In the humidity and the darkness of her mother-in-law's back room, Hawa prays things go better than last time.
She has a backache and the baby, she says with discomfort, is "walking around" inside her, working its way down.
Hawa thinks she might be ready to deliver.
The last time was 2 years ago. Hawa was 18 then, and it was her first pregnancy. The first few months, she didn't tell anyone she was pregnant, but Gbassay noticed something different about her. She's the traditional birth attendant in Benduma, Hawa's village in eastern Sierra Leone. She can spot a pregnant woman a mile away.
Maybe it was Hawa's pale face. Or how she was sleeping all the time. That look—weak, tired, nauseated—she's seen it many times before.
Gbassay knew Hawa wasn't sick; she was pregnant. But Gbassay didn't know what would happen next.
'God, Help Me Get Through This'
Hawa developed a fever, a scorching, all-body ache that left her soggy with sweat, and wondering what was happening inside her. It was malaria, and that had Gbassay worried. She knew that when a mother gets malaria early in her pregnancy, the baby is in trouble.
As the parasite took hold of Hawa's body, she developed hypoxia—her placenta could not supply enough oxygen to the baby. The hours turned to days, and Hawa's fever heated up the amniotic fluid surrounding her baby. It was too much for the child. Hawa miscarried.
The aftermath was graphic—nothing a teenager is prepared to deal with. But for Hawa, the psychological trauma burned worse than the physical pain. At about the same time, her childhood friend, Weah, who was also pregnant, delivered a healthy baby boy, Momoh.
Hawa has a hard time looking at Momoh now—riding on his mother's back, toddling around the village—and not thinking about the little girl she lost.
Forget about it, Hawa's mother tells her. What's done is done. Hawa keeps her thoughts to herself, but the truth is, Momoh, now 2 years old, brings her back every time.
Right now, in this dank and musty room, Hawa is only thinking one thing: God, help me get through this.
Gbassay, who is sitting on the bed next to her, thinks Hawa is going to be fine. During this pregnancy, she's been pampered. Her mother and mother-in-law are anxious for a grandchild—their first—and they are pulling out all the stops.
They've cooked Hawa meat, usually antelope or bush rat, once a week, a rare luxury in a place where most villagers may eat meat only a couple times a year. Hawa left the back-breaking work of the rice field during her sixth month of pregnancy; many women work up until the day they deliver.
Maybe the best part is that Hawa's relatives have arranged for a car to take her the 2 miles to Daru, the nearest town. That's a vast improvement over the hammock that most women—while in labor—take, balanced on the shoulders of Benduma's strongest men.
Someone to Trust
She also has Gbassay. Thanks to a Catholic Relief Services project—financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria—130 traditional birth attendants have been recruited throughout eastern Sierra Leone to make sure pregnant women take an antimalarial drug, which is safe for mother and child. But more than that, Gbassay and the other birth attendants are there for women like Hawa to turn to when they don't feel comfortable discussing their pregnancy with their families. For women who don't have moms or are living with their husband's family, a confidante who lives nearby makes pregnancy a lot easier.
Hawa has always known Gbassay; they live in the same village. She doesn't have a sterile office, but works out of her hut and makes the rounds in the village. She isn't too stern, either. Many birth attendants in Africa yell at and slap women in labor. But Gbassay is soft spoken and kind. And maybe most important, she knows what it's like to lose a baby to malaria; her baby died in 1994.
It's not just Gbassay. Many birth attendants lost babies to malaria during pregnancy. Fatmata Sessay lost one before Sierra Leone's civil war. So did Musu Kongoma. If you travel up the mud road from Benduma to nearby villages, you'll find scores of women whose babies died because of the malaria their mothers contracted during pregnancy.
In years past, when mosquito nets were uncommon and antimalarial drugs weren't available, Gbassay turned to the forest for help when malaria struck.
Women rubbed ginger root or hot pepper all over their body and lay, covered with a blanket, next to a fire. They thought they could sweat the disease out of their bodies. Sometimes it worked, Gbassay said, but often it didn't.
After the birth, the new mothers and babies would lie next to the fire for 7 days, hardly moving. Why? Gbassay giggles. So the baby would be pink and healthy. Nobody does this anymore, she says.
The birth attendants now encourage women to go to Daru to deliver at the health post. As of April 2011, the Sierra Leone government requires that all health posts stop charging women to deliver and that an insecticide-treated malaria net be given to each mother after delivery.
Back in the house, Hawa is getting ready to go to the health post for delivery. CRS will drive her there. She gingerly eases off the bed and waddles to the car. Her mother-in-law scurries around getting food (no cafeteria at rural health clinics in Africa) and fresh clothes ready.
After a slow 2-mile drive down a rutted road, Hawa walks into the delivery room.
Then the waiting begins.
It's a long, hot night, and Hawa doesn't sleep. In the morning, she still hasn't delivered. The pain was a false alarm.
She heads back to Benduma to wait. Gbassay will be by her side.
Lane Hartill recently was CRS'regional information officer for western and central Africa, and was based in Dakar, Senegal.