The mother I was to deliver was a 19-year-old prime gravid patient I had watched all morning as she handled the intensifying phases of labor. At times she would pace, bent at the hips, back and forth beside the bed, like a pained cat, tethered by her IV line. When the contractions grew stronger, she moved to the floor beside her bed and began hitting her thighs, trying to distract from the pain. Her voice changed from a sort of rhythmic chant in her native Lugandan to now screams that she tried to stifle. You see, she and all the others who come here to give birth have no anesthesia, save for those who go for surgery. The only pain medication they have is the mental strength they can muster. She became more and more restless as she now placed herself on the bed. She rocked back and forth on hands and knees as sweat dripped from a face that turned with each contraction. Finally, it was time. The midwives called me in to get my gloves and supplies ready. With careful hands and a pounding heart, I delivered her first baby boy! I placed him on her chest, vigorously rubbed his back, and he let out his little cry.

There was no feeling like it. Head first, this baby boy slipped into the world and I was there! As I placed him on his mom's chest and vigorously rubbed his back to encourage a strong cry, I recognized this intense feeling that this was what I was meant to do. Believe me, I know how corny this sounds, but it is my complete truth. As he cried, I couldn't stop myself from wishing him a happy birthday even though I knew he had no idea what I was saying. I tied and cut the cord and off he went with Joy to get his weight and to be swaddled. I looked down at his mother, who was so much calmer now and congratulated her. She had gone through one of the most natural and most painful experiences, and to look at her now, so quiet and reposed, without the context clues, you would never know it. She thanked me and I thanked her. It was beautiful, and cliché, and I would not trade it for the world.

The Hospital

Kawempe is a government owned hospital which is underfunded and under resourced. You enter and walk up a series of long and broad concrete ramps that connect at right angles, encircling the double elevators that run the middle. Walking up the ramps, one has to take care not to disturb the many people that lined the walkway floor, avoid the occasional bed headed down to theatre (what they call the operating room), and carefully maneuver around the very pregnant women making their journeys up to the different departments (Yes, here, very pregnant and very mobile. They move themselves on the labor bed and, at times, they walk themselves down to the operating room. I'll never forget the woman who was headed for an emergency cesarean who so politely asked me to help her with her shoes so she could walk down to theatre—I was shocked at the soft voice that came from a face that read contraction. But, I digress…). Oh, and depending on the time of day, you had to be sure not to be swept up by the brown river that the staff pushed from floor to floor to clean the hospital. There are plenty of windows to let in natural light and occasional breeze. Unfortunately, they also welcome the heat and insects.

The way Kawempe works is this: it's a free hospital. How so? It provides the doctor and the patient provides just about everything else. Women coming here are expected to come with these items in hand:

• Basin: for vomiting and bedpan needs
• Roll of raw cotton: to help absorb any fluids, clean the patient—essentially used in place of gauze
• 2 bed sheets: for the patient to use
• Plastic tarp: to protect the bed beneath them
• Sterile gloves: at least five pairs to be used for vaginal exams and delivery
• Baby blankets: something to wrap the newborns in
• Large wrap: for them to wrap themselves in
• An attendant: someone who will wait in another room throughout her hospital stay and be available to get supplies as needed
• A small bottle of bleach: to help sanitize the bed, floor, or the operating room after she delivers

The hospital provides pitocin, IVs, lidocaine, and IV fluid.

If a woman sustains a tear that needs repair, she needs to have her attendant purchase sutures. The hospital provides lidocaine, a local anesthetic. If she requires a cesarean, the attendant must purchase:

• 6 sutures
• Tramadol: anesthetic for surgery
• Sterile gloves
• Bleach bottle
• Bed sheets, plastic tarp, baby blankets

Where might a woman delivering in the middle of the night find these supplies? Next door to the hospital is a convenient little pharmacy that carries all these supplies.

I spent most of my time in labor and delivery on the fourth floor, 16 turns up from the bottom floor, which was a great daily workout. The labor ward was largely run by the midwives. There were medical students, residents and full-fledged physicians present, but the show was largely run by the midwives. Many had years and years of experienced and knew how to help deliver births that we would easily do a cesarean for: single breech delivery (when the baby is coming out foot, feet, or bottom first), twin breech delivery and just about anything in between. The midwives ran the floor! They taught first time moms-to-be how to push and knew when it was time for a woman to reposition, to push harder and when it was time to send her down to the theatre. They felt bellies with their hands to determine how the baby was lying in the abdomen and listened intently with fetoscopes--a very valuable tool as there was only one doppler available which was rarely found. These were the women who taught me how to deliver a baby.

The ward was one large room, which is very open, with only large walls that act as partitions between the different section. There were 4 sections, each with about 8-10 beds placed in two rows. As much as I would have thought it would be a shared experience between one woman and her neighbor, it very much was not. They rarely spoke to each other and I certainly did not see them comfort one another through the contractions. I think every woman there understood that this was a solo journey and, scared or not, only she would go through it.

Memorable moments on labor and delivery:

• Catching my first baby, all by myself, and handing him to one of my closest friends!
• Doing a vaginal exam and feeling a foot. That mother delivered a breech baby, and both she and baby did just fine!
• Finally learning how to properly stimulate and swaddle a baby—making a baby burrito as I call it.
• Placing and starting IVs successfully.