I have been doing a program called Grassroots Soccer with some junior high students. The program uses soccer as a vehicle to teach about HIV. We met three times a week during November, and finished our last practice on Tuesday. My top two students walked me home, as they usually do. Along the way, a flock of egrets flew overhead. “Look, Enoch!” Julius exclaimed. “Pure white birds. Aren’t they wonderful?” We all stop to admire them, and pure joy shined on Julius’ face. “They only come at Christmas time,” he explained, “and I think they’re just beautiful.” Standing there, watching the egrets fly into the sunset with Enoch and Julius, my heart felt so full.
My phone rang at 6:02 am. I was awake, but annoyed that someone would call so early. I looked at the screen and saw “Sister Akos” and immediately my annoyance turned to excitement. I’ve been waiting for this phone call for six months. “Mam B, come. A baby is coming” she tells me in twi. Sister Akos is the assistant to the midwife. I have been telling both of them for months that I want to watch a birth, and learn how to deliver babies. But so far, Akos hadn’t called me because she was worried about calling me in the night and about not being able to speak English. Also, she’s a little distracted when a woman comes in in labor, so it’s understandable that she forgets to call. I jumped out of bed and hurried to the clinic. It’s a very foggy harmattan morning. When I arrived, Alice (the midwife) told me to go straight to the delivery room. “It won’t be long now” she tells me.
The mother is young and pretty, and has come from Nketa, a village about an hour away on motorcycle. Her belly is small, so I check her maternal health records. She’s only 32 weeks pregnant. Akos and I sit with the woman in labor for two and a half hours. She is in lots of pain, but in Ghana women are considered weak if they cry out, so she suffers in silence as best she can. When she can’t stand it anymore, she cries out quietly, and begins to walk around the room, pacing back and forth and occasionally drops to her knees. After a while, Akos checks her again and listens for the fetal heart beat. She moves the pinard horn to find a better place to listen. Then she moves it again. She frowns, and calls for another nurse. “You hear it?” she asks the girl. “Kitee kitee paa (very very faint)” Benice replies. They call Alice to come, and meanwhile the ask the mother more questions in twi that I don’t follow. The woman answers, and Akos gets upset and hurries to start an IV. Alice comes in and tells me that the woman fell on her way to the clinic in the early morning. When Alice saw her scraped knees she asked her about it and the mother told her she fell, but not on her abdomen. Now, she admits she did in fact fall on her belly. “We can’t hear the fetal heartbeat anymore” Alice tells me.
While Alice tries to find a vein to start the IV, Akos breaks the woman’s water. They tell her it’s important to start pushing now. She is struggling to push at all, probably because of the fall. “We are just praying for a live birth,” Alice tells me, but her face tells me she isn’t hopeful. The head finally emerges, and after it comes through the rest of the body falls out with it. The baby is tiny, no more than two pounds. She coughs and wriggles her arm, and we all breathe a sigh of relief. I expected a small baby, but not this small. “I suspect twins” Alice tells me. ‘Of course my first birth would be twins,’ I think to myself. She examines the abdomen again, and sure enough, finds a second twin lying transverse way in the back. “We must send her to Dormaa right away” they tell me.
Akos gets on the phone immediately and begins to call drivers. There are no cars in town, and she eventually finds a driver from a town 30 minutes away who agrees to take the woman to the hospital. Dormaa is two hours away, on one of the roughest roads I have been on in Ghana. The poor woman must sit in the taxi, still in labor with one umbilical cord hanging from her with a clamp on it until she can be seen by a doctor. The car takes about 40 minutes to arrive at the clinic. We rush to put her in the car, and Akos and the husband join her.
I learned that along the way, the car broke down and they had to find another. Once they arrived at the hospital, the doctor wasn’t around so she had no choice but to wait. As best I can tell, there was roughly four hours between the time she delivered the first twin and the time she was seen to deliver the second. We have not heard any news from Dormaa. Alice was confident the first twin would survive, but the second twin was under severe distress.
This was not a usual birth. Akos called me expecting to show me a normal delivery. Instead, many unexpected events transpired. Akos and Alice did the best they could, but maternal health in the village is not easy. I just hope the woman and her babies made it through okay.
I’ve heard that when people see a birth for the first time its usually not an enjoyable experience, but I loved every minute of it. I went back to the clinic in the evening to debrief what had happened with Alice and Akos. As I was leaving around 9:00, another woman came in labor. “Are you tired, or do you want to see another?” they ask me. I was exhausted, but I immediately reply, “I want to see another.” We begin to prepare and examine her. Eventually, we determine she is in the early stages and won’t deliver for hours. I decide to go home, as I was leaving early the next day. I can’t wait to see and learn more as soon as I return home.