Who are the women who birth at the Kafountine clinic? Kafountine has permanent residents who are Wolof, Jolla, Mandinka, Peuhl and the various regional sub-tribes of these major tribes. In addition, it has residents who have migrated, on a permanent or temporary basis, from the Gambia or Guinea Bissau. If you were in labor and having a baby at the Kafountine clinic who and what do you bring with you?
When a laboring mother arrives at the clinic the women family members and or female friends bring a large plastic basket which contains numerous “pons” (or large pieces of fabric that can be worn as a lapa or a head piece or a shawl or used as a pad or to tie around things to carry them) and fabric for the mom and baby to wear and any other birthing and post partum supplies.
It is the sole responsibility of the laboring and post partum mother’s family and friends to take care of her.
During labor, they labor sit the laboring mom; they provide her with food and drink throughout labor; they find one of the metal buckets for her to use as a bathroom. They watch over her and report to the sage femmes or matrones when the laboring mom needs help or they have questions. The concept of loving, gentle labor support by providing soft touch and words of gentle nurture and encouragement (warm fuzzies) is rarely done. The women are more staunch in getting the laboring women to move and walk and work hard. Labor is hard work and the faster and harder, the sooner the baby will come. Laboring women do not make much noise; the shake their hands, tighten and beat their fists, compress their forehead, jaws and faces, hold heir lower backs; and first time mothers kneel to the ground; first time Peuhl mothers sometimes call out for their mothers.
Men do not attend birth!! They do visit the mother and baby after the birth and they have been placed in the Le Grand Salon. No women family members or friends are allowed to be present in the delivery room!
After the birth, they keep watch over the mother and her baby. They bring food and drinks, with the necessary glasses and dinnerware. They bring a blanket for the post partum bed. They bring a mat for each person who intends to stay with the laboring mother upon which the women family members and friends can sleep on the floor near her bed. The clinic has 2 foam mattresses for family members to sleep on, but there are always more people than the 2 mattresses. Family and friends simply sleep on the floor with a cloth over them—they do not have mosquito nets. They cook for the mom in the outside courtyard on the coals if they do not bring already prepared meals. They wash the mother’s and baby’s clothes. Most importantly, they let the sage femme or mattrone know if the post partum mother is having a problem, like a post partum hemorrhage, or the baby is having a problem.
When do laboring women arrive at the clinic?
Just like in the U.S., some first time mothers arrive when “they think they are in labor” and after a vaginal exam and timing and palpating contractions are found to be less than 3 cm. dilated and in very early labor. Some first time mothers do prodromal here too! They like all women who enter in any stage of labor are kept but are only admitted if they are 3 cms.
Once you enter the clinic in any stage of labor you are kept! The clinic would be fined if a laboring (even in early labor) mother left and later had her baby at home. The women family members and friends are responsible for labor sitting her and the sage femme or matrone will do a vaginal exam every hour to see if she is progressing.
More seasoned mothers will arrive in active labor when they think birth is imminent; many walk in the door at 7-8 cms. and have their babies within 60 minutes. A sizeable number arrive when they are complete and ready to push. And each week at least 1 woman arrives after her baby has been born at home to have the sage femmes or matrones deliver the placenta and examine the baby. Those women who birth at home go outside in the bush to birth their babies. They do not want their families to see them in pain and it is important that their husbands and male children not be exposed to birth blood.
Women who have had one baby at the clinic tend to stay home as long as they can for any subsequent babies. Why? Some tribes do not trust medical interventions in birth and avoid the clinic for prenatals and birth as long as possible; some women cannot afford the cost of delivery (Senegalese $ 1,250) and need time to collect the money from friends and family.
In addition, the laboring mother and her family need to have money available to pay for any medications that are outside of the routine labor, birth and post partum medications (pitocin, methergine, iron pills, etc.). For instance, IV fluids must be paid for by the laboring mother and they are not always available if the pharmacy is closed.
More costly is the transport to the hospital, usually the one in Ziguinchor which has a surgical team, can cost the laboring other and her family Senegalese $20,000. As a result, medical interventions are made on three levels here with multiple delays:
- A medical determination;
- A family decisions that the recommended treatment is something they agree with and can pay for; and
- Effectuating the decision—collecting the money, getting the pharmacy to open and get the medicine, getting the ambulance here from Ziguinchor or a private taxi to Ziguinchor.