The nurse came in and had us carry her to the table and lay her flat. It took all five of us to get her off the floor because she was so exhausted that she could no longer walk. I cringed as we laid her on the table and tried to maneuver the plastic bag under her so that she would be protected from the dirty vinyl table. There was no water, no towel, and no drugs. She was holding on tightly to my arm, her fingers digging into my flesh, as I held up and opened one of her legs. There were no stirrups or anything for her to brace herself. We cheered her on, reminding her to breathe, and encouraging her to push. We told her how great she was doing, how brave she was and how proud we were. She kept repeating "Mama, mama, mama…" again and again. The midwife told her to hold her breath when the contraction came, while we told her to breathe and make sound! The midwife looked annoyed, but focused on the business at hand. Then finally the head popped out.

I've never been present to a birth before, and I was instantly overwhelmed by the true miracle taking place. A soul had entered the world, just like that. The baby's eyes were closed tight and the nurse alerted us that the cord was wrapped around its neck. I think at that moment we all held our breath until the cord finally came undone and in one massive push Miriam's baby slid into the world.

Needless to say it was a magical moment. Otherworldly, profoundly spiritual and utterly, utterly human.

The baby was coated in blood and a ghostly white film and the nurse quickly tossed her onto Miriam's still swollen belly. Suzanne had to reach out and grab the baby to keep her from sliding off. I put my hand on her head; she was warm and soft, her small mouth gulping like a fish. I saw the midwife reach for a clamp and scissor and as she cut the umbilical cord, the baby's eyes flew open and I watched her take her very first breath. "Welcome to the world, little girl," I silently prayed. "May God bless your journey, may you be safe, may you…"

Sadly, I didn't get to finish my prayer because the nurse grabbed the baby and held it upside down by one leg. The clamp, still attached to the cut umbilical cord, swung dangerously close to the baby's head. Suzanne reached out and took the baby into her arms, and holding her tight against her heart, sang her into the world.

All of the sudden, Miriam began writhing and clutched at my hand as her body contracted to release the placenta. Blood and fluid poured out of Miriam and onto the floor and over my shoes. I rubbed her belly in circular motions, and it took another 20 minutes until the afterbirth came out. Miriam looked ready to faint and I kept repeating, "You did it, Miriam, you're a mama, you're a mama." She weakly smiled and nodded, her eyes searching for her child who was being swaddled. Then the nurse examined Miriam and said she had torn both the wall of her vagina and perineum badly and would need to be sewn up. Once again we held onto Miriam's arms and legs while—without drugs—the nurse stitched her up, the circular needle sliding in and out of the already sensitive and overworked flesh. Miriam continued biting her lip and repressed her screams, which seems to be the standard protocol of birthing babies in rural Africa.


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