Deliverance

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Scenes from the national Maternity Hospital, Kathmandu.

Yesterday all the blood rushed to my head and I thought I was going to pass out. I had to go stick my head out the window and wait for the feeling my face was swelling up to go away. Then for a while I had to fight back tears. "This is not your moment Robin. This is this nice Nepali lady's moment. Do NOT cry." Then when it was all over I just stood there smiling like I was on drugs, peering at the shriven creature whose messy twisting entry into the world I had just audienced. I'm going to be a doctor? Right.

The only childbirth I had ever seen before yesterday was of large farm animals, precisely one lamb and one foal, and the lamb was in kindergarden. Somehow in humans it's different, even though on a nuts and bolts level it's quite the same. There is pushing and resting and wetness and blood and lots of sweating and eyerolling. But that makes it sound beastly, when really, at least to me, in one of my fellow humans it was almost elegant.

I've never been at a delivery in the States, so I didn't have any fast expectations for what would go on at Maternity Hospital, but from my limited experience around American medicine the following I have deduced is different enough to be worth nothing. First, women admitted in early labor all hang out in big hall called the antenatal room, a really tense place with great communal squirming and blanket-clutching, and lots of yelling by nurses and doctors, but mostly silence from the pregnant women themselves. They wait there until things are more or less a go, and then they get wheeled to a bright room full of cabins like office cubicles, open on the side facing the middle, staffed by young nurses wearing baby blue, unless there is some complication like a breach, and then they go to a darker scarier more metallic and wide open room staffed by doctors. To enter either "delivery theater" you have to take off your shoes and put on a pair of communal plastic sandals like a chain-smoking house-coat wearing grandma in Ocean City would wear. The nurses all wield knives and needles and scissors with open-toes, and I even saw a few birthing attendants walking around in bare feet, no lie, among the blood and other liquids on the floor. No one seems to think this is a hygiene issue - no one even made me wash my hands when I came into the delivery room in my street clothes.

Husbands do not stay with their wives during any of it. The women all had a female friend or relative attending them who stayed for the whole thing, but the men wait outside in a cloud of cigarette smoke, sucking on death while their wives are pushing on life. The woman whose delivery I watched start to finish had to have an episiotomy, a really terrible procedure involving a knife, some local anesthetic, lots of blood, and pretty great risk of messing up something important, whose purpose is to open things a bit when the baby is too big. (look it up.) On top of that she had her first child, a boy (a really big deal here), got sewn back up and cleaned up, and hung out with her baby for at least 20 minutes before her husband finally came in to see her. He didn't kiss her or the baby. But he did bring a glass of milk and some cheese crackers. I hoped that that was some kind of specific request - honey all I'm gonna want is to see your face and some cheezits, ok? - but I don't speak Nepali and the wife never stopped smiling so I have no idea how her post-partum snack went over. I do know that during her labor she would look up from time to time and make eye contact with me, the random white stranger who was staring at her crotch for the most important moment of her life. I was usually horrified by half of what what I was seeing or teary eyed or woozy, but if she looked at me I'd smile really huge and nod super encouragingly as if everything were going SO great, and make prayer hands and nod some more - and she always smiled back. I would have kicked me out immediately, so I was really impressed.

I think delivery is handled really well at Maternity Hospital. Of course there is no privacy whatsoever, and there are weird hygiene issues like the bare feet thing, and the fact that they reuse rubber gloves, washing them and hanging them to dry, and then there's the nurse in charge of weighing the new babies who grabs them by the feet and flings them down pretty roughly on a metal scale, a total law suit in the US, but those quirks aside it's a very professionally run show. I guess some part of me expected to leave shaken, pitying the women of Nepal who give birth in squalid conditions (a lot of them do, this is the nicest place you can go) or terrified of ever having a baby myself. But weirdly I felt relieved. It's tough and gross and as gory as I could have imagined, but they make it through ok, and I think I probably could too.