Worst Place in the World to be a Mother?

All year, we watched Mama Sada grow.

Or, to clarify, for nine months, we watched Mama Sada's belly grow.

"When is your baby coming?!" was the frequent question from the kids.  The adults whispered predictably, "That baby hasn't come yet?"  It seemed, as it always does at 40+ weeks, that Mama Sada had been pregnant forever.  She certainly felt like it.

Her baby had a mind of his own.  Firmly bum-first, then sideways, never simple. 

Sometime around her due date, I was called to come check her out.  The doctor had told her that the baby was transverse (sideways) and now she was having contractions and didn't know what to do.  I saw her and agreed that the baby's head was under her left rib, lounging cross-ways in a position that would make labor and delivery very difficult.  At this late date and with a uterus contracting wildly, it was doubtful that the baby was planning an easy exit.

Mama Sada works at Maggie's (another teacher) house, taking care of her little guy, Itamar.  Maggie was prepared to do anything necessary to help Mama Sada and her baby have a safe birth experience. Costs and transportation were covered.  We made a plan that Mama Sada should go back to the very reputable hospital where she had been receiving regular prenatal care and ask for a cesarean section.  (Previous attempts to turn her baby had been unsuccessful.)  


Maggie and I both asked Mama Sada if she wanted us to go along with her.  Her partner is not in the picture and she was going on this 'adventure' all by herself.  Between contractions, she laughed at our silly idea and kindly explained that our mundele presence would probably just make the hospital jack up the price.  We loaded her up in a car with a driver and wished her well, making her promise to call if she needed anything.

From this point on, Maggie gave me updates on the situation...which went on, and on, and on.  Instead of "We have a baby!," the next message I received was to say that the hospital had sent Mama Sada away, telling her to come back when she was "really in labor" and "then, we will do the cesarean section."  The baby was confirmed by ultrasound to be transverse.  Another attempt to turn the baby was unsuccessful.

Mama Sada spent the next 24 hours using various methods of public and private transport, hospital-hopping around Kinshasa, trying to find a doctor who would deliver her baby safely and soon.  Take a second to picture it:  a hugely pregnant woman, in early labor, hauling herself around Kinshasa in a series of crowded, ramshackle buses, desperately trying to buy herself and her baby a safe delivery.

The strange thing about Mama Sada's story is that she had been provided with the one thing that everyone says is the reason for poor maternity care in Kinshasa:  money.   From a recently published response to Save the Children's report: "The State of the World's Mothers" where Kinshasa is listed among the 10 worst places to be a mother:

In several interviews with medical workers in Kinshasa, they all cited poverty as the main trigger of maternal deaths. Three quarters of Congolese women who did not give birth in a health facility cited lack of funds to pay for services as the reason, according to a World Bank survey.
"In some places, when you arrive [for care] and you don't have money, they just transfer you and transfer you. That is part of the reason we have such a high rate of maternal mortality in our country," says Dr. Blandine Aveledi, reproductive health manager for the New York-based International Rescue Committee (IRC) in Kinshasa. "The greatest problem is access to finances."

Mama Sada was "transferred and transferred" even though she had money to pay for the operation she desired.   I was shocked by this.  I assumed that the one thing about an incredibly disorganized and broken health system is that money can buy you what you need, no questions asked.  Not so.

Eventually, a hospital did accept Mama Sada.  She was taken for a cesarean section, and in Maggie's words, "Even her C-section was brutal. They sliced her open right across the belly-button."  Baby Vainqueur (a.k.a. "Winner") was born, healthy, huge, and sideways on April 20th.

A typical hospital stay after a c-section in Kinshasa is five days.  And for this lengthy stay, even an well-run establishment doesn't offer free diaper bags, hospital-issue baby t-shirts, diapers, soap, or sanitary pads as many of us have experienced in American, South African, or European "labor & delivery suites".  Mama Sada was not even given pain medication, food, or hot water.  

L: Dr. Laure's clinic, Kinshasa, DRC  R: St. Francis Hospital, South Carolina, USA

 On her first visit, bags filled with baby supplies and food, Maggie found Mama Sada in so much discomfort, she could not care for her baby.  The hospital staff  was unhelpful and repeatedly asked why Maggie and not Mama Sada's "family" was caring for her.  Mama Sada's biological family is in Goma.  Her Kinshasa family is her eight year old son, Emmanuel, new baby Vainqueur, and those with whom she lives and works. 

I saw an article about desperate Greek maternity hospitals recently.  Apparently, the new revenue strategy for these institutions is that if the mother can't pay, the hospital keeps her baby until she can.  Shocking, right?  

That idea is old-school in Kinshasa.  Hospitals have been holding babies hostage in exchange for payment for a long time.  Maggie and Mama Sada both report that this hospital threatened to keep baby Vainqueur multiple times until they received payment - and payment well in excess of the "regular" fees.  In the end, it cost over $1000 for the hospital to release Mama Sada.  A "regular" patient price for a cesarean section in Kinshasa is around $250 - which is still a good month's salary.

Mama Sada brought Vainqueur to see me yesterday.  He's strong and bright-eyed at 5 weeks old.  Mama Sada is lively as ever, clucking concernedly over her baby.  We talked about all the normal, lovely things he is doing.  We marveled at his head control, discussed his bowels, and complimented his full head of hair.  I asked how he was nursing and we talked about the wonders of breastmilk.

But Mama Sada shudders when talking about the hospital.  And this is a shudder far beyond the painful memories of childbirth.  This is the memory of childbirth in Kinshasa.  "Oh, mama, it's terrible.  But it's over now. And look what I got."