Learning to Speak the International Language of Birth in Haiti

Night shadows seceded to pale blue light over metal rooftops as sharp rooster crows split the early morning highway traffic.  Her pains continued to surge.  Singing, swaying, pushing, praising, she labored down. Fluid trickled onto the tile, hands pressed against painted concrete walls stained by hundreds of hands before her, skin stretched over her bulging belly and flexed, muscular thighs. Squatting with her back arched and mouth open, she called out a Creole birth song.

This is just one of the scenes I observed in Haiti. Inspired by my Columbia Nursing professors, I spent the mid-semester break volunteering at a Haitian birth center to deepen my international clinical experience.

MamaBaby Centre de Maternite is located off a rural dirt road in Cap-Haïtien, a city on the country’s north coast. A colorful, hand painted mural advertises 24-hour birth services, as well as prenatal and family planning clinic days. Four formally educated, full scope midwives practice and live upstairs from the clinic, next to a room where volunteers stay. An outdoor shack lit only by candles serves as a kitchen. Rainwater is collected in a cistern.  Hanging laundry lines the rooftop.

The center is well known to Haitian women.  They arrive in labor day and night on motorcycles, in tap taps- colorful buses that serve as shared taxis,  and on foot. All health care is free, provided that they bring a sheet, two towels, a meal, and another woman to help them wash.

With a look or a gesture, and plenty of encouragement, these midwives graciously welcomed me to participate in births. I compressed backs and hips, protectively massaged perineums, caught slippery babies, clamped cords, delivered placentas, and put babies to breasts. The sound of the front gates opening awoke me each night and I quickly joined the midwives downstairs. I’d much rather watch labor progress than sleep. I’m learning Creole, but birth is a language I already speak.

Before sunrise each weekday, the courtyard queue fills with women lining the terrace steps or on benches under tarp canopies, babies on back and children underfoot. Prenatal, postpartum, family planning, and newborn screening clinics begin with a song, prayer and lesson.

Joining two midwives working with Haitian students, we assessed woman after woman on six wood frame beds. Two exam areas doubled as labor rooms. In between cleaning cord infections and assessing preeclampsia, we simultaneously slid an aluminum bowl under a birth stool, or paused to soak a forehead with a cool cloth as women swayed in tune to dilation, slapping the walls and fanning their strained faces.  I identified fetal heart rates with battery operated dopplers, recorded fundal heights with sewing tape measures, and palpated fetal positions. I also found myself savoring the privilege to come to know each woman and her reproductive challenges.

Haiti has the highest maternal mortality in the western hemisphere, yet MamaBaby hasn’t had a maternal or infant loss in more than 1,000 births. I arrived overwhelmed by injustice, inequality, and lack of access to reproductive care, but I left the center hopeful, and inspired by competent Haitian midwives and their resilient patients at this women’s health haven.