Tale of Two Mothers
Posted on May 22, 2012, by Kate Grant, Fistula Foundation
In spring of 1999 a young woman named Cipriana got married in Huambo Province in central Angola, and became pregnant with her first child. That same spring, after a wedding I think my own mother thought would never happen, I too became pregnant with my first child in New York. Like most first time mothers, as my due date approached I was simultaneously anxious and thrilled, waiting for my big day. Cipriana too was excited about soon becoming a mother -- a role that would give her status and a place in her community. Her labor and mine began with the same universal pain, growing gradually excruciating as the day progressed. After nearly 24 hours we both remained in labor, and here our stories diverge.
When I went into active labor at midnight my husband and I headed off to the hospital. As night turned to day and day turned to night again, after four hours of pushing, my big baby was lodged in my small frame, not going anywhere; a C-section was ordered. I whimpered with a sense of personal defeat and disappointment. But, other than a bruised ego, the only sign of that agonizing labor left after delivery was a small line of staples below my "bikini line" where my healthy baby boy had been removed from my exhausted body.
For Cipriana, a world away, the end game of her labor could not have been more different from my own. Like most mothers in sub-Saharan Africa, she endured a traditional home birth, and with no emergency obstetric care available, her labor continued there even when it was clear she needed help. Forget pain killing drugs. Forget the C-section. Once the baby died in utero she expelled the lifeless body, swept into eternity on a tide of pain and unbearable heartbreak. That's an ugly and deeply upsetting image. But, the hard truth is that every day that is the reality for thousands of women and their stillborn babies.
But Cipriana's situation grew worse after her labor ended, when she discovered that she was left with a large obstetric fistula, an injury created by her extended obstructed labor that left her leaking urine constantly. Her young husband quickly abandoned her and she returned home to be cared for by her mother; both she and her mother moved outside their village because of Cipriana's odor and stigma. For a decade she lived as a social outcast sustained by the love of her mother, until she received much needed surgery to repair her fistula at the Central Evangelical Hospital in Lubango.
Cipriana was just one of the 2.6 million mothers who deliver a stillborn baby each year, and one of the estimated 100,000 who develop a fistula. Five to ten percent of births are obstructed, yet only four percent of women in most African countries get C-sections. You can do that math. That means of course that an awful lot of laboring women don’t get the help they need during labor; the result: lots of dead babies and injured women. We tiptoe around this tragic, often preventable reality. Think of the word "stillbirth." Sounds peaceful, serene, and almost divine. So much gentler than dead baby or grey lifeless body, with the word birth even being a cruel hoax, since the child will never take a breath and their mother's soul will be forever changed by an immutable, indelible loss.
Not a day goes by that I don't look at my own energetic freckle-faced eleven year old boy — brimming with life and possibility — and recognize how very lucky I am to have him. Had I tried to deliver him in most places in sub-Saharan Africa, he would have died, a pure and simple 'stillbirth.' And me, who knows? Would I have awoken the next day to a urine soaked bed, the sure sign of a fistula, or would I have died in childbirth when my exhausted uterus ruptured?
The world-renowned Egyptian obstetrician/gynecologist Mahmoud Fathalla said it better than anyone: "Women are not dying because of diseases we cannot treat. They are dying because society has yet to make the decision that their lives are worth saving." The same can be said for most of those stillborn babies and injured women. We know what works to stop this carnage: prenatal care, family planning services, access to skilled birth attendants and emergency obstetric care.
So today, open your mouth along with your mind and your heart; share this truth with someone you care about: each year millions of mothers are dying or being horribly injured and babies are dying needlessly. Then, if you're up to it, do something else. We are citizens of the richest and more innovative country the world has ever known. We've got the power collectively to bend the curve. If you are a letter writer, write your Senator or Congressman/woman and ask them to support U.S. foreign aid for maternal and child health and funding for UNFPA. Or go on Google: find an organization that speaks to your heart. Act. Do it for your mother. Do it for your wife. Do it for your sister. Do it for your child. Do it for yourself. The late genius John Lennon had it right: "Apathy isn't it."
Kate Grant is the executive director of the Fistula Foundation (www.fistulafoundation.org), the largest U.S.-based nonprofit focused exclusively on fighting the childbirth injury obstetric fistula globally.