The Birth Story (the long version)

Over the past several years, I have become increasingly interested in natural birth, and, being from Oregon, I have a number of friends who either did or tried for a natural birth process.  I’d been pretty well convinced that natural birth (someday) was for me when I moved to Africa and got to see and hear about the conditions that a laboring woman experiences in the hospitals of East Africa.  After some consideration, we decided to give birth in a hospital, but to go up to Kenya to do it, since the private hospitals in the Nairobi area have pretty good reputations.

You may have been wondering why we would travel 12 hours away for delivery when there’s a hospital and nursing school literally in our back yard.  Aside from our nervousness about the conditions at this hospital, it quickly became apparent that I couldn’t even go to the hospital to weigh myself without an audience of several nursing students.  Add that to the fact that the nursing students are required to observe a certain number of births and there aren’t enough that take place at Shirati Hospital for all the students to get their numbers in, so whenever a birth happens, a huge number of students are in the room watching (and that’s just for some random woman from the village, not mentioning the additional draw of the white woman who lives on the other side of the fence).

So, we did our research and settled on Kijabe Hospital, which is about one hour outside of Nairobi.  A number of people we consulted recommended it, but a major selling point was the inexpensive, but nice, guest house 100 yards from the hospital.  From the beginning, we felt like God was really blessing our plans.  We got a ride up to Nairobi from some American doctors, including an OB/GYN, making what would have been a difficult trip immensely easier (and giving my family much peace of mind).  We got a chance to visit with the American midwife I’d met in Newberg right before we came back last year, Amanda Daggett.  She can’t actually deliver babies in Kenya yet, but she gave us some books and DVDs to prep ourselves with, and we made arrangements for her to come out when labor started to coach me.  (Not to spoil the ending, but even though she couldn't make it to the actual birth, her counsel and encouragement were so important.  She was totally my hero, and her advice prepped me really well for labor.)

When we got to Kijabe guest house, we almost didn’t get a room.  Thank God that there was a no-show, and we settled into what would be our home until the baby came.  We visited the hospital again and got a tour of the maternity ward.  Unfortunately, we were disappointed to learn that the two private rooms in the maternity ward (a major draw for us) were being renovated.  There were some other options, but we couldn’t be assured a private room, especially not knowing exactly when the baby would come.  So that you know the contrast, the general maternity ward is about thirty metal cots with a small nightstand next to the bed, curtains for walls, and a shared bathroom at the end of a drafty hallway.  One can hear every noise from every “room” and the lights stay on continuously.  Appealing, no?
My due date of 14 February came and went without a baby.  I fully expected to be late, but as days passed, I grew very tired of being pregnant.  Finally, I started feeling contractions on the afternoon of the 17^th.  They weren’t very painful, just intense and regular.  We called Amanda and she headed our way.  The contractions continued through the night, and in the morning we decided it was time to go to the hospital.  Upon examination in the hospital, however, it was discovered that I was barely dilated.  Soon after that, contractions stopped, so we went back to the guest house to wait again and eventually Amanda headed back to her kids as we resigned ourselves to the fact that it had been a very disappointing false alarm.

I will condense the next week into these two words: waiting and walking.  At this point, let me pause the story to say a few words about due dates and “post-term” babies (aka get on my soap box).  First of all, due dates are calculated based on 40 weeks of pregnancy, but most women carry past that due date, especially with the first-born.  Second, I have to wonder how billions of women for thousands of years have delivered perfectly safely without having any idea of their “due date” or the potential harm they were doing to their babies by going past that date (of which they have no knowledge).  However, in modern medicine, many hospitals and doctors will not allow their patients to carry a pregnancy past somewhere between 41 and 42 weeks.  In fact, the European doctor who discharged me after the contractions stopped told us to return at 41-1/2 weeks for induction.  Induction is usually an IV drip of the synthetic version of the hormone oxytocin, which starts contractions.  However, if the woman’s body (I’ll skip the anatomical jargon here) is not prepared to deliver, the contractions create a situation something like trying to pound a watermelon through a keyhole.  It can be extremely painful, and often leads to women opting for an epidural, which then makes it difficult to push, since she can’t feel the contractions.  She has to be hooked up to a monitor that tells the doctor when to tell the woman to push.  If that doesn’t work after some time, they become concerned that the baby is distressed (no doubt, after such a forcible eviction), and many times turn to Caesarean section to quickly deliver the baby.  Because of the pain medication and consequent major surgery, both the mom and the baby are woozy and may have trouble connecting during those first moments of life.  All of this is what I did not want for myself and our baby.

It just so happened that the day we were instructed to return for induction was the day before Fred had to fly to an unavoidable work conference in Rwanda for 10 days.  We really struggled and debated with the difficult decision of whether we should induce, knowing that it could escalate into a C-section or that it might take long and Fred would be leaving in the midst of very difficult labor, but if we didn’t induce, Fred could miss the birth entirely, and I would be trying to recover and care for a newborn alone in a motel.  In the end we decided to trust that God had a plan for us and our baby, and that He would fulfill it in perfect timing.  I won’t pretend that this was a remotely easy decision, but we were reassured by the strong fetal heartbeat and continuous activity that our baby was safe and strong and healthy.  So Fred left, and I spent six more days walking and waiting.  On the seventh day Amanda returned to try natural induction, using herbal tinctures to prepare the *ahem* birth canal and castor oil to start the contractions.  These extremely unpleasant concoctions had the effect of…nothing, except another set of soft contractions that faded after several hours.  We concluded that the baby (or I) was determined to wait for his dad, and agreed that we would go for induction at the hospital at 43 weeks, the day that Fred returned.

So it was that on 6^th March Fred returned around noon, after I spent the morning in yet another set of soft, fading contractions, and we took a nap, then went to the hospital.  The European doctor was *not* pleased to see that I was still pregnant at 43 weeks, and began to reprimand me for waiting so long.  I cut her off, saying that I knew what I was doing and that I had made the decision to wait in spite of the small chance I could be “causing harm” to the baby.  I knew, in all my burgeoning maternal instincts, that I had made the right choice in waiting, so her annoyance didn’t bother me.  She prescribed the induction drugs with a little huff, and we were pleasantly surprised to be admitted as one of the very first patients in the newly remodeled private rooms!  The baby had waited long enough for us to get a room with a hospital bed, a private bathroom with shower, a couch long enough even for Fred to sleep on, and a television on which to watch the Arsenal match that night.

We settled in happily to wait for the drugs and the match and the baby (in roughly that order).  Hours passed, however, with no one appearing to administer the drugs.  At 10pm Fred went in search of someone to help us, and after several frustrating conversations, was informed that they wouldn’t be administering them until morning because there were so many women already in labor that the labor room was full.  (The labor room is a room with 12 beds where they take women to be monitored when they go into active labor.  Additionally, there is the delivery room with two delivery beds where they do all exams and deliveries.)  We were pretty outraged that they had admitted us for the whole night (which we’d have to pay for) when we could have been told to just come back in the morning.  Fred demanded to see a doctor and be discharged and refunded any bills they said we had incurred.   While we were waiting for the doctor, watching Arsenal beat AC Milan 3-0, I suddenly had a strong contraction.  I went to the bathroom to discover that I had some blood showing (a good thing).  Around midnight a doctor arrived, we explained our frustration and complaint, then I said “But the situation has changed now.  I think I just started labor for real.”  He said they would monitor me, and we tried to get some sleep between contractions.

Over the next several hours, I had painful contractions in increasing intervals, and was found to be dilating, but slowly.  At 7:30am a bed in the labor room opened up, so they moved me to the labor room, broke my amniotic fluid, and taped a fetal heart monitor and a contraction monitor to my stomach, essentially leashing me to the bed.  Before the contractions had been bearable because I could move around, walk, squat, or get on my hands and knees to ease the pain.  Once I was in bed, though, I couldn’t even turn from one side to the other.  A student nurse named Glory was assigned to me, to rub my back, urge me to breathe, and give me water, juice and some food in between contractions.  She had Fred running to the shops for “More juice!  More water!  Food!” to keep my strength up.  Meanwhile, with each contraction, she would massage my lower back like she was kneading dough.  It was the only pain alleviation I had, and it felt…maybe not wonderful, but it definitely helped.

Finally, after the machines taped to my stomach measured three “strong” contractions and a still stable fetal heart rate, Glory convinced the doctor to let me get up and walk around to help the baby settle lower and also to help with the pain.  Our private room was at the other end of the hallway from the labor room, so we set a certain pace that got me to my room for a contraction, then to the labor room for the next one, and so on.  I was getting a lot of stares, especially from the guests of the other women in labor and especially when I didn’t quite make it to one room or the other and had to squat and groan in the hallway until the contraction passed.  Very ladylike, as you can imagine.

At something like 11am I was determined to be 8cm dilated, meaning roughly two more hours of labor if the baby kept descending.  We returned to walking, but by 12:15pm or so, I was “feeling pushy” as they say, and the contractions were so close together that I wouldn’t even try walking the hallway.  I parked myself in a little alcove outside the delivery room, determined to stay there until the baby came.  There was a kind of railing all along the wall, so during a contraction I would squat, balancing against the railing, then I’d drink some water, stand up and simulate walking.  The hospital midwives were thoroughly interested in my progress.  After all, they’d be waiting for this delivery for more than three weeks also, since the first time we stopped by.  They complimented Fred on my agility (in squatting!) and that I wasn't a screamer.  Eventually, in spite of the nervous commands from the student nurse not to push, I started pushing with each contraction.  Both the delivery beds were full, and she was terrified she’d have to catch the baby in the dirty hallway alcove.

About this time, a bed opened up in delivery and I pulled the railing in the alcove clean off the wall (unrelated incidences, except that they happened approximately the same time).  I scooted across to the delivery room doorway for my next contraction, and then Glory asked if I could walk to the bed.  Absolutely I could!  I hustled in there and up onto the delivery bed ready to push that baby right out…except…by this time I’d been in labor nearly 13 hours, and I was exhausted.  I probably could have done it faster squatting in the hallway, but hospitals like their elevated, specially designed delivery beds, so I lay there pushing without the benefit of gravity for ten minutes.  As a contraction would come, they’d tell me “pushpushpushpush” and “don’t breathe, just push!”  After the contraction, Glory would literally pour juice down my throat for an energy boost.  Fred stood by my head, stroking my hair and pouring juice.

Finally, as I was losing confidence and strength in equal proportions, and fearing that they would give me an episiotomy soon to just cut the baby out, I snuck my hand down and touched the top of the baby’s head, which I was surprised to discover was covered with long, thick hair.  The midwife pushed my hand away, but I had what I needed.  The next contraction came, and I pushpushpushpushed the baby right out.  They put him on my stomach while clamping the umbilical cord, and I could touch his slimy, meconium-covered back all I wanted.  He started screaming right away, and didn’t stop as I delivered the placenta, got a couple of stitches, returned to the labor room for recovery and still I could hear him.  Eventually they brought him to me to nurse, and that settled him down.

I was pretty weak and my blood pressure was low, so they didn’t want to release me to go back to my room at first, but Fred advocated that I could get my IV fluids and rest better away from the strangers who kept popping their heads around the curtains to see our little guy.  We returned to our room, Fred helped me shower, and we got as much rest as we could with frequent nurses checking on the baby and I and a laboring woman in the hallway literally screaming like an extra in a horror movie every time she had a contraction (very unusual for African women, who tend to belong to the "silence is strength" school of labor).

We were discharged the next day, spent one last night in the guest house, of which I was thoroughly tired, then we went to Nairobi.  Fred treated me to a "babymoon" at a beautiful hotel that served actual brewed coffee and...wait for it...chocolate croissants.  We pressed on home to Shirati on Saturday, which was a long and brutal and hot ride, but we all made it in one piece.  So happy to be home and resting and getting to know our beautiful little man.


Samuel Wesley Otieno, six days old