The SHEROES Contributor
Sucheta Tiwari raduated as a medical doctor in 2013. She is now on a scholarship to study global health at the University of Oxford. She is deeply interested in understanding and improving Maternal and Child Health through Health System strengthening. In her spare time, she likes to read Vonnegut, watch Doctor Who, listen to indie music, and yet actively denies being a hipster."
Women at work- A birth
The issue of gender equality has been a long-drawn out battle to win our fair share of the world as human beings. For far too long, however, women have not consciously acknowledged what defines us as a biological gender: our choices and abilities to bring new life into the world. Understandably, people addressing women’s empowerment have tried to keep away from reducing the woman to a child-bearing machine. Has this come at a cost?
In her book “Love, Power and Knowledge”, Hilary Rose says that a woman birthing is “a moment when bodiliness and culture mingle boundaries.” To understand how a society treats its women, all one has to do is see how women of that society give birth. Just ask a woman: How many children has she had? How frequently? How many boys and how many girls? Where did she give birth? Did she want the pregnancy at all? Did her choice matter?- and, as doctors, we don’t want to admit it- but how was she treated in the labour room?
I trained as a doctor. I study global health. I have lived and worked in India, and I have known women who work in healthcare on two continents. A lot of my time is spent trying to understand why mothers die around the world. A great proportion of my time in medical school and internship was spent in a government hospital’s labour room. This labour room was an all-female zone. The doctors were all women, the patients, obviously, were all women, and so were the nurses. Male members of the family weren’t allowed in. Male members of hospital staff were only rarely needed.
Let me narrate three stories of one birth. A birth that could have been any one of the hundreds I saw when I worked in that labour room.
I am on my fourth night shift in a row. My body hasn’t completely adjusted to this new schedule, and I feel drained. I am a postgraduate trainee in Obstetrics and Gynaecology. I wanted to be a general surgeon, but increasingly, the demand for general surgeons is falling in big cities. Ob-G is a terminal branch where I won’t need to specialize further. I calculated my choices- I am expected to marry and bear children in the next five years; career will have to take a back seat. My fiancé is a surgeon, and if we want a stable family life, one of us will have to slow down. We didn’t think twice about who had to make that choice. It is a compromise I am comfortable with, now. I just wish the nights weren’t so long, and that there were more than three competent doctors on a shift. On some nights, I have had to take over ten deliveries in twelve hours. For the most part I try to do my best work, but the labour room is a battleground. Towards the end of my last night shift, a patient had to be wheeled in for emergency surgery and I had had to stay on for four hours after my shift ended- Only to return for my scheduled shift in six hours.
There are eight beds in this labour room, and three of them have more than two labouring women. It is an open ward, with the doctors’ desk in the middle, flanked by patients’ beds. It makes it easier to keep an eye out for any complications. Childbirth is dangerous territory. All women and their unborn children have to be frequently monitored for progress. Out of the twenty-odd women, eight are in an active stage of labour and are expected to deliver before her shift ends. Two have had caesarean sections before and need special attention. About four have had more than two children before and are expected to be the easy cases. One of these four women is screaming incessantly. She has been in the labour room all day. Finally, the baby’s head is finally starting to show. Time for action. I call on the nurses and ask the patient to the delivery table.
Screamers are always bad bearers. They are exhausted when it’s time to push the baby out. I have tried to tell her to calm down but there are nineteen other women demanding my attention- two of them at high risk. This woman has had two children before and should be able to bear down easily, but she doesn’t. She is in pain and weeping and calling for her mother. Her husband finally shows up and is asked to bring water. We need to help her push or the baby will get stuck and suffocate. I ask the nurse to give “fundal pressure” to her abdomen to help the baby out. Fifteen insane minutes are spent on the delivery table, and a girl is born.
“Is it a boy?” a small voice asks from the table.
My five year old son has the flu and has had to miss school. I fear I might be coming down with it too. I knew I was on a night shift tonight, but couldn’t get any rest in the day because my son had to be taken to the doctor. The mother-in-law heard about this and came for a visit, so most of the rest of my day was spent in the kitchen. I tried to switch shifts with other nurses, but nothing ever works out on such short notice.
The labour ward is quiet today, except for the woman in her third pregnancy who is yelling incessantly for her mother. I have made five announcements in thirty minutes for this woman’s relatives but no one has shown up. The nurses from the previous shift have prepared all beds, instruments, and documents well for the next shift. It should be a hassle-free night if none of the patients develop any complications. And now the screaming woman is on the delivery table.
“Nurse, prepare the delivery tray!” the post graduate doctor calls out.
Well, must be time for action.
Meanwhile, a student nurse has found the patient’s husband and sent him for water. The woman is visibly exhausted and pale and unwilling to push. The doctor says that the baby’s heartbeat is getting weaker and asks me to apply pressure on the abdomen. I look into the woman’s eyes and see nothing- she is incapable of any consent. She looks so young and so old at the same time. She is a twenty-two year old mother of three. Her sobs are now synchronised with my pressing her abdomen, trying to squeeze the baby out. It’s a girl.
I show the sex of the child to the woman and have her read and sign a sheet saying that she has given birth to a girl child. When the baby is taken away to the warmer, she screams, louder than before: “Kill the child!”
Third time on the table. Having experienced the pain before, you think you will handle it better the next time. No amount of pain prepares you for more. I have been in the ward for over eight hours. My husband and mother came with her to the hospital, brought me some food and water, and assured me that they would wait outside. He works as a medical representative for a small pharma company. He knows the ins and outs of this hospital. We have been married for four years and have two daughters. My mother-in-law wouldn’t visit the hospital like she did the last two times- because she wasn’t happy with the outcome on both occasions. She chose to stay back in the two-bedroom flat our family of six shares. The last nine months have been an exercise in averting remarks about the sex of the unborn child and protecting the little girls from outright hatred from their grandmother. The family cannot afford any more children- I hope this child is a boy just to get some peace of mind.
My bottle of water finished an hour ago. The pains have been getting stronger and longer. I can feel the baby descending. In desperation, I call for my mother. My mouth is parched and the pain won’t let me think. A loud scream erupts from my mouth, and I hear “Walk to the delivery table! Nurse, prepare the delivery tray!”
The baby is on its way. On the delivery table, I feel exhausted. I have been screaming in pain for too long, because no one was there to calm me down. My husband and mother haven’t responded to announcements. The nurse would come on hourly rounds and check my pulse. The doctor would occasionally look between my legs and touch my belly. They would both tell me to be quiet, but neither understood what the pain was doing to me, what the fear of bearing another daughter was doing to me. I try to push, but I’m too thirsty and in too much pain. My husband has finally responded to calls, I hear one of the nurses say. He was tired of waiting and had gone out for tea. Someone brings a bottle of water and puts it to my mouth. Lying down, I see strangers hovering over me, asking me to push. My body is on fire between my legs.
“Do you want the baby to come out or not?” The Doctor says. The nurse pushes my abdomen because my efforts at pushing aren’t good enough. I see her look into my eyes. “You have given birth twice before! We shouldn’t have to teach you!”
A sudden lightness comes over me and I almost weep with joy, but I must check- “Is it a boy?”
A tiny person is brought to me on a tray. It is not a boy. She is beautiful. I remember my girls back home and I can see my mother in law calling me a failure and I can’t see this beautiful girl in that house. I don’t want to. I see another year of breastfeeding and missing my periods and my belly growing in size and hoping and praying for a boy and I can’t take not being welcome in my own house anymore. “Kill the child!” I scream. And I weep because I hate myself as much as I hate my husband’s mother.
Chimamanda Ngozi Adichie warns us about the dangers of a single story. Life is shrouded in layers of stories. Life as a woman, even more so. Women in India are not happy with how our stories have evolved to the present day. Last December, the gang rape of a girl in Delhi opened the eyes of a nation to the horrors of the everyday life of an Indian woman. If we have to steer our stories in another direction, we must understand the plot. We must peel off, examine, and edit all the layers of stories. It is the only way to fix a bad plot.
My work involves trying to understand why women get sick and die. A by-product is learning how sick societies and sick women share the same story.
Professor Mahmoud Fathalla of Egypt has put it succinctly: “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.”