how the baby was conceived. 

               

 As I sat there that night on the floor with her, the small lamp casting shadows all over, looking at her leg lined up beside mine, the contrast in the color of our skin hit me.  We may be from different cultures, but we are both women and both moms.  At one point, when she was in pain, she laid her head on my shoulder.  I thought, there is no where I would rather be right now.  I am so thankful for the people here who invite us, not only into the celebrations – but also the sadness – of their lives.  We are blessed.