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Emphasis on the Right Things

​In my previous articles on the subject of childbirth from a biblical perspective, a number of readers commented that to refuse medical intervention puts both the child and mother at risk, and that I was asking people to return to the dark ages of obstetrical care. These people wrongly assumed that I found no place for obstetricians and hospital births.

Andrea G. Schwartz
  • Andrea G. Schwartz,
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In my previous articles on the subject of childbirth from a biblical perspective, a number of readers commented that to refuse medical intervention puts both the child and mother at risk, and that I was asking people to return to the dark ages of obstetrical care. These people wrongly assumed that I found no place for obstetricians and hospital births. One reader who appreciated and found much to agree with in my perspective included me as a recipient of an email describing her recent birth experience in Africa. With her permission, I am sharing her letter, but have changed names to protect privacy. You will see that there can be a happy marriage between medical assistance and needless intrusion.

Hello Ladies,
I thought I'd share with y'all about my Kenyan birth experience, since you two would be able to appreciate it most! Some friends back in the States seemed to assume I'd be giving birth in a grass hut somewhere--LOL! I'd gladly have taken a home birth with a midwife, but that's just not available here unless you live in the bush with no other alternative. However, the hospital model of care is still midwifery-based, so the experience was a wonderful, non-stressful one.
First off, I had an Italian-Kenyan OB, Dr. Angela Amato.* She trained as a midwife in Italy and as an OB somewhere else in Europe (where the midwifery model is still considered tops). She and her family have lived in Kenya for over 25 years (Dr. Amato is in her early 50s). Dr. Amato works through the birthing center at university hospital here in Nairobi, which is a modern hospital. Half of it is for university students; the other half is just a regular privately-run hospital. But WHAT a hospital! Giving birth there was like being at the Ritz-Carlton: inlaid marble floors, cut glass vases filled with floral arrangements in the hallways, uniformed waiters handing out catered meals, comfortable birthing suites built to include family members, etc. They are even in the middle of building a water birthing suite for ladies who'd prefer that option (would've loved to try that if it had been ready!).
The birthing unit is staffed with nurse-midwives, all of whom are taught to offer support for natural childbirth rather than to expect or offer interventions. Kenyan OBs are horrified at the rate of "routine" interventions like pitocin induction and episiotomies in the West, so their focus is on teaching expectant mothers to be proactive about their health through good nutrition, healthy exercise, and preparation for a natural, unmedicated birth. Because they do serve a large ex-pat community, the hospital will give epidurals if requested, but they do not schedule c-sections on request. Those are reserved for emergency situations only. Because of this, the hospital's birthing wing is fully equipped for ladies to labor comfortably, including labor balls, birthing stools, support bars for standing and squatting during labor, and lots of comforts including hot compresses, back massage on request, etc. Here are some of the things that impressed me the most:
1. The staff all treat birth as a wonderful, miraculous event that is to be celebrated. We had three Christian midwives rotate through while we were there, all of whom thought it was fabulous that we were having our tenth child and thrilled to give all the support they could. The Kenyan midwife who was there when Thea* was born practically danced around happily when the baby was ready to push out. She kept saying, "I'll be an aunty today!" Her cheerful, upbeat attitude was just amazing.
2. Catered meals during labor. "What? I am allowed to EAT?!" This is one policy in stateside hospitals that I have never understood. A woman goes into labor and is told she cannot have anything except sugary popsicles or ice chips, even if her labor goes long. By the time the baby is ready to push out, she is exhausted and has no caloric reserves to get her through that last stage. The blood sugar level has bottomed out after a brief sugar high. This makes NO sense. Whenever I've birthed in a hospital, I've always "cheated" by having family members sneak in food. I understand that the intestines need to be clear during pushing, but light eating is not going to cause problems, and an enema can always come in if it's really necessary. So Kenyan OBs encourage laboring mothers to eat nutritious meals throughout labor. They only rule out heavier meats like beef or lamb (which take longer to go through the gut) if labor has progressed far enough along to warrant that. So I had a lady come in with a menu to take my orders during labor. The food was AMAZING! I had rice with steamed veggies and Indian Jeera chicken, mushroom soup, BBQ chicken breast with mashed potatoes and salad, strawberries with whipped cream...all kinds of really yummy food. As a result, I felt "up" for the entire labor and did not tire out when I came to the end. This was a huge, huge blessing.
3. The parents' wishes are honored throughout the entire labor and delivery. I took my birth plan in, and the OB went over it with all the midwives so they would understand my wishes (darkened room with minimal noise and interruption; freedom to walk around and move to get labor going; etc.). They completely agreed and followed my plan to the letter. They didn't even flip on all the lights when it was time to push. The OB just pulled over an OTT light and shined it where needed for delivery.
4. Vaccines are totally up to parents and are not pushed by the pediatrician. Our baby doctor came right after delivery to check Thea over and give the Apgar scores, etc. He asked us what our policy was on vaccines and said he totally honored it and that it was our decision. He did urge the polio vaccine by four months, since polio still exists here, but he said the a-cellular version is available (dead virus rather than live virus). He told us to make the decision about when to vaccinate and call when we were ready. This just would not happen in the States unless you had a "vaccine-neutral" doctor, and those are increasingly rare as the federal government mandates more and more "routine" vaccinations at younger and younger ages.
5. Cost. There are no insurance-mandated pricing schemes here in Kenya. For a privately run hospital, you pay for what you get--you don't pay for what some insurance company or national health care initiative thinks should be added to the bill. As a result, the total hospital fees were under $1200 (that included two days in the labor wing and a night in the recovery room; all meals; all supplies; midwives; medicine (Tylenol for after birth); etc.). The total doctor fees (for both OB and pediatrician) were about $1300. When we had Libby* in the States, the bill came to over $9000, which we were able to negotiate down to $4000 since we didn't use half the things on the list (like the anesthesiologist). It's just way cheaper to have a baby here, and you get a lot more for the money!
Okay, so back to the birth story! I woke up at Saturday morning around 2:30 because I was having some fairly hard contractions. I pulled out a timer and started timing them around 3am. I saw that they were five minutes apart and lasting two minutes. I should know better by now than to jump the gun, but Owen's* super-fast birth always lingers in my head, so I woke Keith* up. By 3:30, he was ready to go to the hospital, convinced this was "it." So we loaded up and headed out, arriving at university hospital around 4am. Our OB arrived at the same time and got me settled into a labor/delivery room. These are beautiful rooms with a couch for family members, a huge bathtub for laboring comfort if the mother wishes it, CD player for music, but no other distractions. The midwife on duty hooked me up to the monitor for 20 minutes to check the baby's heartbeat, then did an internal check, finding that I was fully effaced but only dilated to 1cm (typical for me!). I asked for a labor ball and did some walking around until it came. The contractions had spaced out quite a bit but seemed to kick back in about an hour later. I labored on the labor ball for a couple of hours (so comfortable!), but the contractions stayed at about the same level. Walking around didn't make them come on any stronger, and I began to have suspicions that this was going to be like Libby’s birth with a long false alarm at the beginning.
Keith and I ate a delicious lunch, and I started getting really sleepy around 1pm (having been up since 2am!), so I decided to labor on my side in the bed and rest while I could. My OB came in to see how things were going and agreed it was best to sleep if that was possible. Long story short, the contractions quit while I slept for about an hour and a half. When I woke up, I realized everything had petered out, so I rang for the midwife. She was surprised that everything had stopped after such good labor early on, but I told her this had happened to me before. She called the OB, who gave me a couple of options:
1. Check out and go back home and wait until things really got moving before coming back.
2. Stay overnight at the hospital and see if labor started back up by morning.
If it didn't, she would give me a small dose of prostaglandin (placed up by the cervix) to encourage contractions. Pitocin is simply not used to induce labor here -- it is used after birth if it looks like there's a potential for hemorrhage. My OB said that "everyone" knows that pitocin-induced contractions aren't really like natural labor at all and can often stress the baby. I told her that practically no one in the States knows that except midwives! Prostaglandin is a hormone the body naturally produces, and, when applied to the cervix, can get natural labor moving right along. She says she has a 95% success rate with it. (Evening Primrose Oil is one homeopathic source of prostaglandin used by midwives in the States.)
After talking to Keith, we agreed that having to go through the entire checkout process only to check back in again once labor started was just not a great idea. I was game about staying overnight (Keith would go home and check on the kids, who were there with our friend Kent Anderson*). So that's what we did. The midwife gave me the half-dose of prostaglandin at 5:30am, and good, solid contractions kicked in by 9am. I ate another delicious lunch around 12:30, and then got on the birthing stool to labor. Contractions jumped to about four minutes apart and were nice and strong. I asked for the birthing ball around 2pm, since it was more comfortable. The contractions continued, but I had only dilated to about 4cm (still typical for me!), so I asked Keith to send out a prayer request to our church home group. I then got up and started walking to get things moving.
By 2:45, I was in serious, hard labor and had moved to the birthing bed, where I knelt, holding on to the upright back (kind of like a squatting position, only more comfortable). I called the midwife in around 3:15 to tell her I thought I was really close. She checked me, and I was now at 8cm, so she ran off to page the OB. Dr. Amato arrived ten minutes later and asked if I wanted to give birth in that position (which would have been fine). I decided I wanted to turn around and birth at a 45-degree angle like I did with Libby. She checked me when I was settled and found I was all the way dilated with a big bag of waters bulging out! She asked if I wanted her to break the water, and I agreed. As soon as my water broke, I felt the urge to push. Three pushes later, and Thea was out! She came out with a huge "splash" -- I apparently had a lot of fluid!
I was given Thea so I could hold her and start nursing, and the doctor waited for her cord to stop pulsing so she could cut it. When that was done, the pediatrician checked the baby's hands and feet for her Apgar score and said to take my time nursing; all the other checking could be done later. The two midwives on duty just grinned and grinned over the successful delivery (no tearing; no problems) and kept congratulating us on being such "rich" parents to have ten children. It was amazing! After Thea nursed one side, I gave her to the pediatrician to check for her second Apgar score and to give the Vitamin K shot. They don't do any eye drops or ointment here, which I thought was interesting, given the high STD rate. But it doesn't appear to be routine. Thea was handed straight back to me so I could nurse some more, and I delivered the placenta and got the green light to simply lie back and rest while the OB monitored me for any excessive blood loss. They did put in a hep lock IV as a precaution, since I'd need a quick transfusion if I did start to hemorrhage. Thankfully, it was never needed.
An hour later, we were taken to our recovery room and asked for our dinner order. The midwife came in to weigh and measure Thea, and we spent a restful night (peaceful baby!). Here's one last Kenyan bonus: A midwife came in at 9 pm to remove my hep lock and tell me to expect my "chocolate" at 6am before breakfast. Yes, fresh hot cocoa is considered a must for every new mother. Kenyans believe it helps "bring in the milk," so I was provided with a hot pot of chocolate at breakfast and lunch the next day! Does it get any better than that? LOL!
All in all, it was a wonderful experience, and I was home less than 24 hours after Thea’s birth (an 8-hour stay is all that is required, but since we finished up so late, I was given an overnight stay). I'm just tickled pink with the level of care and the emphasis on all the right things: nutrition, preparation for natural childbirth; etc. I'd gladly do it again! I only wish the US could "catch up" to Kenya in this area....
Love and blessings,
Joy* (Mother of 10)

*name changed