Photo by Sharon McCutcheon on Unsplash

THE EMPEROR’S CUT, ONLY FOR QUEENS

“Pushing does not make a mother” nor does any technique or process- medical or natural. Nor any sort of facility--be it a hospital, or birthing center or home. None of it has to do with how much she gives.

Giving birth has everything to do with giving. In this final sacrosanct act of pregnancy, all is set aside as the mother does whatever it takes to give her baby life. In every birth, it requires different sacrifices, but the beauty of it, every time, is that the mother was willing to do it.”…Jennie K Brown.

“Doctor please please don’t tell them”…Chizoba had cried out while reeling from pain from the previous day’s surgery. “Doctor, I will die if you tell them, I cannot stand the shame anymore”….She was in tears, a drop away from wailing. “If anyone asks, please tell them that my wife gave birth the natural way”…the husband had added, with some form of grief written on his face. “Please do it for me” I want peace in my house he had said.

Chizoba’s case was a case of a repeat cesarean section. I remembered her first incident like it was yesterday. Charles, Chizoba’s husband was an only son of his parents, the last of seven siblings. He had just married Chizoba, an eighteen-year-old girl with very slender features some months prior to our first encounter and this pregnancy was obviously their first and they had all wanted it to be memorable. Memorable was the word as I had noticed nearly a whole clan present at Chizoba’s room day in and day out, supportive and encouraging, urging her to finish the race in flying colors. Each time I walked past her room, I could hear them chattering away. I could hear them giving advice on the best ways to “push and deliver”. They were all experts in their own rights. Charles’s mother had given birth to eight children “all by myself” she would say. Charles’s grandmother had given birth to twelve, his sisters had a combined count of twenty-four kids under their belt, so little wonder that this pregnancy was a mere formality. They were all there to add to the glamour, they were there to shelve support for Charles “ The golden boy”, they were there to herald the coming of their only son’s first child, they were there to make it “25”, they were there to make sure that it followed family’s tradition. They were all there, not for Chizoba.

Chizoba’s labor had been excruciating for her, being her very first. Her mother and only sister were in one corner telling her to” breathe”, Charles’s job was “applying and rubbing” talc on her back while she paced the room. Charles’s mother and sisters huddled in yet another corner observing the “weakling” Chizoba go through labor with some occasional jabs “ imuputa nwa a, ichefuo ufu ya” the pain goes away once the baby is delivered. “ I had three days of labor”, I was all by myself”,” yours is just twelve hours and you are making a big deal” quipped Charles’s elder sister. “ Don’t exhaust yourself o, you will need all the strength she had continued. It was quite a sight as the pressure of having this baby had become increasingly telling for Chizoba who at this point was crying with repetitive muffled “ agaghi m amuli ya”. Each time she said that, a threat of a resounding slap was meted out by both mother and mother in law. “ Owu umuaka ibe gi na amu four, without a problem”

Chizoba’s case was one of those cases my mother derived joy as a yardstick when teaching nursing auxiliaries and students under her tutelage, “biomechanics of giving birth”. Nobody ever forgot that topic. It was called the driver, the bridge and passenger standing in for the three components that influenced a successful delivery. The 3 P’s, Power, Passage, and Passenger..

Chizoba’s case was a case of the power

The “Power” refers to the forces that move the baby through the birth canal. This is mostly accomplished by the uterus. Did you know that the uterus is one of the strongest muscles in the human body? Strong, coordinated uterine contractions are needed for the cervix to thin and dilate (open) and to allow the baby to descend through the birth canal. Special nerves that travel through the lower spine and pelvis supply the uterus and control how quickly and how strong the uterus is able to contract. During dystocia, these contractions may not be strong enough or they may not be coordinated properly. To allow for optimal “power” to push the baby, these nerves need to be functioning at an optimal level and the muscles need to be strong and efficient.

Chizoba had pushed and pushed but nothing. Chizoba had three of her sister in laws and her mum as delivery coaches, shouting down on her to push like a woman, screaming down her face to take away shame from their family, threats upon threats to redeem her womanhood were meted out while she was in active labor all to no avail. Faces of disappointment laid bare in that room, all you could see where island of heads shaking in sad resignation. “aga m amawapu gi nti, owuru na imuputalighi nwa a…Her mother had screamed in final desperation but it was nothing Chizoba could do, she had exhausted her energy, a forewarned situation, a sure forecast by one of Charles’s sister. She was in a rage at this point, Chizoba had gone against her orders, against her advice. She was spoiling for a fight with an “exhausted”, “spent” Chizoba — a woman that could not bring forth to the world “ Charles’s first child”, pumping her chest in disapproval at this “wimp” of a woman and eventually stumping out of hospital when my father, the attending physician had made it clear that this was a clear case of an arrested labor, with non reassuring fetal readings signaling a move to cut open to save mother and child. A final death sentence since in Africa, giving birth naturally is the woman’s ultimate pride.

Photo by Shane on Unsplash

She had been blamed and shamed .” you couldn’t push out a simple baby, after you will call yourself a woman” was a common line they used on her at any slightest provocation. She was treated differently by her in-laws and was not consulted in some matters as she was not deemed fit and woman enough.

She had recounted once when she was ostracized from a meeting, having fought with one of the women from her kindred. This was a few months after the birth of her child. The said woman’s kid was playing “Monkey post” — a form of soccer with other kids in the compound. Chizoba had warned the kids severally to steer clear of a water well that served the compound. There were no adequate boundaries to serve as caution for the kids around this water well, kids just knew by heart to stay away. On that fateful day, the ball had rolled a little too far, hanging precariously on the well’s makeshift palm frond lid, a wind away from falling into the water well. In “Monkey post”, there was an unspoken rule that mandated whoever shot the ball farther away from normal reach to fetch it. It was on the kid’s shoulders to carry, it was his responsibility, he was looked upon by other kids to fetch said ball and that decision had proved nearly fatal as he had slipped and tripped at the edge of the water well and was definitely falling into the well had the concrete edge of the well not stopped him. Chizoba had screamed and ran towards the well to pull off this kid to safety and had immediately taken off her rubber slippers while repeatedly flogging the kid on his buttocks — a common method of reprimand. The boy had run home crying and all hell had broken loose shortly afterward. His mum had come charging, with no prior knowledge of what possibly was the culprit for reprimand, her sole reasoning then was that someone else had laid hands on her kid. A big fight had broken out between Chizoba and the lady with a lot of insults and banters thrown back and forth. “ That is why you could not push out a kid”, “That is why you do not have sympathy on kids because you do not know how hard it is to push out one”, “ If you gave birth to your child all by yourself, then you will know not to raise hand on any kid”, “ useless woman”, no need talking when real women are talking”.

Chizoba had lost an appeal to the case at the local clan meeting where she was not only fined for fighting, she was also ostracized for a while pending her acceptance of a lesser woman. Albeit to say that the meeting was predominantly constituted by women that “heroically” gave birth to their own children. Chizoba had stood no chance.

The “Passenger” is, of course, the baby! Now we need to consider the size of the baby and how he or she is positioned in relation to the mother. The ideal position for the baby is head down, chin tucked, with their body/back aligned on the left side of the mother. Often, when the baby is in this position, Mom will feel the baby kicking on the upper right side of her abdomen. This position typically allows for the best set-up for an easier labor and delivery.

Amarachi’s case was a problem with “passenger”. Amarachi’s husband lived in faraway Abidjan. He had just moved over there to learn a trade while leaving his pregnant wife to live in the village with his grandmother. Amarachi’s grandmother in law was the strongest woman alive she had ever seen as the woman still rode on bicycles for miles and went to the farm for hours. She put her age to about ninety. She had been touted to have delivered six of her kids at home and for the rest, she was said to have been on the farm when labor started and had strolled to the midwife herself to deliver. Amarachi had benefited first hand from the secrets to longevity and strength as she was constantly on some “ mgborogwu”, “herbs” for different reasons. Some were for early morning tiredness, some were for the loss of appetite, some were for nutrition, some were for “idozi ahu”. She also was a serial visitor to her mother in law’s age-long acquaintance and friend that “rubbed tummies”. These women that rubbed tummies were well known and endowed in the villages. They were lifelines to a majority if not for all of the pregnant women in that village. They made sure that the baby was well positioned in the uterus and if not, they had maneuvers that rectified any misalignment. Today science would term it the Leopold’s maneuvers. At thirty-seven weeks, Amarachi had received a piece of not too pleasant news from the midwife who hinted that the position of the baby was not in the expected position, however, she had been reassured her that it was normal for some babies to realign back to course if a particular concoction was ingested. It appeased the baby they said. It made the baby to change course and engage properly in the pelvis. Amarachi had gone into full blown labor at the tail end of the thirty-eighth week with a footling presentation. A presentation that was not expected by the midwife and one she was not equipped to handle or manage.

Amarachi and baby were now in a very dire situation. The nearest clinic that was near equipped to handle the situation was out of the question as financial constraints were a major key. The surest bet became our clinic that was located about ten miles from the village. When Amarachi and baby arrived, it had already moved to a life and death situation. We had hurriedly taken her to the back where she went under the knife and an hour later, delivered by cesarean section-an emperor’s cut, only for queens -saving mother and child since 1882.

The first call that came in was from the husband. He was very happy that the wife had given him a bouncing baby boy and was elated that the wife was doing well till he popped the next question. Doctor, how did she deliver? “omuru la onwe ya ?” “did she deliver by herself”…sounding very anxious rather than settled. I hadn’t quite understood the reason for anxiety, after all , the baby had been born. That’s what mattered. In this part of the world, people didn’t call to ask about weight of the baby, the color of eyes, hair, or how tall baby was, people were more concerned about the way the baby came into the world. They wanted to know which route he or she showed up in.

Photo by Jill Sauve on Unsplash

“Ole o tu oshiri muo?” how did she deliver?.. was yet another from Amarachi’s aunt. Each time, same response got the same reaction. An instant speck of disappointment, then a quick turnaround of “Thank God baby and mother is alive.

The “Passage” is the space that is available for the baby to pass through. This passage is formed by Mom’s pelvic bones — her physical anatomy. Although the overall shape of Mom’s pelvis is determined by her body type, hormones released during pregnancy (such as relaxin) allow for increased mobility of the pelvis during pregnancy and birth. If the joints in the pelvis are unable to move properly to create space or the bones in the Mom’s pelvis are out of balance, the birth is more likely to be difficult for both Mom and baby. We want a good balance of position and mobility for the bones and joints of the pelvis to create a nice, open birth passageway.

“Who does he look like ?”, “why is he so pink?”, “his nose looks funny”, a barrage of similar questions had reeled in succession as we handed the sixteen-year-old first-time father, his baby. I could as well paint the look on his face on canvas as he questioned anyone within earshot. It was a look of confusion and “not knowing whose baby that was”. The first time mum was only fourteen and had more questions for us at the recovery unit. The boyfriend had witnessed probably what seemed like his scariest experience in life as Brenda’s labor was dramatic to him. One minute he was supportive, urging her to keep strong, other times he was near yelling, wondering why Brenda could not finish this task as soon. Other times, he was huddled in a corner with the biggest earplugs I had seen in recent times, shutting and drowning Brenda’s screaming. He even threw up when Brenda defecated, he had started yelling at her for doing such a “gross” act. Little did he know what the young mother was going through, little did he know what the young lady was giving to bring life.

I can’t do it anymore, I just cannot…she had kept yelling. Greg was over her “ yes you can, yes you can"… more like a stanza in the choir” when she says, I can’t do it”, the response “yes you can. It must have gone for three hours and poor Greg had to go home. He had seen it all. He probably left thinking why it was so hard to give birth to a baby. He probably walked home thinking why a mere ten minutes of pure bliss led to an almost eternity of pain. He sure might have been discouraged on that walk home to do any act that led to this outcome. He absolutely would not underrate birthing in his life ever. It was everything.

Brenda and baby were saved by the emperor’s cut. A cut meant for queens who were ready to give whatever it took to give life. Brenda was already exhausted, baby readings were non-reassuring and progression was minimal, still remained in the high negative stations despite active labor and a decision was reached for a supposed vaginal birth to be quickly converted to a cesarean section.

In any of these situations, it was quite evident that the woman was ready to give all it took. It was also evident that no single woman knew exactly what she would be called on to give. “Man proposes, God disposes”- birth plans change all the time, birth plans even go sour but the women at each time remained steadfast to the change and still gave and gave.

Birth is a humble, submissive, sacrificial act — every time. It is always a gift.

For all the women that gave through long hours of labor, long bouts of contractions, for all those that successfully pushed and delivered, for all those that sacrificed themselves on the altar of birth, for all those that had terrible labors, for those that endured for days, and felt “shitty” for days, for those that upheld womanhood and those that fell short , the real truth is that they all became mothers and gave everything. These women gave everything and all to bring life. They gave all, physically, mentally and emotionally.

For all the women out there that feel a type of way when confronted with shame or guilt of not doing it “yourself”. Congratulations. You did it just like anyone else. You just didn’t know how you would be called upon to. You were chosen by the Emperor. You now have a scar to show for it. A scar that embodies you as a strong woman who fought the battle and came back unscathed. You have a trophy to hang on the wall to prove that you gallantly fought your battle. You have an addition to your name -the brave. You have yet another accolade to your stripes, an accolade given only by the emperor -the strong.

Our resolve is to attempt to change this perception. We will attempt this social change in a multi-faceted fashion.

Education : This would play a big role in making sure we meet our desired goal. The society of the old that created this perception did not know any better. They must have felt that other forms of childbirth asides from the natural route were a taboo or abomination. They also must have thought that it debased their womanhood and pride. Educating the younger ones right from the onset of junior secondary and high school will instill a sense of knowledge about the benefits of childbirth regardless of route. It will form a foundation of reference for would be mothers to accept knowledge-based decisions as the norm. It will validate the preference of health over perception and hopefully will have a ripple effect in generations to come.

  • Incorporation into syllables : We will push for incorporation of sensitization programs in syllables of schools. These programs will provide knowledge-based facts about childbirth and would attempt to steer away from age-long belief that is not fact based.
  • Provision of resource aids : We will strive to provide resource materials that support these facts hoping to create a bank of knowledge that defends misconception.
  • Crusader creation : We will create crusaders among the girl groups by arming them with enough information to disseminate to peers and immediate environs.

Social circle optimization : We acknowledge the fact that social circles play an integral part in people’s total development. Exploring and identifying these outlets would be key to reaching our goals. The churches among us would be approached to serve as mediators. These churches serve as a house of succor and respite to many and will come in handy if they serve as dissemination outpost for social ills like this one. The numerous women’s organizations “Home and abroad” would be presented with mandates to support our cause. We will urge them to include in their talking points, a comprehensive need to heed to knowledge-based facts about childbirth.

Point of contacts : We will strive to have a presence at the point of contacts that provide services to pregnant women. These point of contacts might range from the antenatal clinics to immunization fairs. Any outlet that provides an interface would be explored- where we can provide and prove that cesarean section, if needed is an acceptable alternative to save mother and child.

Experiences are bedrocks of events and we are harbingers of our future. Let us get it right once and for all and create women that will become queens, not only in the eyes of the emperor but under God.

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I am a crusader for common good. I derive joy in starting conversations that make sense.

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Uchenna Iwualla

Uchenna Iwualla

I am a crusader for common good. I derive joy in starting conversations that make sense.

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