Despite its infant and child mortality rates, Haiti is a land of young people. And pregnant women. This hospital is trying to specialize in high risk pregnancies. Pre-eclampsia, high blood pressure and swelling in the legs, which can lead to eclampsia—seizures—is not uncommon in Haiti. Ideally, the hospital would care for women with this and other risk factors for pregnancy, including being under 16 or over 40. But this is Haiti, and nothing is ideal. If women show up in labor, they are not turned away. This makes for a very busy hospital.
We snaked our way through the line of people waiting outside the hospital—we later learned that they have to limit the number of visitors, otherwise the already crowded building would be impassable. We asked for “Mary” an American nurse John had met, who is volunteering at the hospital for the better part of a year. Her name, along with John’s scrubs and our white skin, got us instant admittance. “Today, it’s not too busy,” said Mary, a clarification that our untrained eyes needed as there were women and babies all over the place.
On the first floor, was a room full of women with tiny swaddled babies, waiting to be discharged. In another room, nurses took vital signs of women in various stages of pregnancy. Across the hall behind a large canvassed-draped opening we could hear the cries and moans of women in the early and middle stages of labor. John examined the drugs on the shelves of the small but well-stocked, for Haiti, pharmacy. Hydralazine, a blood pressure medicine safe for pregnant women and toxemia drugs, like magnesium sulfate, were neatly stacked in the room that was the size of a large pantry.
When women have normal deliveries, they and their babies stay in the hospital for a whopping four hours. If a c-section is required, they remain for 48 hours. Mary points to a stack of used cardboard boxes against a wall. “When a baby dies, that is what we put them in for their trip to the morgue.” Prior to this system, the mothers were responsible for their babies’ bodies, which led to little bodies being found in the sheets and under the beds. Infant and maternal mortality rates in Haiti are the highest in the hemisphere 680 women out of 100,000 die giving birth and 84 children of 1,000 don’t make it to their first birthday. This compares very poorly with U.S. ratios of 17 and 6, respectively.
As we were processing this information, a woman in a gown came from behind the canvas doorway, escorted by the one of the hospital workers. They walked up the stairs to the second floor. “She’s going to deliver soon,” said Mary as we followed her.
The second floor is where most of the obvious action takes place: babies being birthed. There is a small delivery room a larger room where women who are toxemic are monitored, and an operating room for cesareans and emergencies.
We walked into the delivery room, which measured about 10 feet by 8 feet. There were three young women on the three beds in the room with two young midwives attending them. “Yesterday we were so busy that a baby was born on the floor where you are standing,” said Mary.
Today, the woman in the middle bed was farthest along; you could see her baby’s head with its thick black hair at the opening of the woman’s vagina. Already the experience was upping my heart rate in sympathy with the woman and the baby. I felt like Prissy in Gone With The Wind, who says, “I don’t know nothin’ ‘bout birthin’ babies.” But despite my apprehension, I was where I wanted to be. A doctor came in with a fetal monitor to check the baby’s heart rate. This soon-to-be mom along with the woman on her right were having their first babies. None of the women had family member with them.
Mary went to the head of the woman who was close to delivering and began stroking her forehead. She would yell and moan as the contractions intensified. The women at this hospital receive no pain medicine or epidurals while they are in labor; it’s just them and their pain. Sometimes the midwife would say, “Ferme la bouche!”—Close your mouth—which seemed rather harsh to me. Later John said that perhaps the midwife wanted the mom to save that energy for pushing.
As the baby’s head continued to widen the vaginal opening with each contraction, the midwife stood over watching. At last, she began to tell the woman to push. There was no keeping the mouth shut now, and the woman cried out as she pushed. With a couple of pushes, the head was out. With another couple of pushes and some pulling and turning by the midwife, the baby’s torso was out. The umbilical cord, which looks like long, thick, gray tubing, was wrapped around the baby’s neck, but apparently not tight enough to be a problem. One more push and the baby was out along with a lot of fluid and some blood. A metal bowel had been positioned underneath the woman to catch most of these fluids.
The midwife immediately put the baby on the mom’s torso. The mom seemed so relieved that the baby was out and that most of the pain was over that she wasn’t too interested in the baby. The nice-sized baby was covered in the damp, white chalky substance, vernix caseosa, which protects the baby’s skin from the amniotic fluid. With her dark skin underneath it, the substance gave the baby a rather ghostly appearance. But after the midwife gave her a little shake, she wasn’t quiet like a ghost. She let out a very loud cry, which sounded so good. The midwife began tying off the umbilical cord near where it attached to the baby. The other end of the cord was attached to the placenta, which was still in the uterus. It would not come out until later.
The second woman’s birth was similar to the first, except that her baby’s head was bigger. The midwife made a small episiotomy so the woman wouldn’t tear. This baby was also a girl with a healthy cry.
Both times this process made me teary. There is something so primal yet so otherwordly about child birth. To see women go through such an agonizingly painful and body distorting experience gives me new respect for the strength of women’s bodies. And then to have this new, little, beautiful creature result from all the pain and blood and effort. Only God could be behind this. I could have watched babies being born all day.
Of course this is Haiti and not all the births go as swimmingly as the ones I witnessed. A young German obstetrician, who has been at the hospital seven weeks, says she has seen in Haiti fetal abnormalities that she could hardly imagine. As the hospital somewhat specializes in high risk births and has the stack of cardboard boxes attests, the medical staff see a lot of tragedy too. When I commented to John how healthy these two babies looked he said, “They are as healthy as they are going to be right now.” It’s a depressing thought.
And yet. What’s that quote: a new baby is a sign that God wants the world to go on. We have an obligation to give these babies a better world and a chance at a decent life. Seeing these babies born makes me realize that all the more.