Saturday, January 22, 2011

Birth Around the World: A VBAC in Tajikistan

Rhiannon Laurie, a doula and student at Western Washington University, sent me the story of a birth she attended last year in Tajikistan. Rhiannon recently returned from a 10-month stay in Tajikistan studying childbirth and culture, funded by Fairhaven College's Adventure Learning Grant. She writes: "In Tajikistan I worked with an Intergovernmental Organization on AIDS prevention in Birth Hospitals, studied traditional medicine at a University, attended/observed one and a half births (read about them here), and (perhaps more importantly) sought to form deep and genuine friendships with the people I met."

Rhiannon runs the website Childbirth for Transformation.


by Rhiannon Laurie
An examination room at the birth hospital
The room is dirty and cold. There is a bare electric light hanging from the ceiling, but the power is only one from 6a.m. to 8a.m. and 6p.m. to 9p.m. and right now it is midmorning. So our light comes in through the dirty glass of the window, and the little heat we have is from wood stove boiling some water in the middle of a room.

“We” are a young woman, her kurta dress up over her knees, her long smooth legs bent into stirrups, and me. I’m the American standing uncomfortably on the side of the room in a borrowed white lab coat. The one who keeps putting her notebook down on the table and then picking it up again.

For ten months in 2009-2010 I lived in Tajikistan on a grant to “study childbirth.” It took me the better part of the year to manage to sneak through the red tape to see one, but it was certainly worth it. Even when the KGB chased me out of town later that week.

We are in a mountain village named Jirgatol in the valley of Gharm. It is one of the poorest parts of Tajikistan. Villages here cling to tiny bits of flat land between looming mountains and the river far below.

It was poor even to start with. Then the Gharmis lost the recent civil war and things got worse.

I am visiting from the capital, and the people I’m staying with won’t let me out of compound without an escort. Actually, they won’t let me go or be anywhere without an escort. This is the type of life I came here for, but already the KGB are pestering me for more documents every day, and the squat toilet visible to all the nearby houses is giving me a run for my money.

All this for a chance to see a birth.

Let’s call her Nodira, though no one told me her name. She has one of those gorgeous Tajik faces – light brown eyes, freckled skin, and softly curling brown hair. She’s so thin that her belly looks like it should belong in early pregnancy – and yet here she is pushing her baby out.

She is accompanied at various times by me, the doctor, the nurse-midwife, a “sanitation worker,” and her friend. And yet she seems thoroughly alone to me.

I’ve preached endlessly about cultural relativism – that reminder that something abhorrent in our culture may be quite right and good in another. But I can’t help but flinch at the way these normally kind people treat her.

The doctor, a small and equally pretty woman with four daughters (she plans to try again for a boy when her youngest turns two), turns into a force of rage and brutality in the birth room. She and the midwife stand between Nodira’s bent legs, chatting about unrelated subjects between contractions, and repeatedly flipping her dress farther up her body whenever she tries to pull it down to cover herself.

A contraction comes up and the midwife leaves the room to get something, opening the door briefly onto a busy hallway with medical students rushing by – no money for curtains for privacy here. The doctor wedges herself between Nodira’s knees – one shoulder digging into one and both arms pushing the other. Her legs are braced against the bottom of the bed so as to force Nodira to open even farther.

I do yoga every day and there is no way I could get myself into that position at all, much less on a high steel bed as I tried to birth my baby. Nodira cries in pain. Her friend, standing at her left side, worriedly shushes her. I remember my host mother’s proud words: “The Russians and Americans might scream in birth, but we Tajik women keep quiet.”

When the contraction is over, the doctor flashes a frown. She picks and plucks at Nodira’s belly with her fingernails to start another contraction, and begins to lecture.

“You think we’re just going to cut this baby out too because you’re too lazy to push? That’s not an option. You either kill your baby by not trying or you push it out.”

Nodira is crying, “Oh Ochajon, please don’t do this to me.” The doctor just glares. “Try harder.”

I move over to her side, uncomfortable with the voyeurism of my situation. I pick up Nodira’s smooth hand and smile. I know that Tajiks feel affection differently than I do – that a stern word can be a sign of care and love. But I can’t leave this room without having given her some warmth and light, even if it’s culturally inappropriate to do so.

She rolls her tired eyes over towards me and smiles back through her surprise. I’d be surprised too – a stranger showing up in the birth room. It breaks all my rules of conduct for attending births in the U.S. but here I am.

Before the next contraction, Nodira slips into that late labor sleep I’ve seen in births I’ve attended at home. There we would see it as a good sign, provided labor was progressing normally. It means that the mother is staying relaxed, getting the rest she needs, and that she’s basking in all those late birth hormones.

The sanitation worker, a kindly old woman boiling water with which to scrub gloves and aprons, lets out a “oy!” and the rest of the team is called into action. The doctor flicks cold water in Nodira’s face.

“Didn’t you sleep last night? If you pushed better you’d be in the recovery room napping by now.”

When the next contraction comes the doctor is once more pushing legs every which way. I lean down close to the mother and whisper “good job, wonderful job, you’re doing so well,” though I can’t tell from her response if she even understands me. I learned Tajik in the south from southerners and the Gharmi accent is different.

A few more contractions pass and more lectures are given. I quietly demonstrate what effective pushing looks like and Nodira watches intently. This backfires when the doctor sees and exclaims “see, even this unmarried American knows how to push!” but with subsequent contractions she seems to be doing it better. Finally the baby begins to crown.

Now it looks like all the U.S. birth rooms I’ve seen, with everyone screaming “push, push, push,” though in the U.S. we ought to know better.

As the baby comes out, Nodira reaches down to feel its head, to guide it out with her hand. The doctor slaps her, “Don’t touch! What’s wrong with you!” and begins to wrestle Nodira’s right hand back up the bed towards me.

Her friend and the midwife are both working together to hold down her left arm but I am aghast at the brutality of it even as I’m once more in awe of birthing women’s power. The sanitation worker has to lay on her right arm by herself, without help from me.

Then suddenly, like it is always sudden, there is a big wet baby in the room. She’s a big healthy girl. I can’t believe she fit in such a small body. The set her on a blanket on her mother’s stomach to cut the cord, suddenly upset that she won’t touch her baby. “Are you going to let her fall off you?!”

That is only momentary. She’s whisked off to the other side of the room to be cleaned, dried, measured and wrapped – all with supplies Nodira had to bring herself. Then they turn her to one side (presumably so she won’t choke on anything) and leave her all alone on the high table.

As soon as they take her baby away, Nodira begins to shake. Through her tremors she asks if it’s a boy or girl, and lets out a small wail when she hears “girl.” In most of Tajikistan, people are excited by all children and most families want girls as much as they want boys.

But in Gharm boys are a much more important commodity and a young daughter-in-law’s status is precarious until she’s had a boy. With a second girl Nodira has deeply displeased her husband’s family. The doctor looks at her kindly and says “girls are gifts from God too, you know.” I want to hug her and strangle her at the same time, but I’m still holding Nodira’s hand.

The placenta is easily delivered but then there is a tear to be sewn up. A struggle ensues between the wildly panicking Nodira, who bucks and shakes as though she wants to crawl right out of the bed and into the sky, and the determined doctor, who is going to give her stitches. I can’t watch. I can’t listen. I walk back over to my notebook and pick it up. Put it down again. It’s all over soon.

Nodira’s friend asks if they can put a jacket on her. It’s almost as lovely as her kurta dress – I guess they are the finest things she owns, gifts from the birth of her first child. She is covered up and turns her head on the pillow, closing her eyes as if to sleep.

I realize that everyone is leaving the room. The midwife is already gone, monitoring some of the other women in labor. The sanitation worker has finished mopping the floor and left as well. The doctor looks at me, that familiar look telling me I’m doing something strange again, and says “let’s go have some tea.”
I glance at the baby, lying on the table a good ten feet from her mother, and back to the doctor. “Come on. It’s tea time.”

You don’t disagree with your elders. I go.

That was my Tajik birth. I was invited to another later that day, but the woman was Kyrgyz so I couldn’t communicate with her and she seemed uncomfortable with my presence. Still feeling conflicted about my role in the earlier birth, I bowed out. And then the KGB kicked me out of town and there was no way for me to see more.

I don’t want to give an unfair representation of this clinic. Most births in that region take place at home, though home birth is technically illegal. Births in the clinic are the worst cases – often women who’ve been brought in from hours away on donkey back and near to death.

Hemorrhaging and pregnancy induced hypertension were high. And yet the doctor and her team did the best they could for women every day with the skills and training they had. And they were kind enough to let me hang around observing and asking questions.

All the births I’ve attended sneak up on me sometimes. I’ll suddenly stray into a memory of a mother’s breathing, or relive the moment she truly accessed her inner force. But this birth is with me even more. It stalks me, calling me back. Calling me to midwifery training and then to organizations which improve birth practices in Central Asia.


  1. All in all, a very nice insight.

    Still I cannot but remark that the KGB ceased to exist in 1991 and it was the USSR security police.

    In Tajikistan, as much as I can tell, it could be the KDAM or SCNS in English.

  2. @Kata - Completely right. But the locals still refer to them as the KGB.

  3. Wow, it is so hard to look at things subjectively without our culturally biased judgments. I know nothing about this culture but have lived abroad for a time and know that it can be a confusing experience.
    It is all too easy to want to impose our cultural beliefs onto others. I am really impressed at your sensitivity to the situation especially when you left with the doctor even though everything in you wanted to help the woman. But I am also glad that you felt a need to show compassion to this woman despite what was "appropriate." I really hope that you realize your dreams. Good luck!

  4. It amazes me how unkind women can be to each other.

  5. WOW.


    It's jarring to realize how stark the difference in birth practices is worldwide. Edifying.

    Thank you for posting this, and for your work!

    Kristine Burneko

  6. maybe not so different in many ways to many 'western' hospital births, just that we understand/accept the negative parts of culture, the nuance better and forgive it more because we understand its roots , better in our own culture. I read birth stories here in Oz hospitals and am just as horrified.


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