Doula in Tanzania (Part 1 of 4)

Yesterday afternoon I was puttering around waiting for Mr. Ben to collect us. (This term is used here to describe picking someone up, or meeting up with someone.) He had invited us to come see his house at 2pm. It was nearing 3:30 and I was beginning to think perhaps I had misunderstood, or maybe it was not a firm commitment. T. had been in a meeting most of the afternoon. T. came to me and said “I am pretty sure Ahadi is in labor. Do you want to go sit with her for a while and do your doula thing?”

Ahadi is a teacher here at the City of Hope private school. She approached us about attending her birth when we first arrived and word got around that I am a midwife. Of course, I am not, I am merely a doula-in-training, and I have explained this as best I can, but I don't think there is an equivalent profession in this area so I am not able to really make it clear. Babies are mostly born in their homes, attended by a traditionally trained midwife. In some cases, women use the government hospitals, where they are not charged anything.

To be perfectly honest, my immediate reaction was fear. Ty was willing and comfortable with delivering the baby in Ahadi's hut, but I was concerned that IF something were to go wrong, we would be thoroughly unequipped to handle it. The hospital as yet has no equipment in it—it would be impossible to do any kind of emergency surgery if there were a need. Even the sutures are buried in a shipping container and would not be easy to locate if we needed them. The responsibility of the lives of both mother and child weighed heavily on me. I stalled a little while and then T. encouraged me just to go sit with her, to see if she was in fact in active labor.

I grabbed my backpack, into which I threw my camera, a bottle of water, some cookies, gatorade powder, notebook, pen...I was thinking “this is a really lame doula kit! I really wish I had more to offer her” and then it came to mind, that what a woman in labor needs most from a doula, or friend, or mother, is a voice that speaks love and encouragement to her, and hands that touch and hold her. I had both of those, so I hurried right along.

Entering the hut was like stepping into a documentary film. Ahadi was kneeling on the floor, which is made of mud and dung, panting and groaning. Obviously contracting. Two of her friends, young teachers who had never given birth were sitting with her, looking a little bewildered but clearly offering the best support they could. I began to time the contractions-they were about 5 minutes apart. I wasn't really sure how to help Ahadi. I started rubbing her lower back during her contractions and I told her “let me know if you don't like this.” Every woman is different and some love to be touched and massaged during contractions and some don't.

Although Ahadi speaks english, she was definitely in "labor-land," the mystical place that women go in their minds while they are in active labor-and I wasn't sure if my english was being fully understood. At the next contraction she told Damaria in swahili, to tell me to keep rubbing her back. This gave me a momentary surge of confidence-although I was still entirely out of my element.

Ahadi's house is one half of a two-room mud house, rectangular in shape with no windows and only one small door. The house faces west and we were blessed to have the bright African sun pouring in through the door, which was open with a sheer curtain hanging across it. It was blowing in and out of the hut with the wind. Between contractions we chatted like women do—her friends told me she had cleaned the house from top to bottom that day, and even covered the walls with a coat of mud and dung. A fresh coat that was perfectly smooth and even, covering the sticks that were the structure of the house. It looked like brown stucco. I nodded knowingly and said, “yes, she is nesting! This is how we know a baby will come soon.” I explained about mama birds building their nests and the friends nodded comprehension. Against the far wall was a short bed with a foam mattress on it. On the floor was a very small piece of carpet remnant. There was a charcoal cooking stove, some pots, pans, and thermoses against one wall, and on the other, a plastic chair and small table. The room was very small, maybe 8x10. With us four women and T. inside, it was definitely crowded.

As Ahadi labored I wondered at her instinctive techniques for managing the pain and also for bringing the baby down. She started to do things completely naturally-some of which I have learned about only in books or in class. She stood between contractions and stomped from side to side, squatting in between stomps. She groaned in a deep meaningful way. She knelt, the squatted. She slapped her thighs. She didn't need me to tell her what to do.

She said she felt sick and I asked for a bowl. Just in time we were able to catch the vomit. Vomiting can be an indication of transition. I was a little concerned that this birth was going to come quickly, and we had not yet really made a decision about whether to keep here here or take her to the hospital, which is an hour away on a terrible road.

I called for T. he came and I told him her contractions were getting closer together, she had thrown up, she was acting like she wanted to bear down. I was pretty sure I heard some grunting during the last contraction and maybe she was already pushing.

With her permissoin, he checked her, grinned and happily announced that she was fully dilated. She asked if she could push and he told her, “you can push whenever you want to.”

Through her next contraction we observed her bag of waters bulging externally. He checked her cervix again. This time I detected in his brow a very slight furrow. So slight I thought maybe a mosquito had landed on his brow...

-J