In Isiolo they prefer home deliveries, but...

Playful children greet you at the entrance of their mud-walled, grass thatched homestead. At a corner are elderly and middle-aged women in elaborate neck adornments.

It is 8.15am at Louwangila Village in Isiolo, about 270 kilometres northeast of Nairobi, and no single man is in sight in this homestead except Noah Esekon, a hospital-trained community health worker and birth attendant.

A young pregnant woman walks past the women and children towards a nearby cattle pen. She seems not to notice any of the women conversing in hushed tones, and her apparent disinterest in their banter explains itself in a short while as she makes the laboured journey back.

She is in pain.

Rose Akomol is nine-months pregnant. Labour pains began early this morning at 4am. After a discussion with her husband Julius Lorinyo on our desire to witness a home delivery the Turkana way, we are welcomed and introduced to two midwives; 65-year-old Christine Ng’asike and 35-year-old Margaret Akiru.

Then the wait begins.

This being her first child, Akomol has chosen, largely for cultural reasons than cost, to give birth at home with the help of community midwives known as ngakethudounok. Over the centuries, the ngakethudounok have passed the science of midwifery from generation to generation here, and Akomol is confident they are up to the task.

With her mind set on the home delivery and a congregation of birds chirping her on, she takes a walk around the compound as she has been instructed by the midwives. It eases the pain of contractions and will help speed up labour. Everything seems well ordered and according to plan. No one is running helter-skelter here.

“I fear going to hospital for fear of being operated on,” Akomol tells us in between the contractions, which are getting sharper are more frequent with every passing minute. “Everybody around here gives birth at home.”

Giving birth in hospital is considered a sign of weakness among the Turkana, and, for the women, this is a sure way of losing respect amongst your peers. Few want to risk their place in the community, sometimes with disastrous effects.

When the labour pains intensify, children and men are usually sent away. Today, the men have already secluded themselves from the action and are seated under a small tree about 200 metres away, engaging in idle banter. Others lie on the ground, their necks supported by the ekicholong — the Turkana wooden stool. No one seems harried. Or pestered.

Akomol paces back to her house, where she is followed by Ng’asike, one of the traditional birth attendants. She lies on the mat on the floor and Akiru reaches out for an unlabelled medium-sized jar of cooking fat.

She slowly lifts Akomol’s maternity dress and, aided by a generous amount of the oil on both palms, palpates the stomach to feel the uterus.

She places her left hand at the bottom of the abdomen and the right hand just above it. Then she moves her hands in a clockwise direction — towards the right side of the mother’s stomach, making sure she completes a full circle.

She confirms that the baby’s head is already in the downward position and estimates “the baby will be born today at around 4pm. Everything is fine”.

Although she is in mild pain, as shown by the lines on her face, Akomol is getting some relief from the midwife’s massage. Pre-natal massaging is an important technique used by traditional birth attendants all over the world. Christine Ng’asike was trained by her mother, and her delicate hands have massaged scores of other mothers over the hills and across the valleys here over the years.

And she has seen it all: multiple births, umbilical cords coiled around necks, breech deliveries, shoulders stuck on the sides of the birth canal, babies born weeks beyond their due dates and newborns gasping for resuscitation.

The baby’s head must face downwards for easy delivery, she explains. But when the baby adopts the breech position, she somehow manages to correct things by massaging the mother’s tummy here and there and encouraging it to descend.

We watch as Akomol takes a second, third, fourth and even fifth walk around the homestead in the next four hours as the midwives monitor the progress of her labour. The hut where she will give birth has already been swept clean and the necessary birthing equipment put in place.

Once in a while, Ng’asike gestures to her fellow birth attendants and together they go to the hut to check on the progress. At around 3.17pm, more than 11 hours after the labour pains began, one of the birth attendants signals to the rest that delivery time is nigh. Children are ordered away as it is a taboo for them to watch birthing mothers.

Akomol lies under a tree outside the homestead. The pain is now almost unbearable. The water has broken. Noah and other women rush to her and ask her to explain her situation. Her lower abdomen is on fire, she moans.

Ng’asike palpates her stomach and tells her to take a deep breath and push firmly. One, two, three... she takes the deep breath as instructed, but it is not strong enough to give the required push.

Two women support her back as they urge her to take short breaths and only push when instructed. At 4.07pm, 12 hours after the onset of labour, baby Anguotong Ngorot drops to the floor inside the mud hut, which has been disinfected with ash.

For a minute, all is quiet in the room. Akomol seems overpowered by emotion, or maybe she is just tired.

One of the women picks up baby boy and slaps him gently on the buttocks, whereupon he lets out a sharp, piercing cry. Then a birth attendant severs the umbilical chord with a razor blade and clamps it.

And around 4.20pm, Akomol holds her baby for the first time and manages a smile. She cuddles him, but she will not feed him yet. According to tradition, the newborn must be fed on a mixture of salt and water until the next morning, when he is breast-fed and named.

Tradition here demands that mother and child must remain in seclusion for four days. No male is allowed to see them during this period, not even the father. After the fourth day, a ceremony is conducted to mark the end of the seclusion period and a goat is slaughtered to celebrate the successful birth.

An hour after the birth, we catch up with Mzee Lorinyo, the excited father who has broken into song.

“I am very happy,” he exclaims. “I look forward to the day my son will grow up, get circumcised and marry. From now on, when I see children playing, I will be contented in knowing that my son is one of them,” he beams.

It has been a long wait for him. He believes he should have done this two, even three decades earlier, but he was just not ready, and at 62 years, he is now the proud father of a bouncing baby boy.

Astonished? E-mail the writer at [email protected], or send your comments to [email protected]