We have a secret in our culture, and it's not that birth is painful. It's that women are strong. ~Laura Stavoe Harm

It was about an hour until dark in the village, nearing 5pm. I was busy recovering from a minor GI illness, i.e. sipping Gatorade and watching The Man in the Iron Mask (really enjoyable movie by the way). I got a call on my cell phone from Joseph, the Ghanaian whom I do most of my work in the village with. He sounded most excited and happy on the phone, which has a very contagious effect on me. He said, “Madam, the TBA is planning to deliver this afternoon, you should come.” I said I’d be right there. TBA stands for Traditional Birth Attendant, also known as a traditional midwife. From Wikipedia, “Traditional midwives provide basic health care, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated.^” From my experience here in Ghana, this definition is mostly true.

I’ve told Jumbo’s TBA multiple times that I wanted to be present for any and all births she attends; it’s taken this long for her to take me seriously. I believe she thought I wouldn’t be able to handle the scene, even though she knows I was a nurse in the states. I walked over to the TBA’s house. I was told she was in the bathhouse (pictured below) and that I should go see her. I looked around the corner of the bathhouse and the pregnant mother, for being in such an uncomfortable location and position, looked calm and comfortable. She was sitting on a concrete step on the floor of the bathhouse in the clothes that God gave her. Labor must not be happening I thought to myself, this woman is in no distress at all! It was a cool evening, as a storm front had passed over, bringing no more than a few sprinkles of rain, but bringing welcome cool winds and a cooler temperature. It was even sprinkling lightly still.

The "delivery room" was the one on the right ----------------- note: concrete step

Not 10 minutes following my initial assessment of “not in labor,” she had moved to the floor of the bathhouse, shoulders resting on a light piece of fabric. Now join the reinforcements. Two women entered the bathhouse with the TBA and me; they were the knee-holder-backers. I envisioned a squatting birth, but instead it was to be a birth brought forth while in the least gravitationally assisted way (while lying on one’s back). She pushed for 2 seconds, and then relaxed. She spoke calmly something in Likpakpaln - I imagined it to be something like, “I’m tired and am just going to lie here, and I could use some water.” I couldn’t believe how quiet and calm she was! At this point, I was given a little stool. About six inches off the ground, with a base (for my bum) 6 inches by 10 inches; I shared it with another woman. Believe it or not, it was a lot more comfortable than squatting on my heels and not the most uncomfortable seat I’ve experienced in Ghana. I then realized that there were a number of additional people in this small bathhouse-turned-delivery-room. I stopped for a second to count six people total: the TBA, myself, 2 leg-holder-backers another women with a flashlight sharing my humble stool, and, of course, the pregnant mother. The midwife was not squatting, instead she was standing bent over at what seemed like a 90-degree angle, constantly “checking the baby’s progress” and preparing the way for the baby’s head. How can a woman of at least 60 or 70 years of age be bent over in that fashion for that long? I was amazed at her agility. I envisioned a less hands on labor, but though it appeared uncomfortable for the mother, she displayed no signs of suffering.

As it was now growing dark, I utilized the most amazing function on my cell phone, a light! I soon became the reliable source of light to illuminate the slow progress of the labor. As a Ghanaian would say, “the mother was not serious at all!” Her version of pushing consisted of notifying the assistants that she was going to push, pushing for a second or two, and then relaxing back saying something quietly. After long, the women began to grow tired of her lackadaisical manner. They would encourage her verbally whilst pushing, then yell at her and threaten to whip her with a long, thin stick. The bathhouse was a dual bathhouse, meaning 2 bathhouses attached to each other with a 5-foot wall separating them. At one point during the labor, a man came to bathe in the adjoined bathhouse next to us. He spewed some advice (like he’d know) and yelled at her for being lazy. Two hours into the labor, I began to worry; we had been able to see the baby’s head for over an hour, but her contractions were not intense, the woman had no drive to push well, and some of her anatomy seemed to be blocking the best route for the baby. What now? Another younger TBA came to help figure out what was taking so long. A rag soaked in alcohol (the drinking kind) was placed over the baby’s would-be entrance to the world. A long prayer was said over the pregnant mother’s belly. There was a very hushed conversation between the mother and the TBA. My concern grew. Many different women exited and entered the bathhouse. I stayed constantly with the mother; I didn’t think she should be alone.

I paused to say a prayer of my own, then listened to my surroundings. A large semi truck, likely full of yams, was slowly navigating the Jumbo hill, down-shifting loudly. Frogs were calling for their lovers in the Jumbo River. A chorus of children under the age of five were bantering in the compound attached to the bathhouse. Two dogs, also in the compound, had found something to fight over. Women were angrily shouting advice and distain at the mother. A mother goat had lost track of one of her babies, and was desperately bleating for it to come back. Men were discussing their days and their latest grievances (usually pitifully minor) as loudly as possible. Someone had a radio blaring static. Further in the distance was some hip-hop Ghanaian music playing, heavy on the bass. I was sure the baby could hear all that was going on outside its safe, dark world. Would I willingly enter such a chaotic place? I guess I did by joining Peace Corps Ghana, but did I get a 9-month sample of this soundtrack to help me make my decision? I did not.

Throughout the labor, we had many observers at the bathhouse. A dog came to see what all the fuss was about; many chickens flurried in and out; the would-be big-brother (in his birthday suit) often peeked around the corner; women from the compound and neighboring compounds came to let the mother know she was taking too much time; and men came by too, though they didn’t come close for a look but rather clicked their tongues (the best way to vocalize disapproval) when receiving the status update. There were now a total of eight women in the small “delivery room.” The baby’s head was visible still, and the woman was going to give it one last go. Thankfully, her last effort was her best, and the baby’s head emerged, and with some encouragement from the seven non-laborers present, the mother was able to push one last time to help the baby fully enter its new, noisy world.

I shouted “usaapwaan!” A girl! They all laughed and agreed. The little girl gave a healthy albeit gurgely cry and the TBA washed her mouth and nose secretions away. She was squirming vigorously, a good sign. Some thread was brought and the umbilical cord was tied in a few sections. I helped hold the slick, flailing limbs so that ties could be made well, cell phone light between my teeth. A new razor blade was brought and the cord cut (I checked it to that it had the correct 2 arteries and 1 vein). I then tried to give the slippery baby to the mother, but instead was instructed to carry it to a room in the compound. With surprising security, I carried her in one arm to the room and placed her on a soft bed made of several clothes on the cement floor. I gave instruction that the mother should eat well when she was able and that she should start breastfeeding immediately. Those present agreed that it would happen that way. I was offered drink (probably to be something heavy on the alcohol content) as it was tradition to do so after such a difficult labor, but respectfully declined. They thanked me repeatedly, and the TBA gave me an approving smile (I imagine she was thinking, “You didn’t pass out!”), I told her, “until next time,” to which she responded, “until next time.”

So ends my first first-hand-experience of a birth in Ghana. I believe it will be the first of many - at least I hope that is the case. I have not found a more important, blessed, or happy event to lose sleep over. This particular girl was born into a life of hard work and likely disregard, but she has also been given the chance to overcome adversity and change our village of Jumbo and the whole of Ghana for the better. I have certainly set my sights high for this baby girl, but without wishes, hopes, and dreams, how can one begin to envision a better world?