Two Babies: A Congo Birth Story

Mupwa has two babies now.

Remember Mupwa?

His two little girls were born on Monday:  Miriam and Katherine.

They look exactly alike, except that Katherine has a small mark on her left cheek.  I told Mupwa he was lucky - some parents of identical twins resort to toenail polish and color coded clothing.  For months, Mupwa believed he was going to have two boys.  He has known their names for months.  Three ultrasounds declared each time that his wife was growing " Les Deux Garçons."   So, when two tiny girls appeared, it was a shock.

The thing is, right now, those little babies are at one hospital while their mother is stuck in another.

Though their birth month was to have been March, these babies are so tiny.  Just under 2 kilograms, or 4ish pounds, each.  They needed special care and were immediately taken to a fancy downtown hospital, where a neonatologist practices.  Their mama is still sitting in the hospital where she gave birth, somewhat of a hostage. They simply won't let her leave until Mupwa coughs up $300.

That's a lot of money for a jardinier and this situation is very common at cash-strapped clinics and hospitals in developing countries. (Read about Loretta's story here.)

Loretta.  From PRI's The World.

Sometimes, they let the mom go, but keep the baby until the bill is paid.  True story.

This afternoon, Mupwa's head was covered in flour.  He explained - a bit sheepishly - that Mama Vida, Mamitscho, and Mama YouYou threw flour on him to celebrate the babies being born.  They are happy for him - two babies!

He said he wished he felt like celebrating.

However, the reality of crushing hospital bills, the confusion of a makeshift NICU, and knowing a little bit what it takes to raise two babies on a gardener's salary in Kinshasa sours the excitement.  As we talked in the afternoon sun, and I saw sweat caking the flour on his brow.

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Mama Congo Turns One!

Mama Congo is One Year Old Today!

To celebrate, here's a walk down memory lane.

Sarah's Top 5: 

#1.  The day Mama Congo launched, I was juggling a bunch of teenagers in Kenya and trying to keep myself from leaking. And thus, my first post: Milk Share: UN Style.

#2.  I really love the image Jill describes here when she found Mama Vida and Mama YouYou raiding the star fruit tree. Role Mamas, indeed. You will never catch me up a tree, which is why I employ someone braver than I.

#3.  Ah yes. Remember that extended breastfeeding debate? It's fun to look back on this post and remember a time when nursing Ani was Mama approved. These days Mama YouYou shakes her head at Ani when she whines to nurse and says, "Tu n'as pas pas honte?!" or "Have you no shame?!" By Congolese standards she's now too old. And really, by this age she should be helping to fetch water and carrying small things on her head.

#4.  I really think these posts by Jill need to go viral. Since baby wearing is all the rage, why not follow this DIY and use just one simple piece of fabric. And, of course, I love the baby model. The photos are so great, one even made our Christmas card. Wear Your Baby: Part 1 and Part Deux: The Front Sling.

#5.  With over 1,000 views, this might be our most viewed and searched-for post. I'm re-posting it here in hopes that Woodward's will see it again and become an official Mama Congo sponsor. (Hey, they commented, which pretty much made our week.) Gripe Water or How We've Kept our Sanity.

Jill's Top 5:

#1.  Here's my first post.  Five months into our Congo tenure, I was still grappling with the fact that being "mama" wasn't so unique anymore.



#2.  Sarah's simple story of some bridesmaid dresses received a primetime-worthy twist when the Congolese military got involved:

#3.  This post got a lot of attention - and rightfully so.  It was the beginning of Mama Congo's adventures in Congolese childbirth:




#4.  I remember laughing until I cried while adding photos to Sarah's Whac-A-Mole post.  Best line ever:

That was some expert parenting you just witnessed. Did you see those moves about 7 hours in when these kids were seconds away from simultaneous meltdowns and we balanced 4 meal trays, 2 babies and 5 petit sachets of French cheese on our laps?"

#5.  And, for my last pick, I'm having a really hard time deciding between two radically different posts: Nude Pumps or How to Be Devastated.  I'm going to go with the depressing one, though.  Working on that piece felt like therapy and evolved into one of the best little essays I've ever written.  I'm wondering if I can somehow use it for grad school applications...  

So.  Happy Day, Mama Congo!  Hip Hip Hooray!

Long live the Pink Arrow.

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Meeting Madeleine at 10 Centimeters

Last weekend we celebrated the first birthday of Menorah.

Madeleine & Menorah

And the 1st Anniversary of a wild adventure for Jill and Sarah. About a year ago I asked my French tutor Tchic if I, along the new girl in town (who also happened to be our favorite labor and delivery nurse) could come to the birth of his daughter.

Tchic & Menorah

 That's not a weird request, right? For whatever reason, Tchic was game.

So on the day Tchic's wife Madeleine went into labor, he gave us a call. Moments later Jill and I were bumping down narrow dirt roads, rolling down the window for every stranger to ask directions to the tiny clinic. We finally found CELPA, which was not more than a cinder block building and Tchic waiting for us outside.

As Jill and I sat waiting for permission to go in, I thought of an old study I read that said anyone could gain access to top secret locations by acting confident and carrying a clip board. I demanded Jill put her stethoscope around her neck. "Just do it! Act confident. They'll let us in." And sure enough, even though regulations prohibit the father of the baby from entering the delivery room, two white girls who had never met the mother were ushered back like royalty.

We first met Madeleine at 10 centimeters pushing her  heart out on a rusty table half her width. The room had to have been about 95 degrees. Everyone was dripping sweat all over each other. Mind you, I was fresh from having Annais so I brought what I thought any woman would want during labor. A fan and a cooler full of ice packs.

Jill got to work doing her thing and I tried my darndest to keep that woman cool. I remember thinking I wish I knew the words for "freezer burn" in French so I could confirm with Madeleine that I wasn't freezer-burning her temples. In retrospect I think that was the least of her worries.

It turned out Menorah was a big baby weighing over 9lbs, and it wasn't a pleasant labor. At one point a nurse was up on the table practically jumping on Madeleine's uterus to get her out. I was so disturbed I swear I started having sympathy contractions.

Nonetheless Jill and I kept shouting our best French labor coaching phrases. The nurses and doctor thought we were truly ridiculous. By the expressions on their faces, I'm quite certain they thought the ice packs and cheerleading were the strangest things they'd ever seen. It was clear they were not there for emotional support.

Finally Menorah was born and took her first giant breath after Jill sucked her nose out with the same bulb syringe I brought from Ani's birth at Martha Jefferson. Babies forever bonded by bulb syringe.

Afterward we escorted ourselves out, kind of wondering what on earth had just happened. And imagined Madeleine (who we were not convinced even knew who we were) being totally confused too. Who were those crazy white girls? They just appeared and disappeared!

A few days later Tchic confirmed Madeleine was truly grateful for the support and was not suffering from freezer burn. Menorah is a healthy, happy girl who I hope has no memory of the broken "French" cheers shouted at her mother during her birth.

Note from Jill: Wondering why she's named "Menorah?"  According to Tchic, it's to signify light after the seven years of "darkness" (a.k.a. no babies) between his older son, Ariel, and new addition, Menorah.  And no, Tchic's not Jewish.  

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Just 3 Mamas with an Idea

On Saturday Jill and I met with our dear friend Laure. You remember her, the obstetrician at the Promesse de Dieu clinic out in the countryside. We've started working with her to draw-up the plans for a maternal education project with her patients. She's going to write a proposal to these guys and hope to secure some funding. We're going to help. Jill's got the nursing expertise. I've got a master's degree that says I know how to plan projects. And Laure's pretty much the strongest, smartest person we know.

 Saturday afternoon found Laure 9 months pregnant with her 6th child. Her husband has just started chemotherapy for a cancer that may take his life. Still, she was insistent we meet and discuss. We sat on Jill's back porch and threw around ideas for a maternal education program similar to the model of group prenatal care. You can read more about it here and here.

Laure loves it. She wants to spend more time educating her patients. She wants safe deliveries and healthy babies. Seems simple enough, but when you don't have much, it's a daunting task.

We also launched a mini-project and handed over some medical donations, thanks to you, dear readers who were inspired by Laure's work and our previous posts. Promesse de Dieu will be stocked with basic supplies to keep babies and mamas a little bit healthier this year.

P.S. If you have an idea or are interested in supporting our little project somehow. Get in touch with us!  We especially welcome know-how regarding group prenatal care and Centering Pregnancy for socially high-risk populations...(expert friends, we know you're out there!)

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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." 

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