by Kris Holloway-Bidwell
[Editor’s note: This article first appeared in Midwifery Today Issue 80, Winter 2006. This story is an excerpt from Monique and the Mango Rains, Waveland Press. The book was reviewed in Midwifery Today Issue 79, Autumn 2006.]
Lantern light. Mud brick. Sweat. These are the elements of birth as I first experienced them, years before I gave birth to my own children. It was in a remote village in the country of Mali, West Africa, where one in twelve women dies in childbirth or pregnancy. No electricity, no running water, no emergency backup. Only the grace of whatever god you believed in and the skill of the midwife.
What did I learn through working with a midwife for two years as a Peace Corps volunteer? Midwifery creates an opening for deep connection, not just between a woman and her baby, but between people and ideas. As such, it has the potential for changing lives, and through human contact and relationship, changing the world. Participating in births (and I was not a midwife, but simply an eager, inexperienced assistant) allowed me to form a sisterhood with a woman vastly different from me.
I had only been working with Monique, my friend and the village midwife, for a year when our friend Korotun went into labor with her first child. Korotun lay naked on the concrete birthing slab, knees up, and head against the wall at an uncomfortable angle, her chin on her chest and her mouth slack. Monique was next to her, quiet. Only the pungent smell of impending birth moved through the mud brick birthing house.
Then came a contraction. Korotun grimaced and groaned, her belly looked as hard as concrete for a moment, and then she released.
"I am so tired," she panted, "I cannot do this."
"You can do it, Koro," Monique said. "You can."
Monique shot me a nervous glance. "Let's get you sitting up, where you can push with more strength."
Monique and I slowly raised her by the elbows and eased her meager frame back against the wall as she braced herself for another contraction. The hours passed.
The room grew hot, wet, fertile.
"The baby is coming down," Monique said, wiping her brow. "You are doing it. Don't give up now."
Korotun pressed down. The head pushed forward, and then finally burst out in a spray of blood.
"Good, Koro," Monique said. "Now stop, stop. Just breathe."
Monique held the head in her palms, investigating with her fingers and thumb to make sure that the umbilical cord was not around the neck. There was so much blood.
"On this next one, push slowly," Monique said.
Korotun pushed the shoulders out and the rest of the being quickly surrendered to the world. Monique put the crying newborn on Korotun's chest while I wrapped clean cloths around it. Monique quickly took another cloth and pressed it between Korotun's legs. She held it in place with one hand and checked the cord with the other.
"Is it a boy?" Korotun whispered.
Monique didn't answer, but remained fixed on the amount of blood that was reaching her hands. Slowly, she lifted the cloth and gave a sigh of relief. Then Monique took the wailing baby off Korotun's chest and unwrapped the cloth to answer her question.
Korotun took one look at her daughter and rolled her head away from us.
I peeked down at the pinkish-white face. She had Korotun's full pink lips, her husband Dramane's straight nose, and almond eyes. Monique quickly wrapped her back up, quieting the piercing cries.
"She is so beautiful," I said.
"Is she beautiful? To you perhaps," Korotun said. "She would be beautiful in her father's eyes if she were a son."
Korotun's daughter took quickly to her mother's breast. As Monique prepared for the arrival of the placenta, she removed the blood-soaked cloth. The right side of her vagina was shredded as if the birth had been literally ripped from her. Her vagina looked less like an organ of wonder than a wound. I had glimpsed women's vulvas that were distorted and uneven, some with jagged edges, but I had never looked this close.
After examining the placenta, washing Korotun off, checking Korotun's blood pressure, feeling her stomach and forcing her to rest for an hour, Monique and I walked Korotun home. We poured her a warm bucket bath, extracted promises from her not to work and left.
"Why did she want to go home so quickly?" I asked.
"She will try and please her husband. She will cook a good sauce and make a clean home, hoping he will notice less the absence of a son. The baby was big for her to push out. She tore badly. Almost every woman rips on her first baby. Have you not noticed?"
Ripping was such a horribly accurate word.
"Some women tear back through to their bottoms." Monique traced a curved line in the air. "If they do not keep clean, pati, the infections I have seen… Most women have not known this pain since they were young; since their koloboli. What is it called in French? … Oh, yes, I think it is called l'excision."
I wracked my brain. I remembered reading about female circumcision in a Peace Corps manual; it was a ritual that entailed the clipping of the clitoral hood. What I had seen at the birthing house seemed far worse.
"You don't know of it?"
"No," I shook my head.
"You have not been cut?" Monique looked concerned.
"No," I said, and reluctantly added, "tell me what you mean by ‘cut.’"
Monique paused, choosing her words carefully. "Well, here, it is done when girls are nine, or ten, like that. It is hard for me to remember exactly when it was done. It was so long ago. I was in a small, closed hut with my friends and other girls I knew, other girls my age. I remember being very excited that it was time. I remember being talked to, being held down tightly, and … Hup! The old woman sliced."
Monique dropped her hand. I jumped.
"It was so fast, it happened before I knew it. There was so much blood, but none of us cried. But afterwards, pati… we cried. Oh, we cried! When they would clean us, we had to stay still, with our legs apart, to prevent infection. They cleaned us with alcohol. Ah! I have never had such pain. Never, even in childbirth."
I shook my head. "What exactly did they cut on you?"
"I don't know, some parts that we didn't need."
My stomach felt empty.
"Who cut you?"
"An old woman in Koutiala. She is dead now. It is the old women who do this work."
Tears welled in my eyes as I thought of Monique, and of her mother, Jeanne, before her, and her daughter, Gene, after her, all under the knife.
"She used no anesthesia?" I asked.
Monique shook her head and waited before she spoke again.
"I have never met a woman like you, who has not gone through koloboli. I thought every woman had it," Monique said, with that concerned, sad voice again. "Does anyone have it done in your country?"
"In the US? No!"
"Hmmm. Here we say that koloboli helps girls become good wives and bear children. But, I can tell you that I have noticed myself that it does not help the baby pass through. As a midwife, I have certainly noticed this."
With that, we began walking again, side by side.
Kris Holloway-Bidwell holds a MPH from the University of Michigan and has used her unique background in writing, health and development to further the mission of numerous nonprofits and educational institutions. She lives with her husband (whom she met in Mali) and their two sons in Massachusetts. A percentage of proceeds from the book go towards funding "Clinique Monique," a maternal and child health clinic in Mali. To order the book or learn more about the clinic, go to www.moniquemangorains.com.
More information about female genital mutilation (FGM) can be found at the World Health Organization Web site: http://www.who.int/mediacentre/factsheets/fs241/en/
If you appreciated this article, you'll enjoy Midwifery Today magazine! Subscribe now!