I have been at a loss for words. The days pass by like months and then with a spark they are over. Last year this hospital was refuge for the girls who were night commuters; they sought safety in the sweat soaked walls from the terrorists from whom they escaped. Now these girls come back to this place to deliver their babies. They return with mothers, aunties, sisters, or alone. They bring with them a piece of plastic, which they lay on the seventy year old metal gurney to birth on, and a blanket to wrap the baby in. If they have a little more money, they may bring two blankets. There are five metal birthing beds. Soon after one woman delivers, the plastic is removed and another woman comes to take her place.

Often there is only one midwife on the floor. Or maybe just the woman who does the cleaning. She has become a lay midwife by virtue of spending time in that space. Women labor in the halls and come onto the beds to be examined and when they are close to pushing. The first baby of the day is strong and comes out with a cry. As we deliver the placenta a woman who has delivered at home comes in because she is hemorrhaging. She has a displaced uterus and is HIV positive. I triple glove, push it back up inside of her and massage it into place. She must lay on the floor because all of the labor beds are in use. I send her auntie to make her tea. Another woman pushes for three hours while two more deliver. We have one set of clamps and a pair of dull scissors. If the power is out they cannot be sterilized so we use string and a razor blade to clamp and cut the cord. Even if the power is on, there is not enough time between each birth to sterilize. The child mothers seem to take the longest because they are young and they are scared. One girl refuses to push for two hours while her baby waits just below the pubic bone with a very low heart rate. She is scared she will poop on the bed and no amount of coaxing will convince her that this is an ok thing to do. Another woman lays in fetal position and cries out for Jesus to save her. She has been in labor for two days. We have packed a small lunch of sim sim paste and mango marmalade on stale white bread. We take five minutes and while we are gone another woman has been admitted. Late in the day a woman comes in from the Congo. She has a group of seven Congolese women with her. They wear charcoal on their eyes and bright red blush. They stand around her and rub her and speak to her softly, holding her hands and feet as she labors. As she pushes they begin to wail, flailing their arms around, beating their chest and then they begin to slap her and strangle her (there is no way to contextualize this properly, but from what I can gather this practice is used to stop a woman from blowing out her nose when she pushes) this baby has the cord around his neck very tightly. The sisters are still wailing and strangling this mother and I have to scream at them to stop. They stare at me strangely, but pull their hands away from the birthing mother. The clamp and scissors are in use so I hold the head while Aimee uses the string and razor to cut him free. When he comes out he is lifeless and blue. I flash to the first baby of the day and feel the tears well up in my chest. I push them down. This time the bulb syringe is clean so I am able to suction him and massage him into breathing. While I am working on him his mother gets off the metal bed, cleans up the fluid (they all clean up after themselves) from her birth and walks out. One of the seven women comes to take the baby and I explain that she must keep him very close to her body for warmth. His skin is still blue, clammy and cold, but he is breathing and his heart rate is good. With each mother I make a connection and then forget her name. When one returns because she is bleeding too much I cannot remember if she has delivered today even though she is the one who spent three hours pushing. The placenta bucket is overflowing and one of the orphans who lives in the hospital brings it out to empty it in the placenta pit. There is a moment of silence and while one young mother pushes (it will be a while) and another tries to sleep I step outside to see the sun setting.


We leave the hospital at 6:30. Two hours after we were supposed to leave, but this is when the night shift midwife shows up. I feel I have no personality left. The nuns invite us to tea and it is all I can do to sit for ten minutes as the milky warm liquid swishes in my mug. When I return home I step into the cold shower, immerse myself and cry. The water beads up and trickles slowly into the drain. The cold feels shocking and real. The dinner bell rings but I cannot imagine eating. My head is swimming with images of placentas and tears, spurting blood, amniotic fluid and feces. This was today. I cannot remember the ten women whose babies I caught yesterday.
I feel numb but also terribly alive. The aches in my back and feet, the pulse in my chest, the chapped skin on my hands from all of the gloves, the washing, the purell, converge together as both witness and testimony to my day.

Aimee and I stay up late talking. She re-enacts parts of the Congolese drama that I missed because I was so focused on the baby and the cord, I laugh hard for the first time today. We question ourselves. What are we doing here? What can we do that will really impact this situation?The medical information being used is dated. There is no one here to update it. One of the midwives was talking about how the TBA’s are contributing to maternal death rates because they only refer women to the hospital when labor is obstructed. I wonder though, if there is anything in that hospital that could help an obstructed labor. All we have are razor blades and string. Perhaps the herbs and gentle coaxing of a TBA would better move a labor along. Of course it sounds ‘better’, it sounds like progress from a western governmental perspective to send women to a hospital, but when the circumstances are dire, I am not convinced.

The individual stories are pieces of one larger story. We will hold our first story circle on Saturday, and then a mini ‘conference’ for the hospital midwives where we will exchange best practices. Ideas flow in and then out. At the end of the day I fall into a deep sleep and I dream of working in a clinic where legs are falling off and women carry double headed babies on their backs. This is a lot to process. I have been at a loss for words.