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This woman’s work

by
22 December 2016

For many women, giving birth is no better than it would have been in first-century Palestine, says Jemima Thackray

Daisy Onkoba

Support: Jane Rica rests in a manyatta with her “mother companion”

Support: Jane Rica rests in a manyatta with her “mother companion”

And while they were there, the time came for her to give birth. And she gave birth to her firstborn son. Luke 2.6-7

 

A YOUNG woman travels many miles under a hot sun, her stomach heavy with her first child. She has dreamed about who he will be — it is this promise, a deep mystery soon to be revealed, that keeps her going through the heat and dust.

When her time comes, the shock of the pain interrupts her reverie. Through tunnel vision, she stares down this next leg of the journey, and no longer smells the hay or feels the dirt floor under her fingers.

This is Jane Rica, of Isiolo County, Kenya, full of expectation as she enters the early stages of la­­bour with her first child. She has travelled many miles from her vil­lage to the Ariemet health centre. She has been told that she can spend the first part of her labour in a manyatta, a traditional hut made out of mud and straw which has been built by local vo­­lunteers and funded by Christian Aid and its partner, Anglican Development Services, of Mount Kenya East.

The small birth clinic can accom­modate only a couple of women at once; so the hope is that these new manyattas will encourage more pregnant women to make the jour­ney in plenty of time, as they will have somewhere to rest beforehand. In the final stages of labour, Jane is moved to the delivery room, and her baby is born under the care of trained health workers.

 

IN THE previous months, Jane has also at­­tended monthly meetings of a mother-to-mother support group, where she learnt about the import­ance of regular antenatal check-ups, pregnancy danger signs, and how to take early action if she becomes aware of a prob­lem.

“I was so happy to be educated on how to stay safe as a pregnant woman, and how to deliver a health­ier child,” she says. “And I thank the community health volunteers who constructed this manyatta, because it would have been difficult for me to get here once I went into labour.”

This is a truth that Susan Nan­yore learnt from bitter experience. She lost her first child, and almost her own life, too, owing to heavy bleeding while giving birth at home. “I lived 15 kilometres away from a health facility,” she explained. “Here, we don’t have any means of transport, and we live with wild ani­mals, which is a threat to our lives since we have to walk long distances to get access to the health facility. I therefore opted to give birth at home, which I regret to this day.”

 

THE Gospel accounts offer little detail about Jesus’s birth, only that Mary laid the child “in a manger” when it was all over. Even Luke the physician does not seem to have asked these indelicate questions when preparing his account. But we can assume that the condi­tions were basic, if not squalid — a place where animals were usually kept. Perhaps there was a bucket of cold water, some rags, and a local woman with an unsterile blade — or strong teeth — to sever the cord.

This is still the “birth story” of many women around the world, 2000 years later, although, according to the World Health Organization (WHO), 830 women a day do not live to tell it. In 2015, approximately 303,000 women died during and following pregnancy and childbirth, the result of prob­lems such as severe bleeding, infections, high blood pressure in pregnancy (pre-eclampsia and eclampsia), and complications during delivery. Ninety-nine per cent of these mater­nal deaths occurred in developing coun­tries, and most could have been pre­vented if these women had had ac­­cess to skilled health care.

This is better than 25 years ago. Since 1990, maternal deaths world­wide have dropped by about 44 per cent, from 385 deaths per 100,000 live births to 216. The WHO Sustain­able Development Goal 3 is to reduce this further to fewer than 70 per 100,000 births.

The key to progress has been improving access to the care of trained health professionals. In sub-Saharan Africa, where half of all maternal deaths occur, most women give birth at home, relying solely on traditional birth attendants: mem­bers of the community who have experience of childbirth, but no medical training when things go wrong. They are culturally import­ant figures, their position often blending practical tasks with the spirit­ual and pastoral.

In Isiolo County, Christian Aid is working with local government on a re-orientation programme for such birth attendants. Re­­deployed as “mother companions”, their prim­­ary task — for which they are paid a stipend — is to get the women in their care to a health centre before they give birth. They also ac­­company expectant mothers to antenatal groups.

 

IT SEEMS absurd, then, to hold up the picture in Kenya alongside the debate about the over-medicalisation of birth in the UK. In recent years, many organisations in the UK, includ­ing the Royal College of Obstetricians and Gynaecologists, and the Royal College of Mid­wives, have criticised the rapid increase in caesarean sections, which now account for nearly a quarter of all births. The most recent NICE guide­lines caused a stir by recommend­ing that women with a low risk of preg­nancies would be better served by giving birth at home.

In the UK, it is now a question of optim­isation rather than medicalisa­tion. A new system being intro­duced by NHS England next year will give pregnant women their own “personal budgets”, worth at least £3000, en­­abling them to choose the care they receive, from private mid­wifery services for one-to-one care during labour to pools for home-birthing.

A whole industry has grown up around maternal health: an array of antenatal, hypno­therapy, yoga, and massage classes, not to mention all the items you can buy. And, where there is a market, there is competi­tion, not only for the best products but in pursuit of an idealised birth experience. Marketing
to mothers can make birth sound like a con­sumer activity, or a competitive sport.

Pain relief during childbirth is a particular area of scrutiny, a senior policy adviser for the National Childbirth Trust, Elizabeth Duff, said, but “there’s no reason to feel ashamed of any [pain relief] options. It’s time to bust the myth that woman are ‘failures’ if they choose pharmaceutical help with pain relief.”

 

SUCH preoccupations show how far maternal services in the developed world have come: women are no longer primarily worried about their own mortality. A report published this month, the latest Confidential Enquiry into Maternal Deaths, sug­gests that it is safer than ever to give birth in the UK.

In Isiolo County, for every 100,000 live births, 790 mothers lose their lives. In the UK, the equivalent figure is nine. The same report, however, shows that other problems have emerged: suicide is now the UK’s leading cause of death directly related to pregnancy. One mother in ten is believed to suffer from post-natal depression.

A few years ago, I set up a mothers’ chap­laincy service in Winchester (Feature, 18 October 2013), and this statistic was certainly borne out in my encounters with new mothers. The conversations, even with women not necessarily suffering from diagnosable mental-health conditions, were loaded with the weight of what had just hap­pened: their journey — like Jane’s, like Mary’s — from that place of such expectation and promise into the extreme vulnerability of labour, culminating in the responsibility of new life. These testi­monies showed that, for all the improvement in medical care, childbearing will never be a routine procedure.

There will always be the telling of “birth stories”, as we call them in the West. And, although the most famous birth story in the world is told in a just a couple of discrete sentences, it is significant that it should occupy any space at all in Luke’s account.
The blind spot in Matthew’s version is per­haps more what we would expect. Moreover, the angels announce that a Saviour has “been born to you”, not simply “arrived”.

We can remember, then, that the risk-laden, visceral reality of Jesus’s birth is part of the miracle of the in­­carnation: “forasmuch then as the children are partakers of flesh and blood, he also himself likewise took part of the same”, as well as the women for whom preg­nancy and birth are still not as safe as they could be.

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