re-framing the adoption narrative

She came to us on a Saturday night, after lying alone in a room for nearly 48 hours. We hadn’t planned for her. In fact, earlier that morning, I stood together with Jeremy in the storage shed while we debated getting rid of all the clothes our youngest had outgrown. 

We’re done, right? 

Uhhh… I think so???

…

Let’s just hang on to them a little longer, ok?

Ok. 

And an hour later, Bana K was at our door explaining what happened. 

Mom had been on the way to the clinic when baby M came. Somewhere between home and safety, she birthed, bled and died. A neighbor pulled them both into a hut and the funeral began. Baby M was wrapped in a blanket and placed in a back room. With no one to nurse her, the family prepared for not one, but two burials. 

Something in her cries that night must have pushed the family to think differently. Several of the funeral attendees knew us, and a messenger was dispatched. I arrived to find Dad, his seven other children, and the 200 or so mourners typically found at a village funeral. I was ushered into a two room house. The four-year-old on the other side of the brick wall was wailing for his mom who wasn’t coming back. The family sat with me on the dirt floor while other curious bodies crammed in, blocking what little light would have come through the door and triangle windows built into the exterior walls. Dad leaned on the wall across from me, no longer coping with the two-year-old fussing on his lap. The fifteen-year-old next to him was little help. They both looked like they'd been run over by a truck. 

The family asked me to speak, and I asked first to just listen. In turn, old women said the same thing, one after another. “We need help. We can’t manage. Please help us. Please help.” I said, “I want to help. She needs to eat. It has been too long. I can have milk here in a few hours.” 

They had already decided though what kind of help they were looking for. 

“Take her.”

“Uhhh…”

“We just can’t right now. We’re not managing with the other seven. We need you to take her.” 

There we sat, between a rock and a hard place. A shell-shocked family desperately asking for help. Me, rolling over attachment theory in my head. Above the clamor expressing this challenge and that, I blurted out, “She needs her family!” And they upped the volume a notch and yelled back, “We need YOU.” And ten minutes later, someone was shoving into my vehicle a bundle of blankets, at the center of which was a darling little girl. 

Every year when Adoption Awareness Month (November, fyi) rolls around, I get this sinking feeling in my gut as I see the internet filled with stories and pictures of happy adoptive families who would center the narrative around the beauty of adoption. And truly, adoption is beautiful. To choose to love is beauty incarnate. But, truly-truly, it is beauty from ashes. We owe it to the adoptees in our midst to acknowledge that ashes are a bi-product of something being burnt to the ground. 

There is no other way to arrive at adoption other than extreme trauma and loss. A mother dies. A family breaks. Addiction. Disfunction. Abandonment. We can’t manage - take her.

Sometimes I feel like we are so busy celebrating the redemption that we hold precious little space for the tragic. It is both lovely and awful at the same time. Like my favorite Ann says, “Joy and pain are arteries of the same heart,” and intentional orphan care means we handle both well. 

It might seem unreasonably pessimistic to even suggest re-directing the conversation towards trauma. Who doesn’t love a happy ending? What’s wrong with you, Emo Adoption Lady? 

What’s wrong with me is that I grew up in the first world and have lived my entire adult life in the third, and now as a foster and adoptive mother, I see the trajectory of orphan care from two different continental views, and I’m still unsettled. 

In America, we have focused on keeping children safe, and with family when possible, which means we major on two actions: removal and reunification. “The system” is swamped and foster parents, bless them, are doing their best. In Zambia - to our shame - we have largely focused on crisis management which has meant institutionalization. As I’ve written about before (here and here,) the funding flow out of the West fuels the glorification of orphanages and the result is thousands of children in “care” (a misnomer) while their DNA is out there. 

What has my gut twisted in knots and wrapped around my heart is that, on either continent, in any context, when I hear talk about adoption awareness, the thing that I’m NOT hearing people talk about is prevention. 

Every single adoption is the result of a brokenness which we, the community of privilege, have failed to prevent. I think about this for our own son, and for all of our adoptee friends. I cry about how scared my son’s birth mom must have been, and how someone clearly wasn’t there to support her. I think about the parents who sign papers and hand kids over because no stepped in to say, “keep your child, I’ll pay for everything.” I think about the homeless mom and the addicted one and the one with an abusive boyfriend and I feel the burden of responsibility. How many steps along the way were we not there for you? 

Baby M stayed with us for three weeks at which point, I won’t lie, we kind of wanted to keep her. There’s something about waking up every two hours at night to feed a baby and wearing her close to my heart throughout the day – I think any mother would have to be a little off to not feel the bonds of love forming. And truthfully? It would have been easy to make her ours. 

Her family already had asked for a long-term placement. We could have shown off our house and resources and promised her the world and her family would very likely have made a “smart” and terrible decision to leave her with us forever. And we would have been praised by the internet as a beautiful, adoptive family. But thankfully we have super good and reliable friends who snapped their fingers in our ears and just repeated, “She needs her family. She needs her family.” And they were absolutely right. So we set our feelings on the shelf and got serious about getting her home.

Convincing the family to receive her back was easier said than done, but we kept at it because we know it was right. We can never bring her mother back, but we can work to PREVENT the trauma of adoption. 

And work it is.

The first week baby M was home, Grandma called me several times after midnight just to say, “M is crying and won’t stop.” I never slept after those calls. On my first visit to the home to deliver more formula, I was given a list of things they needed. She wreaked of pee and I noticed that the rats had chewed through every one of her bottle nipples. We talked about burping and why babies cry and why laundry soap is too caustic for newborn skin. I taught them what a selfie was because the day deserved some levity. I drove away feeling like the band-aid had been ripped off too fast. 

Driving home, the thought rushed into my mind and I pushed it out the other side – This is a huge commitment. We are paying for everything anyway - it would be easier to just keep her with us. Thankfully the grace of conviction swelled again – prevention is worth the work. 

Unfortunately, our adoption culture celebrates the exact opposite. How many times have I seen a viral facebook post of a cute couple offering (begging) to adopt some other woman’s baby. We christen them as saints and speak nothing of birth mom’s story out on the margins. And after 6 million likes and 50,000 shares, the words “We’ll take her!” have become more admirable than, “We’ll move heaven and earth to make sure she stays with you!” And just like that, we facilitate loss instead of preventing it. 

Is it possible that the narrative of redemption in adoption has desensitized us to the flaming mess we didn’t address on the front end?  Is it possible that we aren't serious about family preservation because we don't yet believe in the primal wound we are inflicting? Do our meager efforts through pregnancy centers and WIC programs really amount to all that we can do? Are we skilled at putting out fires before they create the ashes out of which adoptees must then rise? 

I don’t think so. Not yet. We’re not nailing access to health care, marriage counseling, education, mentorship, therapy, childcare, job support. Not even close. Smart people have made these lists for us: they have curated research around what destabilizes parents and what kinds of structural and relational safeguards must be in place to support and preserve families. The stats are there: we're not doing it.

It feels like, in November, of all months, when we are supposed to be most “aware” of adoption, that prevention is the message we should be pouring over. Prevention is what we should be discussing and rallying behind and setting goals for. Because we love our adoptees more than life – this is a fact – but we need to get honest and admit that our adoptees wouldn’t have needed the "traumatic blessing" that is adoption if someone – WE – had done the hard work of prevention in the first place. 

Obviously not every person of privilege is in a position to help every mom and family in crisis – for reasons of geography if nothing else. None of us is omniscient and unknown crises are impossible prevent. Which is why I think the overarching narrative around adoption is so important – because while you may not be the neighbor to the newly pregnant woman who needs long-term support to keep her child safe and in her own home, that facebook friend of yours who thinks adoption is all rainbows and sunshine certainly is. It is our responsibility to cultivate a climate that is wise enough to know what needs to be done, and courageous enough to do it. 

For my part, I write words. I hug my son and mourn his loss with him, and celebrate the beauty of our forever family too. Together, we deliver tins of formula and become full-time cheerleaders of families preserved. We pour out, and advocate and hope. We do our best, which is all we can do. And we pray that you will too. 

when the data doesn't know your name

It’s overcast today, which seems quite representative of how everyone around here is feeling. Yesterday, a little boy died who shouldn’t have.

He was extremely ill and needed more intensive care, and the staff at the clinic knew it. They told his mom that the child should go to the hospital right away. They handed her a referral note and when mom asked how soon the ambulance would arrive they simply said: the ambulance only comes for maternity cases.

It’s a phrase I hear regularly these days as this is the new policy. One of the most reckless public health initiatives I’ve encountered in my 12 years, I don’t know who specifically wrote the new ambulance rule, but it’s maddening. Patients (who are not pregnant) needing the hospital (25km away) are expected to stand on the side of the road and pray someone picks them up, which is doable if you are sniffling or in need of a mere consultation, but absolutely insane if you are unconscious or actively dying. Family members trying to save their loved ones often rush to our home where they speak the words, “maternity only,” leaving us to decide whether to pick up the government’s shirked responsibility – or not.

Not that it changes anything, but at least we know where the policy came from - just follow the money. The vast majority of funding in the health sector right now is targeted at MCH – maternal & child health. Zambia’s statistics are more than embarrassing when it comes to birth outcomes for both mothers and newborns and the influx of money is specifically meant to change that. So long as numbers stay happy and programs are deemed successful, the money keeps flowing which creates huge incentive for health departments to push systems that please the funding source – at whatever cost.

In Zambia, MCH is the priority of today which means that if you are neither pregnant nor post-partum, you are quite literally not the priority. This narrow emphasis has meant that emergency medical services – such as ambulances – have been reserved primarily for maternity cases in an attempt to save all the women in labor… at the expense of everyone not in labor.

The father of the sick boy rushed to our house and begged for help. I explained that while we would normally take him, Jeremy was in Lusaka with the vehicle and that he needed to push the issue with the nursing staff and remind them that an emergency is an emergency – maternity or not. He shrugged his shoulders in a way that resonates with how I usually feel when talking to government workers: preemptive defeat. He turned and slowly walked back – not rushing, since there was no where to rush off to. I shrugged also, mirroring his sadness and simply murmuring in his general direction, this sucks.

Four, short hours later, the sounds of mourning grew audible and the little boy died while an ambulance somewhere sat waiting for a “priority” case to call.

Wavering between acceptance and rage, I called Jeremy and talked/screamed/wept into the phone. We invest so much into community health, give me one reason why we should keep doing so while the people who can save the lives won’t!  The steady voice on the other end reminded me that the clinic staff are just following orders from someone above them – probably from someone who doesn’t care either, but is also following orders – orders from someone who is probably not in this country and whose paperwork keeps them detached from localized pain.

Fighting for women’s health might include reserving life-saving resources for mothers in need but truthfully I don’t think the woman burying her child today feels any bit of solidarity in this fact.

The ambulance policy is just one piece of a much larger MCH package by which women and children are being victimized for the sake of better outcomes on paper. Along with the promise of an always-available ambulance, our village received a “mothers shelter” which is a waiting house for women who live far and need a place close to the clinic to stay while awaiting childbirth. The concept makes great sense. On paper. But after the NGO seconded the building to local staff, the warm and welcoming maternity “shelter” soon became a concrete and controlling maternity “jail.” All women – even those who literally live across from the clinic ­– are required to move into the shelter a minimum of a month before delivery. If a mom goes into labor without having slept in that shelter, she is issued a fine. If the fine is not paid, the child’s immunizations are withheld until she pays.

Awesome. (insert face palm) 

Women loathe the shelter because they are consistently under-fed and constantly worried about the children they have left unattended at home. Many resort to using herbs and traditional “medicines” to induce labor – the only hope of jail break.

Apparently the only way we can improve delivery outcomes is to hold mothers hostage. After all, according to clinic staff, “You know how these women are.” Actually yes, yes I do, I know quite a lot of them, and they would love a safe and competent delivery in a place where they are treated with dignity and respect. And what’s happening here is not that. I was once asked by a regional MoH official why I chose to birth my children in America instead of at our local clinic and I couldn’t find any words for him other than, “are you serious?” The disconnect is unreal.

I have two friends who delivered babies in the last month. One mom, six weeks after moving into the mothers shelter delivered a baby that only lived a few hours. Mom had torn significantly during labor but the attending nurse, wanting either to protect herself or to avoid recording the infant’s death, decided to handle the stitching on site. For three weeks, mom was refused discharge while “waiting for her swelling to go down.” Finally the family demanded referral. Transporting her home from the hospital, I asked what the OB-Gyn had said. Sitting on her left hip and staring blankly out the window she answered, “he asked who the hell did this to me.” I gripped the steering wheel a little tighter, stewing on how I’m sure my friend must be so glad to have spent two months in maternity prison only to walk away empty handed and unable to sit.

I ran into another mom-friend crying outside the shelter. Her eldest, a three year old, had fallen into a fire and been terribly burnt. With mom gone at the mothers shelter and without a consistent person to watch him, the boy had been neglected and seriously injured. I encouraged her to go home and take care of her son, reminding her that she could come back if she went into labor. Wiping tears from her eyes she explained that she couldn’t leave because she wouldn’t be able to pay the fine. Realizing she wasn’t going to take my anarchist advice and just walk out, I told her I’d look after her boy’s burn care. With every dressing change, listening to him scream for his mommy, I felt both their pain. A few weeks later, mom went into labor and this baby too did not live. She went home to her burnt child, and wept bitterly for days.

Every funeral feels like emotional deja vu and I yell into the phone at Jeremy who is missing all this while enjoying ice cream in the capital, Is this what “saving mothers” looks like? Systemic violence and denial of agency, and still, the children die? I don’t believe for a moment that the public health experts want this. I’ve seen their shiny white pick-ups arrive for data collection, occasionally accompanied by a researcher from the US, looking very “fresh-out-of-Michigan-in-the-winter-white.” Brilliant minds have rallied around the challenge that is improving maternal & child health and their skilled research is meant to drive productive change. The data says “do this,” so the money creates systems to “do this” and the people on the ground are told they’d better “do this” – but I’ve attended three baby funerals in the last month and something here seems remiss.

And maybe, today, the people who call the shots and cut the checks are staring down at papers and not people, and they are looking at numbers and not names, and they will produce P scores that say this is all ok because, “on average,” the initiatives are working. But 184 villagers will gather around another little coffin tonight, and a mother will bring her burnt child to me for a fresh bandage, and a young woman will wince as she gingerly sits on a wooden stool, and none of them have the luxury of knowing where their stories fall on the scatter-graph. 

I don’t believe that the researchers who are driven by faceless data and impersonal  indicators are evil or that they hate women, but I don’t think they hear the stories that matter either. “Data,” as compared to living, breathing humans are two different sources of information and the unspoken confession of the NGO world is that data is just less messy to handle.

Sometimes, I’m frustrated by our search for funding to make our work go farther and deeper only to hear, “you’re too small.” Really? And by too small you mean too intentional? Too compassionate? Too relational? I get your math and what you mean by “efficient,” but my moral compass won’t lead me down that path. The individuals matter. The Big Numbers will win the Big Grants, but neither will feel the weight of grief resting on this village today. A small body will be lowered into the ground and the data capturers of Big Aid will take no responsibility because they didn’t even know his name.

Raphael.

His name was Raphael.

Leonie Michaela's birth story

I’m sitting happily on the couch with the gentle doobie doobie doo of the bouncer seat singing next to me, occasionally glancing down at a tiny, chubby, perfect, little body, and my heart swells.

Leonie (lee-OH-nee) Michaela (mi-KAY-luh) Colvin joined us on the outside Sunday, May 24^th at 5:55 am. This is her story.

The story begins quite a bit before Leonie’s actual birth. On Wednesday May 13^th, I had woken for my standard 2:30 am pee and noticed quite a bit of bleeding. I wasn’t sure whether this was in the realm of normal, but decided to go back to bed anyway. As I got myself situated again, I felt a small gush and my eyes opened wide. Ummm. Did my water just break? My frantic google search about third trimester bleeding and water breaking did nothing but confuse and agitate me so I went ahead and woke Jeremy and we decided to call on it. Given my description of quantities and colors and all such things, the midwife didn’t seem to be too concerned but told me to call again in the morning. Jeremy and I caught a few more winks and called later in the morning at which point we talked to a different midwife who did want to check things out, so we made arrangements with a friend to go in with me to the hospital so Jeremy could stay with Bronwyn.

The hospital visit confirmed that my water was still in tact, which I was thankful for, but it also revealed that I was 4 cm dilated! Really? A free 4 cm? Didn’t I almost die getting that far with Bronwyn? Merry Christmas to me! The midwife snapped off her gloves, squeezed my knee and said, we’ll see you back here this weekend.

Well hallelujah.

We canceled our plans to travel to Boston for a wedding and to visit friends. Sad, but realistic considering our circumstances – and we commenced the waiting.

Oh the waiting.

Dear practitioners of obstetrics, gynecology and midwifery. Feel free to never tell a woman that she will deliver “that weekend” for if you do, she will most certainly NOT deliver “that weekend.”

The weekend came and went. We had missed the wedding, were still pregnant and I officially entered the land of the screw its. I lost all willpower to be functionally productive and pacified my annoyingly fidgety mind with ice-cream and back to back episodes of Fixer Upper. I overanalyzed every Braxton Hicks contraction and fought with my rational side about relinquishing control.

Through much prayer, by the following weekend, I had begun to accept that I might be 4 cm for the rest of eternity and repented of my impatience in the matter. I started reading more scripture about fearing not and started singing Bronwyn’s songs about trusting and obeying and peace like a river.

trying to relish those last few days

I spent a lot of time processing the roots of my unrest. It wasn’t that I was “done” being pregnant. And it wasn’t that I “couldn’t wait” to meet my baby girl. I finally realized that all the emotions were wrapped up in the anticipation that I was about to be hit by a mac truck – and I was growing weary of bracing myself for the blow. Bronwyn’s birth had taken me to my limits – utilizing every last bit of energy, resolve and faith to bring her into the world. I was afraid that I would be asked to do that again, and that I wouldn’t be able to… or, more likely, that I really, really wouldn’t want to.  

More reading, more praying, more singing, and finally, Sunday morning, May 24^th rolled around. I woke for my 2:30 pee (of course,) waddling to the bathroom – tired, achy and without expectation. As I sat, I noticed I felt more achy than usual. The dull cramps that had hurt-but-not-hurt, and that had gotten me to 4 cm without any further action seemed to be a notch stronger than what I was used to. I didn’t come back to bed right away and so Jeremy popped in to check on me.

I told him that I didn’t feel right, that these contractions were starting at the back, wrapping around to the front and were of a different beast all together. We waited a few minutes and I knew – THE REAL DEAL.

Show time, go time, brace yourself for the mac-truck-blow time. Dear Lord, be merciful, I asked. There was no point in trying to sleep. I started vomiting. (This is what my body does, bless it.) Mom woke up and checked on us too and we all got into our groove. My job was to focus while the other two tiptoed around the house taking turns getting things together, holding my barf bucket and pushing the “start” button on the contraction timer app.

I had resolved to not pay attention to clocks or timers but to let my body do its thing at its pace. I tried laboring on the bed, hated it, and after a while found my sweet spot in the glider. Jeremy coached me famously, transferring encouragement without smothering me and I felt steady enough in the contraction rhythm to focus entirely on the mental game. Instead of fighting the pain and asking for it to stop, I gave thanks and prayed into it. I could feel the baby moving and talked to her about sliding down and coming out. During a few particularly powerful contractions, I felt the actual stretch of dilation and tried to stay composed and breathe into it instead of against it. The words “holy crap” may have escaped my lips a few times. But unlike my first labor experience, this time around, I welcomed it. I had finally learned that labor is not something that happens to you, its something that you do, and I was ready to do it right.

I didn't deviate from THIS for pretty much the entire labor

I could tell after two hours of this that mom was getting pretty anxious. She sensed I was progressing quickly and communicated her thoughts to Jeremy who I heard say something about the hospital and 5 am. I had no idea what time it was and I loved that. I felt that I should pee and decided to make the epic journey to the bathroom in between contractions that were now coming 2-3 minutes apart. Good Lord why is the bathroom always a mile away. I hurried down the hall, sat, a contraction started, I relaxed all the muscles and GUSH – my water broke. Jeremy wasted no time, calling the midwife and letting her know we were coming NOW as we both knew that things were about to get crazy.

At 5:05 am we got out of the house and into the car and commenced the worst possible 15 minute car ride of all time. The pain of transition and the pot holes of Ithaca are not compatible and I commanded Jeremy with my “I am literally  dying, therefore do what I say or I guarantee you’ll die too” voice to go faster, slow down, not touch the break, break quickly, run the red light, wait at the green light and for the love of God just get me there. Only twice did he disobey and he now reminds me that twice I told him I hated him. Sorry bud. You did good.

My calm, serene, inward focus had completely died and gone to wherever they bury placentas and I was border line in panic mode over the fact that I was feeling pressure reaaaaaallly low and was not convinced that this child was going to hang out with me much longer. We pulled up to the front door of the maternity wing and Jeremy opened the door and I just sat there. I felt like I was having one never ending contraction and there was no good time to move any part of my lower half. “Let’s get it over with” was Jeremy’s sage advice and I threw myself out of the car and into the wheel chair. During pregnancy, I had had visions of walking into the hospital during this labor, taking my time and stopping only when I needed to breathe through a contraction.

Yeah no. The serenity ship set sail somewhere between Hudson and Buffalo street and I needed to either poo my pants or deliver a child post haste. As the sliding doors parted, Jeremy pushed me over the initial bump and we hellishly made it across the snow catching rumble strips because the hospital clearly has no compassion for women in late stages of labor. We rolled up to the maternity ward, got ourselves buzzed in, went to the front desk and listened to the spiel about ID and insurance while I huffed and puffed maniacally. Jeremy had just brought me, letting mom park and schlep the bags which meant we had none of the things this woman wanted from us but thankfully a L&D nurse rescued me and took me to a room. They parked the chair, I winced as I stood, the angels in scrubs stripped me and I hurled myself onto the bed announcing that I needed to push NOW.

Kate, the midwife who had delivered Bronwyn as well, donned her gown and didn’t even bother to check me. She knew. I have a very readable face and it was saying all that needed to be said. For the next few minutes, my body took over. It felt good to give up and in and bleat out a long stream of honest pain sounds until I felt the ring of fire and knew that it would be minutes, not hours. I said little, announcing an understated "ouch" and requesting that Kate not cut me. I felt with my hand her slimy little head and in disbelief found the courage to push the rest of the way. Sweet relief when her head came out, I was anxious to finish the rest of her body but suddenly I was hearing “stop, stop pushing” and I heard the words “nuchal chord.” I wasn’t at a good enough angle to see what was going on at the time but I know now that the cord was around her neck twice and Kate couldn’t slip it off without cutting it first. Clamp, clamp, cut, ok you can keep pushing and with one more burst of force, I pushed her shoulders and body out and with a sigh of relief welcomed my slippery baby onto my chest.

I spoke words of congratulations to her only briefly until the nurses picked her up and took her. She had not cried and the seconds were passing and no noise was coming out of her yet. Come on baby, cry for mommy, I said to her across the room. Come on baby, let me hear you. I pleaded with her, and a solid minute passed during which time I heard several others plead with her as well. We all sighed and said thank you, when finally she let out that precious cry and we could return to our celebration of new life.

Our family snuggled, euphoric and somewhat in disbelief over what had just happened. It was over. Three and a half hours from its beginning, the mac truck had committed its hit and run, but I didn’t feel like it had run me over, backed up to hit me again running me over repeatedly like it had the first time around. 

I actually said to Jeremy, “I’m not sure I earned my push present.” He laughed at me and reminded me that even though I knew it could have been worse, that does not discount that any and all childbirth requires superhuman strength, and so yes, I could still consider this one an accomplishment.

I would spend the next 48 hours staring at my little miracle and thanking God for both her life and her merciful arrival.

my first born suddenly looks like a giant to me.

As we are settling into our new normal as a family of four, we are excited for the next chapter in this wonderful story. Thank you for joining us Leonie Michaela!

the culture of motherhood: the other side of the birth story

The first birth I ever attended was back in 2008 in the middle of the night during the cold season. At the time I was living right next to the clinic and I had been recruited to come and hold a lantern so that the other women could see what was going on.

view of the clinic from my old house in fimpulu

The nurse on duty had told the women that his head hurt and not to bother him, so they were officially in charge of the delivery of this child. I stood at the foot of the bed holding the light source, shivering a bit, wondering how long it actually took to birth a baby. Off and on the other women made small talk, asking me if white women had vaginas and how many children I was planning on having. The light in the room grew dimmer and dimmer as the night wore on, the soot from the paraffin lamp clouding up the glass votive. Just when we were all starting to squint at one another, the woman on the table began to squirm. The other women in the room jumped into action, yelling at her to push until out popped a baby – squirt- plop-splash – into a pile of blood and amniotic fluid. I was immediately queasy. I could have sworn that that woman just ripped in half and was now bleeding to death. The baby that had just fallen out on to the table was picked up, wrapped up and laid on the bed without its gender being announced. No one counted fingers and toes. No one said anything, really. The aunties began wiping up the bare-metal birthing table, the mother got dressed and everyone proceeded to walk home, in the dark, at 2am, with the newborn. I went home slightly shell-shocked, wondering if all women gave birth in cold, dark and scarily stoic rooms. My ponderings after that first birth was what prompted me to keep learning. Difficult as it has been at times, I’m grateful for everything I’ve been fortunate enough to witness – the good, the bad and the ugly.

morning after bana kalobw's son lucky was born

In my last post about birth preparedness, I wrote about some of the good, indeed the GREAT(!) aspects of the birth culture in rural Zambia. But even as I was wrapping up that post, I already knew that there was more to the story. There is much beauty in the birth culture here – a quiet trust and acceptance, a support system bar none and the strength of a pride of she-lions. But there are specific realities running parallel to all of these truths that are less attractive, and often down right dangerous. They are things that keep Zambia’s maternal death rate and infant mortality amongst the highest in the world. The joy of peaceful childbirth can quickly turn into life-threatening terror here – something which the first world also needs to hear. 

helping babies breathe flow chart on clinic wall

Most women are painfully ignorant regarding their own physiology. Asking me whether I had a vagina was only one indication that most ladies don’t know what all is stuffed inside their midsection. The Bemba vocabulary doesn’t lend itself to specifics either. While there are technical words for most of the individual organs and parts, “mu mala” or “the stomach” is the catch all for anything in that region. Asking women to identify pain is a challenge as “mu mala” is always the answer. Whether that’s a nauseous stomach pain, abdominal cramp, lower back-ache or a deep contraction – its all “ndekalipa mu mala” – my stomach hurts. Likewise, when discussing contractions, there are no words for that either. Women in labor do not articulate between the contraction pain and general pain. The vagueness of pain identification means that there is no attempt to alleviate it. The clinic nurses refuse to let women change positions while in active labor for fear that she might sit on the baby. It is common for women to be commanded to “push until you die!” whether or not she is having a pushing contracting, and this even before dilation is complete. The forceful pushing often results in first, second and third degree tears, which are sutured up with ZERO anesthetic. The midwives I’ve talked to about this don’t seem bothered by not knowing when contractions are coming or how often or how intense. Most birth attendants do not know how to determine dilation or effacement either. Their job is mostly to command the woman to lie down flat on her back and stay there until the baby crowns at which point someone will rush to get a nurse who cuts the cord.

visiting nurse Becky helped bana Judy know when to stop pushing

 For all their strength and perseverance, the women aught to be commended. And yet I’m waiting for one mama to finally scream out, “It doesn’t have to be this brutal!” But that’s the problem with not knowing what you don’t know. Women don’t complain because they don’t know when they should or that they should. The mothers, traditional midwives and even most of the clinic staff have an attitude of “This is birth. Birth is suffering. It is what it is.”

spartan birth beds

Our local clinic was built in the late 1990’s. Before then, all babies were delivered at home, unassisted. The government has been pushing women to come to the clinic, hoping that that fewer home births would mean fewer maternal deaths. My recent conversation with the Chief Nursing Coordinator at Mansa’s District Health Office revealed that while there has been a dramatic increase in the number of births happening at the clinic, the maternal death rate has not decreased AT ALL. Statistics report that only 53% of all women deliver in a facility attended by a skilled worker. Given that most of the “skilled workers” that we’ve seen “attend births” only pop in to cut a cord after the baby is born, I’d argue that 53% is probably an inflated figure as is.

First labor ward in Fimpulu

 Our clinic has commented that at least a woman coming to birth at the health facility can be rushed to the hospital in case of emergency. However, the ambulance is almost always dispatched elsewhere, outside of coverage area, sitting in Mansa out of fuel, or waiting for the driver to finish lunch. Calling Jeremy and Bethany is the second best option and we have rushed dozens of women to the hospital in the wee hours of the night. Through these emergency hospital runs we have learned that many women stay at home for long periods of time with fevers, bleeding or other danger signs before asking someone to take them to the clinic.

poster in the maternity ward

We’ve distributed our phone numbers and made it known that we are available to help pregnant women in any way we can. During the last full moon, we were called eight times to come and rescue a laboring mother. Most of the calls we get are from women who don’t want to sit on the back of a bicycle for 30 minutes to an hour, bumping along through the bush, all while contracting every three minutes for a minute at a time. I don’t blame them.

bana mwandwe moved in with her sister a month
before she was due so that she wouldn't have
to make the 20 kilometer trek from her
house to the clinic

I don’t like to be a Debbie downer, and to an extent, its quite easy to romanticize bush living. Furthermore, focusing on the positive is often a coping mechanism to avoid becoming irritable, frustrated and (cringe) cynical. The truth is that as much as I admire these women, I don’t envy the entirety of their birth experiences. When I was talking to that same Nursing Coordinator at the District, he asked me, “So why didn’t you give birth to Winnie in Fimpulu?” I answered him diplomatically about missing my mommy and wanting to let the grandparents spend time with the baby. But I was thinking in my head, “You’re kidding, right? You’re asking me this after lamenting the District’s poor record of keeping women alive?”

poster hanging next to the labor beds

 We’ve known several women who didn’t know they were expecting twins until a second baby came out. It’s normal to hear of babies who were breach without anyone realizing it until a single foot appeared. We’ve seen prolapsed cords and extreme hemorrhaging responded to with a casual “oopsie daisy, maybe she needs a hospital.” We’ve watched as nurses yell in the faces of babies who are born but never cry and seen nurses actually dunk the baby’s head in a bucket of water to stimulate a cry reflex. Such neglect of women and children is considered a breach of human rights in much of the first world, and yet, my neighbor ladies labor on. In Zambia, 591 maternal deaths occur per 100,000 live births. Compare that with the United States where approximately 9 women die for every 100,000 live births – a statistic that ACOG and others still feel is unacceptably high. Can we just let the disparity sink in a little? 591 vs. 9… Ouch.

every life is precious.

I had my reasons for going back to the states to have Bronwyn. I had my reasons for choosing to deliver in a hospital setting. I had my reasons for pursuing a natural child birth. I had my reasons for posting pictures of my Zambian mama heroes on the wall at the foot of the bed, right next to the labor map and 6 needs of a laboring woman. The biggest factor that separates my story from the story of every woman in Fimpulu, is that I had the chance to make an informed decision about all of these things. While my heart longs to praise these women from the rooftops for what they go through to give their children life, my heart also weeps for them in their unknowing and therefore defenseless state.

our wall of inspiration. yes, it helped.

And so I tell their story, so that you too may know; that you may have the opportunity to pray for them, advocate for them where you can, and recalibrate your senses for the for the next time you hear the word birth.

Thanks for reading.

ps, HAVE YOU JOINED THE PARTY YET?