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Babies love to make surprise entries into the world


Why you can't prepare for labour

It is obvious that babies have a mind of their own

As the Christmas season winds up, it is not lost on us that the holiday is solely built on the birth of our Lord. A little tot born in a barn and laid on a manger as there was nowhere else for his mother to be accommodated.

I can imagine Joseph in distress, having travelled for miles with a heavily expectant Mary, the awkward silence between them as they both silently pray to make it to the destination before baby Jesus arrives. Mary, a first time mom whose conception was already out of this world, struggling to bottle her fear and uncertainty as the donkey carrying her trots on towards Bethlehem.

Most normal couples look forward to the birth of their newborn, having planned for months, shopped for baby stuff and visited maternity hospitals to decide on where their baby will be welcomed. Joseph and Mary did not have such privilege. They had a baby coming that they did not make together. Mary was carrying the Messiah. What does one need to do in preparation for birthing the Son of God? It must have been very intimidating.

In the absence of hospitals as we know them now, Mary must have visited a wise old woman in her neighbourhood who was known to aid mothers in birthing. It must have been extremely unsettling when the census decree was made. She must have run to see the old woman before setting off to Bethlehem to seek reassurance that she would do just fine in the event her baby chose to come during the sojourn. I am sure no first time mom would want to be in Mary’s shoes!

Joseph wasn’t having it easy either. The only direction first time fathers want to be headed to with their term pregnancy wives, is the hospital. Not a trek to the ancestral land for a census. A place where you cannot even find accommodation for the night except with kindly farm animals. Where those who have secured a place for the night will not look kindly at you even when your young wife is so obviously in labour and in need of a room to welcome the new one.

It is obvious that babies have a mind of their own. They come when they want to come, not when we think they should. From a professional lifetime of delivering babies, I can attest to that. Our best laid plans have been thwarted many a time by a little one in a hurry to get here.

COMPROMISE SAFETY

My first encounter with these strong-minded babies was when I was just six. During a merry festive season in the village, a member of the extended family went into labour. My mom, having a background in midwifery, was summoned to help. The woman was already walking to the local dispensary with a crowd of women. I ran after my mom to witness the wonder. Let’s just say that we never made it. The young mom was laid on a layer of khangas on the soft moist mid-morning earth and the little one dutifully announced her presence within minutes. I leant that day that a sugarcane peel makes for a substitute scalpel to sever the umbilical cord.

Sonya* knew her baby was four weeks away. She was hard at work on her desk when she suddenly felt wet. What followed was a wave of contractions like she had never felt before despite two previous deliveries. It felt like eons before the ambulance could arrive. Sonya’s baby was born at 36 weeks in the ambulance in the parking lot of Sonya’s office building.

Nancy* went to sleep happy. She was home alone. Her husband was working the night shift just 10 minutes away from home. Nancy woke up at two in the night with contractions. She called her husband, who took her to hospital, though he thought it would be a while before baby comes. At the hospital parking lot, he had to call for help. The nurse came with a wheel chair, but ended up calling for the delivery tray. Baby came in the car. At least it was in the hands of a skilled birth attendant.

Babies on many occasions arrive unplanned. It may be due to premature birth like in the case of Sonya, where baby needs special care immediately. It may be precipitate labour (labour that progresses abnormally fast) like in the case of Nancy, where the mother is at increased risk of post-partum haemorrhage, hence aggressive management is required to prevent complications. In some instances, it may be a result of delays in getting to the hospital for delivery.

This is why it is important for a mother to have a birth plan that is well known to all around her. The hospital where she intends to deliver, how to get there once labour sets in, where the necessary documents are at all times and how is the cost of care being met. This prevents unnecessary delays as decisions are being made during unexpected events.

Such wayside deliveries compromise sterility of the delivery process, increasing the risk of infections to mother and baby that are critical to prevent, keeping in mind that infections form the fourth highest cause of maternal mortality and the second in neonatal mortality. This further emphasises the need for tetanus toxoid vaccination for the mother during pregnancy as this vital vaccine protects the mother in the event of such exposures, but most importantly, protects the newborn from neonatal tetanus, an infection with over 90 per cent mortality in our little ones.

Wishing all the moms in labour a safe delivery!

Dr Bosire is an obstetrician/gynaecologist