PRE-MATURITY

When you get pregnant, the world congratulates you. Mothers share their labor stories with you. They will mostly tell you about the pain which is always so much, words cannot describe it. They will tell you about the not so wonderful regular vaginal examinations that you will be expected to endure. They will advise you about where to go for your antenatal clinic, what to eat and what to avoid, where to buy your maternity and baby clothes, how much pain you should anticipate et cetera. Nobody will ever talk to you about going into labor pre-maturely. Nobody will talk to you about giving birth to a one kilogram child. Because it is never expected. Everybody assumes you will get pregnant, have an uneventful pregnancy, deliver at term to a bouncing baby boy or girl and everything will just be normal.

But sometimes, you will give birth pre-maturely for one reason or another. While a normal pregnancy is assumed to last for forty weeks, some women may deliver at late second trimester or early third trimester. A child born before term is usually under-weight, has immature lungs, is unable to regulate their body temperature, has fewer stores of essential vitamins and minerals and has reduced or no native reflexes. These are children whose suckling reflex is either absent or not well developed hence cannot attach on the breast. They need to be fed via a naso-gastric tube, need to nursed in a warm environment. They may need to be put on oxygen, especially during the first days of life.

Some of the reasons why a pregnant woman may go into labor prematurely include;
– Multiple pregnancy– most twin or triplet pregnancies will rarely get to term.
Mothers carrying multiples should be psychologically prepared to deliver before term
– Hypertensive disease in pregnancy– severe cases are normally induced at thirty four weeks
– Preterm rupture of membranes– followed by drainage of liquor “water”
This is mostly caused by infections
– Third trimester bleeding– may be due to placental separation or abnormal placentation. If the bleeding is massive, then delivery may be done before term.

Going into labor before term is actually a nightmare, the child comes when you are just not ready for them, both emotionally and psychologically. One minute you are pregnant and the next minute you are holding a tiny little thing on your hands who is then quickly snatched from you and rushed to a nursery. Then you literally become a prisoner, living in the hospital waiting for your child to grow to at least two kilograms. Every three hours of the day or night, you are seated before your child, who happens to be sharing an incubator meant for one with four other pre-terms who look extremely like your own.

So you live in the hospital waiting. Your child adds three grams in three weeks and loses five grams in a day. Sometimes you leave them well only to come back and find cardiac monitors sticking from an impossibly small chest, and nasal prongs inserted into the tiny nostrils, with oxygen being literally driven into those tiny lungs. But they live through such days and so do you.
When you have your child too early, the temptation to leave and quit the whole motherhood thing is strong. But then you draw strength from your pre-term child every time you see them work their muscles so hard in a bit to breath. Every time you see their eyes open and they gaze at you, you learn that the gaze is just as genuine, just as penetrating as any other and that alone is enough to push you through the rainy days!

Children born before term, if they receive good care, grow. They grow up normally, attain normal milestones and become as normal as those born at term. No, prematurity doesn’t cause intellectual disability or short stature. I have seen big men and women whose birth weights were as little as one kilogram. I know a doctor who was born pre-maturely, a university student pursuing engineering and as teacher. With pre-maturity, once you grow past the neonatal age, then you can grow on and conquer the world with your smallness!

LABOUR

I knew the time had come when I had my first contraction. Never in my life had I experienced such pain that intense. I remember calling the names of my relatives to the third generation, pacing the entire length of the sitting room, clenching and unclenching my hands, closing my eyes tightly and gritting my teeth. It passed after what seemed like an eternity. My next contraction found me in the hospital on the examination couch. I remember shouting obscenities in my mother tongue. I caught a glimpse of amusement on the face of the male nurse who was putting on gloves, ready to examine me.

He was kind enough to let the contraction pass before finally doing the vaginal examination. I was not a good patient I must confess. First off, I had climbed onto the examination table with my panties on! That didn’t sit well with my nurse who gave me a little pep talk. Apparently, there are some things you must lose when you walk into maternity and one of them is your undergarments. The second thing is shame. Yeah, once you walk into the maternity walk, you hang your ability/tendency to be ashamed on the maternity door and get in.

The vaginal examination was a little worse than your worst nightmare. Nobody had warned me that a reasonably fat gentleman would thrust two fingers inside my vagina then try stretch them and then look at my face and tell me that I am “only four centimeters dilated, and that my pelvis is adequate”. I had four more vaginal examinations before my son came out. And I remember each one of them. I remember fighting with the nurses but giving in in the end.

In between contractions, I remember counting from one to one thousand, counting the number of boxes in the ceiling board, listening to music from my phone, playing phone games and listening to other women wail and collectively curse the male gender for putting them in the family way. One woman vowed to remove her uterus. Another vowed to join the convent after having this one child. A teenager promised the gods to go back to school and chew the books like she was supposed to do. I remember one woman swearing to become a secondary virgin and remain thus till death. I on the other hand cursed my husband silently. All this time he was pacing in the hospital parking lot, dead worried about me. He sent me thousands of texts telling me the way after all it was just me he wanted and no child would ever come between us (I am not sure if this holds to date).

I had my son after what felt like hours and hours. he wasn’t easy that boy. I remember pushing and pushing, with some nurse standing at the foot of the bed urging me to keep pushing. And I pushed. Pushed all the stool from my rectum, then pushed out a three kilograms male who announced his arrival on earth with a shrill cry. Thirty minutes later, I was holding the boy on my hands, my husband was hovering around with a big chicky grin, and I couldn’t help but think to myself that it was all worth it, that I could go through all the pain if in the end I would hold a little version of me on my hand!

Free Maternity: A big fat lie

It is all quiet except for the blip blip of the anesthesia machine and the chiming of the clock. Standing on the right side of the patient cutting through skin, fat, fascia et cetera, I almost feel alone with my thoughts.

It is three thirty six hours, and the four humans in theatre four are either too lost in their own thoughts or too tired for small talk. Soon, the fifth person arrives and without respect for the silence, announces his arrival with a shrill cry. This brings a tired smile on the human lying on the operating table. He is wiped and wrapped with warm and fluffy blankets then placed under a warmer. He kicks and throws tiny pink fists punching the air, and then realizing he has been ignored, breaks into a continuous monotonous newborn cry.

Nobody tries to soothe him. I am stitching the uterus, the scrub nurse is busy massaging it, the anesthetist is trying to maintain the pressures, preventing them from falling, and the circulating nurse is on phone, calling everywhere she thinks we can get even a single bottle of oxytocin. Her pleas for oxytocin are punctuated by calls to the lab for blood. This woman walked to the hospital to have her second child. Her first child was born vaginally but this one wouldn’t just come out. Her uterus won’t contract on it own, and the last oxytocin dose was used on the previous patient hence nothing is left for her. So she is losing blood slowly but steadily, in other words dying, becoming a statistic, one among the many face-less women who die while giving birth. Her baby is about to become motherless, her husband is about to become a widower.

Women from her village or estate will have too much to talk about caesarian section. For many, it will re-affirm their strong hatred for c-section. She will be used as a warning, and so most women will prefer delivering under the watchful eyes of their mothers-in-law and traditional birth attendants. Most husbands will warn their wives against signing those theatre consent forms and we all know that maternal mortality will remain high.

Free maternity is a good campaign slogan that is currently a big fat lie; it has been a lie for the last one hundred and Fifty one days that nurses have been out of work. It was a lie for the one hundred days that doctors were on strike. It is a lie in many hospitals that make women to carry their own water to the hospital, their own cotton, their own examination gloves and their own infusion fluids, oxytocin, sometimes even cord clamps!