Liberated by Liberia


I’ve just watched a wonderful midwife from Sutton Coldfield spend two weeks – compressed into 57 minutes – working in Redemption Hospital in Monrovia, Liberia.
If you didn’t pay much attention in geography (if indeed it was ever mentioned in geography), Liberia is a little country in West Africa, recovering from a civil war, which has a stillbirth rate of 1 in 25, and a maternal mortality rate of 1 in 12. You’ll find the programme here.

It’s left me, er, conflicted. Here I am calling over and over again for women in the UK to be treated with more respect during this rite of passage in their lives. For their privacy, their autonomy, their triumphant brilliance to be respected and honoured. Here I am calling for us to stop and think about how nature intended us to birth. For darkened rooms, for an acknowledgement – celebration, even –  of birth’s sexual nature, for getting back to basics.

And Africa is where we all came from, after all. For over half of the period of human existence, that’s where all humans were.  But as Suzanne Saunders-Blundell, and we, were shown so brutally, that doesn’t mean that in Redemption Hospital, at any rate, they’ve got it right now. Instead, intervention, albeit low tech, is queen. Babies are literally squeezed out of women, writhing, supine, howling, with nothing but a curtain, if they’re lucky, for privacy. The mother of a stillborn baby is on a bed beside a woman giving birth to a live baby, beside another who has just had an abortion, and another who has diarrhoea. Tender loving care, or a principle of being ‘with woman’ – mid wife – is absent.

Some of us in the West can have an idealised view of a more natural culture, where people still understand how Mother Nature intended human beings to live. The Perfect Indigenous Birth Story goes something like this:

Perfect Indigenous Woman (let’s call her Piw) understands instinctively that she is pregnant. She does not need to pee on a stick to accept that a baby will come. She waits for the quickening – her baby’s movements, which appear three moons after she has noticed her absent period, and with that she begins to bond with the miracle of life inside her. When ten moons have passed, during which she has attended the births of several of her fellow villagers, sensations tell her that her baby is on its way. It is a dark, warm night, and the moon might well be full. She is surrounded by loving women who understand her. She belly dances through her birth while her midwives massage warm, fragrant oil into her lower back, and nurture her physically and emotionally. Before long, she is squatting, and her baby is born, healthy and fat, into her arms. Her placenta follows easily – a feast for the new mother, who lies in for several weeks, needing to do nothing but cuddle her baby skin to skin, and breastfeed on demand, while others wait on her.

Neither we, nor Suzanne, saw Piw giving birth in Liberia. In fact I wonder whether such a thing really does exist in the developing world, and the reason why I wonder that is down to an extinct Jewish psychoanalyst called Abraham Maslow, who came up with a ‘hierarchy of needs’. Here it is.

It’s pretty simple to translate this into birth. The women we saw in Monrovia were fairly firmly stuck to the bottom of the triangle, their basic physiological needs unmet. Of course, Maslow would tell us, they’re not going to be dreaming of self-actualisation (in birth terms, an empowering, uplifting experience) because getting out of this experience with two people alive is a good start here, and a roof over one’s head, and free medical care is a bloody miracle.

And that’s why I feel conflicted watching this. There’s a very real sense of ‘now we know how lucky we are’ – cut to Suzanne back in Sutton Coldfield, swishing the warm water around the birthing pool in the clean, air-conditioned, well appointed labour ward, just to prove it. So perhaps there’s just a teeny tiny implication of ‘who am I, then, to suggest that birth in the UK could be improved upon?’ We’re doing very well, thank you very much, with our 1 in 100 stillbirth rate, and our 1 in 10,000 maternal mortality rate. Live mother, live baby goes without saying, as does running water, a sound roof, antibiotics.

Still I strive for more. We’re not Liberia. I am reasonably certain that my great great great grandmother, and her mother, and her mother gave birth in conditions unlike the ones I saw tonight in West Africa via BBC2. But somehow we’ve crept up that hierarchy of needs and are sitting rather closer to the top, perhaps swinging our legs in nonchalant defiance, in the manner of the spoilt child not knowing how lucky we are, demanding ‘no decision about me without me’, insisting on epidurals and elective caesareans and birthing pools in rooms with lava lamps and disco balls and iPod docks with relaxing birth music on repeat. But is that such a bad thing?

Actually I’m not sure that it is. This is where we are, like it or not. Appreciate it or not would probably be more accurate. So take on board what Suzanne showed us in Liberia, then, and cherish, and applaud the fact that we do have the wherewithal either in Sutton Coldfield, or in most of the UK, to bring about the birthing equivalent of the tip of Maslow’s triangle.  Unfortunately too many UK births are still stuck somewhere around the middle layer – and that’s still a damn site better than the Liberian women – but when you know something can be better, you’ve still got to strive for it. You don’t put up with it just because you know that there are people who’ve got a whole lot worse.

Bring on the autonomy and empowerment, then.

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~ by Kedi Simpson on February 27, 2011.

6 Responses to “Liberated by Liberia”

  1. Fab post Kedi. I’ve yet to watch this, saving it for this evening. However, I wholeheartedly agree!

  2. Fantastic, thoughtful post Kedi. I’m looking forward to getting to know this blog better!

  3. Interesting take Kedi, I was reminded of the saying ‘birth as you live’ and life is indeed harsh there.

  4. Kedi, thanks you for putting into wods, so eloquently, what I was trying to get straight in my head.

  5. Great post. I just watched the program and I am struggling with all of the same issues! x

  6. Kedi, I haven’t seen (and will probably choose not to) the programme, but thank you for putting into clear, coherent language something which I feel but struggle to express.

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