Thursday, May 9, 2013

Market place abortion

There are no empty beds anywhere in the small hospital. We move across the open courtyard from antenatal to postpartum to labor and delivery, trying to assess women and provide care.  There are suppose to be three distinct rooms; one for each part of the birth process but they are all in all the rooms so it is hard to be predict what might happen in any given room.  Twins are just a likely to be born in the postpartum room as in labor and delivery with  a room full of aunties, grandmothers and sisters trying to help while someone runs for a midwife. 

The rooms are hot.  The smells of blood, urine and sweat can not escape and linger in the air. The cleaning woman is asleep on the counter in the delivery room.  She has prepared a clean and comfortable bed and I can not rouse her even when I desperately need a clean delivery room. 

It is about 2:00 am when a very young woman comes in to the delivery area.  She has been placed on a table but no one is tending to her.  I cannot find the translator so I begin on my own, asking the questions that might give some insight into why she has come to the hospital.  Her uterus is small but I can hear a heartbeat.  Her vital signs are all normal and she is not bleeding.  I can tell she is waiting for me to do something so I do a vaginal exam hoping still to uncover the reason for her visit.  

When I feel for her cervix. At first I think it is hard and closed but then, I can feel that there are feet or arms hanging down out of the cervix.  Pencil thin legs resting in my hand.  She is showing no signs of discomfort and no contractions and yet the baby is hanging out of the cervix.  There is a heartbeat. I slowly take my fingers out and consider what to do next.

She like, many women, in Haiti and around the world has decided that she can not provide a good life for this baby. She says she has another baby at home and the father has twenty other women who are also pregnant.  This seems extreme but I understand what she is saying.  This baby, she knows, has a one in three chance of living after being born and only a 50% chance at a primary school education.  She can watch this child slowly die of malnutrition or she can let it go tonight. She chose now.

 There are no corner drug store pregnancy tests and so she and other women in her situation wait until the baby kicks, go to the market and find three little white pills to swallow.  She lies there waiting for it to be over; waiting for us to do something so she can go on with her life without another baby.

At the same time, another mother has come in from the countryside because the clinic there said that her baby had no heartbeat.  A woman has given birth in the postpartum room and another woman is laboring across and next to her.  Of the four women in labor and delivery, three have come in with babies who have already or will shortly die.  A woman with pre-eclampis will deliver in some other room and they will bring in her 20 week baby who is still alive but can not survive.  They hand me an adult bag and mask and look at me as if I should save this tiny baby.  I try to explain I would need an infant ambu bag with a mask for premature babies but it does not really matter. He is too young.  I wrap the baby boy, all snug and warm, and sit with him while he sighs his last sweet breaths.

The mother with the baby who is still half born is given more medicine and the baby is teased gently out of her with small pushes.   She does not bleed and in a short time is dressed and ready to go home.  I want to believe she has good birth control options in the future and that her older child will have enough food and an education.  I hope she can flee the man she fears.  It is estimated by the Hatien health department that 10% of all women experience violence from intimate partners.  Rape is common and tolerated.  During the coup to oust Aristede, it is estimated that 19,000 out of every 100,000 women in Port Au Prince were raped.  It was used to punish women and families who favored democracy.

World wide, 45 million women each year seek an abortion.  In Haiti and many places it is illegal so women take their chances and many die.  24% of all deaths in women 15-19 are pregnancy related. 

 I believe abortions are an indicator species; a marker of society's commitment to women and children.  Most women who are well loved and know that their child faces a secure future and has good access to birth control do not need abortions.  Societies that protect women from rape and violence, fund schools and health care and protect local food production prevent abortion.  

I think of the  African women who let their babies slip away rather than birth them into slavery.  I can see that this mother does not see a future for her baby that is not full of pain, hunger and violence so she lets him slip away.

Three babies are not born alive.  One is 16 weeks old, one is twenty weeks old and one is full term.  We cannot tell why.  I wrap them in blankets and they are put in one box for the gardener to bury together.  I see the cardboard box in his wheelbarrow as I leave the hospital.

If you are reading this and are sad about her self induced abortion, as I am, reflect on pro life United States presidents who campaign on a right to life platform and then create policies that cause vast suffering to Haiti's women and children; policies that destroy food production, health care and schools for many generations to come.  If you knew your child had a 1 in 4 chance of  dying of starvation or malnutrition  what would you do and what will we do when we know the cause and we, who love women and children cannot find a song powerful enough to stop it.

It is impossible not to feel that, in part, those three babies died so that the richest of our world could enjoy larger than needed profits, tax breaks, and extreme wealth at other people's expense.  The young woman of our story does not know exactly why she is hungry or why she was first raped or why her partner beats her and cheats on her and she never got to go to school.  She does not know and yet she knows.

 The mother who lost her full tern baby sings for a long time after the birth. She lies on the table holding her baby and sings and sings until she gives her up.  The song goes on for a long time. It is so sweet and so full of love and faith. It fills the rooms of those around her. 

By morning, everyone is preparing to go home.  Each of us walks by the box with the babies that is sitting in the wheelbarrow.

The mangos that are turning yellow will be sweet to eat at the end of the day when everyone is tired and there is time to sit and talk on small wooden chairs with seats woven with plants that grow by the roadside.   The rain will wash the day away and prepare us for still another.

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