The Agape Health Clinic here in Kiboga is run by a nurse and her husband who opened the clinic in memory of the daughter they lost a few years ago. When I first arrived in Kiboga, I explained to the director of the school what a doula was and my desire to work with the birthing women in the community. He brought me to the directors of the clinic and first introduced me as a doctor. After trying to explain that no, I was not in fact a doctor, I realised that in a town like Kiboga I would be more involved than I had originally intended.
I spend much of the day at the clinic - the director called in the local midwife and nurses and together we sat and discussed birth in Kiboga. Though traditional birth was at home squatting, the birthing culture in Kiboga has been very much influenced by Western practices. However, the learning process stopped many years ago and what remains is a birthing culture which reflects many of the medical practices and mistakes which were forced into our own medical system some time ago - minus the equipment, supplies and available treatment.
Women in Kiboga come to the Agape clinic for prenatal care (a program they have recently been encouraging) and go to the hospital for birth. Far too many women experience birth by cesarean section and there are no drugs available at the hospital while performing the operation. When I asked the midwife why there was such a high cesarean rate, she explained that it was necessary because many women were not built to deliver and were too small! My heart fell a little. (they either perform an episiotomy or cesarean for each birth, so either way the birthing experience involves cutting)
I brought out some sheets I had brought on prenatal anatomy, we talked about the position of the pelvis and even used a piece of paper and scissors to show the integrity of the perinuem once cut VS left intact. We discussed the movement of the baby's skull bones and the natural adaption of both baby and mother. I then invited some of the nurses to move into a variety of birthing positions (including on the back, strapped to the table-which is used in Kiboga). After taking quite some time to go over all of this a silence fell over the room...followed by much discussion in the local language and finally the director responded, "Women's bodies were made and adapt for birthing. Are you saying that intervention is not required for every case?" It was a beautiful moment, one which I don't believe I will ever forget.
I took out some of the personal lubricant from the birthing package donated by mama goddess birth shop back home (http://mamagoddessbirthshop.com/) and explained how to use it during birth. I also gave her the pregnancy calculator and together with the nurses, we played with it using various conception dates.
Later, we went over some breathing suggestions and even did a little prenatal yoga. The midwife was unaware of the importance of pelvic floor excercises during pregnancy and had only been instructing women to use them after birth. I left some of the vit + min supplement packages with the midwife along with a package of gloves.
As our day came to an end, the director who ownes the clinic came in a said in fun, "didn't you bring anything for men?" I reached into my bag and pulled out a photocopy I had made on an information package I got from Gloria Lemay on the importance of an intact penis. I handed it to him telling him that he might find it interesting and said goodbye to the staff. I left the information package with the director to read over and decided to leave that topic for my next visit. I am hoping to work with the midwife once a week at the clinic and at the local hospital.