We’ve heard from Virginia and how she felt abouther trip to Pakistan and the wonderful family she met there. Now hear what Sofia has to say about her experience.
Day 14 – Homecoming
And so at the end of the day, 14 days after I arrived scared, worried, and wondering what the near future had to offer, my time here in Karachi, Pakistan has drawn to a close. I am awaiting my transport to the airport; the much loved and trusted Muna will take me back to the place where we first met. It’s late at night and Sofia is asleep with her two babies. The beautiful new baby girl is to be named Lily May.
“She didn’t stop until she proved all of those, and more, that she could and would have her right of passage.”
Am I please to be going home? Oh yes, for sure I am excited and relieved that the day has finally come. I can’t wait to snuggle up with Sean and see the rest of my family. But am I glad I came, did I have a good time? Yes, I did. Am I upset to be leaving this wonderful family, this amazing contradictory country? Yes, I truly am. I met a wonderful, strong woman and her mother who showed me how hospitality should be done. I have met so many strong women when it comes to childbirth over my years as a midwife, so many who have fought for what they want in a country where normality and midwifery is the norm. But when you have a whole family, a whole society, and what appears to be a whole medical establishment to fight, most women would have given up. Not Sofia, the pocket rocket of just 21years old. She didn’t stop until she proved all of those, and more, that she could and would have her right of passage.
She took Lily May outside today to show her off to the staff and I could feel the pride in what she had achieved just oozing out of her. With her newborn baby girl in the sling and little Ebo on her hip I knew the love this little family had would see them through life’s tough times.
Dr Azra came by today. She had said she would help Sofia with obtaining a birth certificate, and once more we discussed what is so wrong with childbirth practices. She asked if I would come and speak to the teachers who teach the local lay midwives. Of course I would love to do something like this, but as I explained the problems is I have a mortgage to pay in the UK. Without hesitation she replied that she could put some sort of package together so I would be paid! Wow! I will certainly be keeping in touch with Dr Azra.
“It was as if she had been in on the full home birth plan anyway.”
We discussed Sofia’s homebirth, and although we had never been fully open about the homebirth being an absolute plan and instead had focused on “staying at home as long as possible”, our discussion appeared not to acknowledge that. It was as if she had been in on the full home birth plan anyway. She told us that many of her colleagues had given her a lot of flak for supporting Sofia’s birth plan (the one where Sofia had written “I do not consent to bla bla bla” all the standard interventions for a VBAC) so I say “Good on you Dr Azra.” I wish we had more doctors like her, and even more midwives, standing up for women’s’ informed choices worldwide.
We took some great photos of us all and we certainly look the A team in them, or maybe that should be the P (Pakistani) team. Right to the bitter end Muna and Sofia made sure I was neither bored or lonely and today they wanted to make sure I had missed nothing. So after a spot of lunch brought to us by the sweetest, ever-present maids; Rumi and Sunia, it was time for Muna to take me on our last excursion. We were off downtown to the market. On the way I was quite surprised to see lots of street sellers with huge hordes of valentines balloons! Of all the western cultures to hit the 3rd world, and one is red heart helium balloons on February 14th. As I knew Sofia would not be getting a Valentine this year I asked Sharif to pull over so I could buy her one. It was 50 Rupees (38 pence).
We arrived at the market, which was indoor, and housed many stalls filled floor to ceiling with fabrics. An amazing and abundant display of brocades and silks, cottons and chiffons. Each stall was like a mini theatre with stall keepers literally elevated on a stage displaying their wares to an audience of excited women sat on chairs facing them. I would have love to have purchased loads of the wonderful fabrics but using a needle is not one of my better skills!
After our outing I had to do the rounds of saying goodbye to people, and the first was Sofia’s grandmother (the baby who was born in the Caul). At 88 she is frail but she is sound of mind and has a lovely heart. She gave me a gift of a beautiful 2 tone soft cashmere pashmina, and it is not one of the cheap imitations either! The hug I gave her was genuine with affection and I was sad to think I would never see her again.
Back home Sofia gave me the glad news that her baby had finally had her 1st meconium poo which we had all been waiting for. I had already done her first day examination to check her hips, eyes and heart, so Sofia had no need to rush off to see a paediatrician any time soon. With all boxes ticked I was now content to go. The time had almost come. Just one last thing to do…
I wanted to see where this huge amount of food went that the family chef cooked every week. So not only was the boot loaded with the latest hot pot, but I contributed a huge amount of oranges for the grand price of £3 and jumped into the car.
Muna, as always, at my side, I was glad of her company when we arrived at the orphanage to deliver the food because the area felt anything but safe. Although we had two male staff members with us, Sharif and the chef, it still felt sinister when we stopped in a dark street hardly bigger than an alleyway and several males were hanging around. Then orphanage was really two apartment blocks; one for girls and one for boys; and although it was painted in bright colours it was pretty bare except for sofas and beds. There were no toys, books or games, and no TV from what I could see, but the kids were healthy and very happy to see us. Muna asked them about their backgrounds, and many still had at least one parent, but the common problem was that the parents could not feed them. One brother and sister had a mother who had re-married and there was not the choice to keep the kids. The ages ranged from 3 to 17 and all the kids went to school. Two of the older girls were even planning high school and university educations. This particular orphanage was set up by an English woman, and is run purely on donations from the communities.
Back home and dinner was with the whole family, including Azaan’s mother and aunt. It was probably the only meal I didn’t enjoy for the whole time and that was because it was a take away! All the lovely home cooking has spoilt me! Azaan presented me with another beautiful local fabric made wrap and said it was tradition to give such a gift to the person who had helped deliver your child. I was touched and honoured to receive such gratitude.
And now here I am and it’s over. My case is packed, the room is bare and all that is ahead of me is a long night’s journey…
I am coming home!
Day 13 – Showtime
Last night we wound down with a very relaxed but also exciting evening of Henna tattooing. Sofia had said we need to be home by 6.30 because someone was coming to paint her belly. In the morning we had been ‘ooing and arhing’ over all wonders of artistic designs on pregnant bellies which Sofia found on the internet. I was expecting a grand artist to be coming, so was somewhat surprised therefore to find that it was Rumis’ daughter Fatima who was going to be our artist of the evening. Fatima is just 12 years old! I was doubtful that some of the intricate art from the pictures we saw could be replicated by such a young child. However, I have been delightfully surprised by many things about my time in Karachi and Fatima’s artistic skills were just one more such occasion because, boy oh boy, is she clever. The beautiful floral and bird design flowed up around Sofia’s pregnant bump all the way to between her breasts. Sofia was like an excited puppy dancing around showing off her new funky baby belly. We took lots of pictures and no woman could have appeared prouder of herself than this happy mum to be.
And so another day in this strange and interesting country was falling to a close. I felt tired and decided to take to my bed and try to sleep a lot earlier than usual. So 10.30pm saw me winding down and almost ready to fall asleep.
However, day 12 was determined to end on a bang and day 13 to be the ultimate day, the climax, the reason for me being here. The baby was on its way!
The long awaited knock came at approx. 11pm. I jumped up out of bed in a nanosecond and opened the door to find Sofia in a state of nervous excitement, “I am having contractions, it’s just started what do I do?” she asked. I lead her to the sofa and asked her to remember all the talking we had done. I reminded her that this could all stop, that it was early yet and could potentially go on for quite some time. Eventually, after lots of reassurance, I went back to bed, only for her to knock just 40 minutes later to tell me that water was running down her leg! It didn’t take long of observing Sofia for me to know that this labour was coming on fast and I was not going to be getting any sleep. Instead I cleaned my teeth, pulled on some clothes and began to do what I do best. I was once again in my element and supporting a woman in her hours of need.
“The room was filled with positivity, with love, with oxytocin, and with belief.”
All worries about us being in another country, Sofia having had a previous caesarean section, about post-partum, resuscitating babies and shoulder dystocia floated away to the back of my mind to be replaced with calm confidence and strong belief in the process that was beginning. I had done my skills drills in my mind over the preceding days and had all safety plans in place. I knew Sofia was making fully informed choices and we had mutual trust and a strong bond between us. It was going to be fine. There was no room for doubt, no room for worry. The room was filled with positivity, with love, with oxytocin, and with belief. There was only left for a little more love to enter the room, and that love would be bought by the two people yet to know that labour had begun, Azaan and Muna.
As Sofia called to be doused with ice water all over her body, to bring comfort from the heat-filling surges of power that were rushing through her body, I observed that labour was progressing fast. I could see, as she lay over the sofa with her back to me the Rhombus of Michaelis bulging proud, and as I massaged her back I could also spy the telling pink line of progress creeping up between her buttocks. I dialled Muna’s number from Sofia’s telephone and in turn she called Azaan to come too. Sunia, who had roused sleepily from her bed was, as per the plan, filling the pool. However, one glance at the ever deepening water and I was off in my mind arguing with myself about what I thought. The water was not the clear, crystal see through depths I was used to in the UK, but instead it was a murky yellow colour. Did this mean it wasn’t clean? Was this a problem for birthing the baby or was this just normal for here? I suddenly had horrible thoughts of a baby with legionaries disease flitting though my mind. Oh dear what to do?
“The Entonox we had fought so hard to find was some comfort to her.”
Sofia started to get expulsive whilst laying on her side on the sofa at around 01.30, and was just a little distressed. The Entonox we had fought so hard to find was some comfort to her, and she sucked on it during every contraction. Afterwards she said she was glad of the Entonox mask because it muffled the noises she needed to make and that helped her not worry about little Ebo hearing her. Once a concerned mother, always a concerned mother!
The ice cold flannels were giving her lots of comfort and she continued to ask that they be put all over her body. I looked over at the warm pool and thought she probably wouldn’t enjoy it anyway. However, she wanted to try it and so we helped her into the murkiness.
Unfortunately for the doubts and worries in my mind concerning the water quality, she found it to be heavenly. A vaginal examination in the pool found Sofia to be already 9 centimetres dilated. Wow! “I never got past 2 last time” she cried with a delighted smile on her face. She continued to be expulsive and I continued to fret about the water colour. I had taken my birth mirror all the way to Pakistan, but there was absolutely no chance of it allowing me to see if the birth was imminent in the yellow murky water. I was worried the birth was close, and by now the water issue was a high priority in my mind. I wanted to get her out of the pool! Sofia had now been pushing strongly, albeit prior to being fully dilated, for around 2 hours so I suggested “a change of position may help baby come down, so how about a quick walk around the room?” Sofia agreed happily, and out the murky water she got to my instant relief.
"Baby was gently born into my waiting hands at 04.16.”
A supported squat showed baby’s head clearly visible with a black mop of hair. It was now 03.35, and Sofia asked me “how much longer?” That typical, asked a million times over by women in labour, question. I felt confident to tell this brave woman that it would be minutes, not hours, before she would hold her baby. After a few supported squats Sofia wanted to lay on her side on the floor, and did so for the last bit of birthing her baby. As baby was gently born into my waiting hands at 04.16, I noticed a tiny hand up next to a shoulder, a hand that Sofia and I had regularly massaged up and away from the pain it had been causing in Sofia’s pubic bone in the last few days of pregnancy.
As Sofia reached down to receive her healthy baby daughter, her emotion was raw, and I could hardly see for the tears that coursed down my face. Within just a few minutes the placenta was also born with ease. No woman could ask for a more perfect birth. There was no damage to her perineum and no bleeding, just prefect physiology and a whole room full of positivity and love. There were tears and sobs from Muna, and Azaan too wiped his face as he was gazed on in wonder. It was an experience he could never have imagined, especially after the last traumatic birth of Ebo.
What a start to day 13, not unlucky in any form for this delighted new mother, her midwife and her very supportive wonderful mother Muna. We really were the dream team!
“Just like Mary Poppins the wind has changed and I am no longer needed.”
The end to day 13 was somewhat different to the exciting beginning. We all sat around lounging and eating snacks and sweets bought and prepared by the extended family and a few visitors who popped in to congratulate the new family. We let Dr Azra know that baby was born and all was well. She was delighted, and said she had been hoping that it would all go to plan and Sofia stayed home! She has offered to come and visit tomorrow so she can say she has seen Sofia and baby, which means she can sign paperwork and get a birth certificate. So now just like Mary Poppins the wind has changed and I am no longer needed. My job is done and I must think about leaving….it seems strange that after all this waiting and wondering that in the blink of an eye it is over. I don’t quite know how I feel about that.
Day 12 – Reflections and Relaxation
I really had high hopes that after the lovely relaxing and laughter-filled day yesterday, that last night I would get a knock on my door. However, I have to be patient as I always tell women and accept that baby will come when she is ready. Sofia did tell me this morning that she had been aware of cramps during the night, so at least we are getting some positive signs.
Last night I finally finished, not only 2 seasons of Game of Thrones but also all my caramel eggs have now been, most enjoyably, eaten! So now both my milestones have come and gone. I am just praying now to my birth angels that the next milestone, my birthday, will not come and go with me still here and still waiting, because by then I am sure it will not be quite so patiently. The good news, however, is that when I told Sofia that my night watch ING (bit of a pun there on night watch MEN, for those readers who are Game of Throne fans) had come to an end, she instantly made a phone call and, hey presto, within 15 minutes’ series 3,4 and 5 were delivered to the door. There are some benefits in countries where the rules are not always the priority.
Talking to the maids about their experiences of childbirth is both amazing and shocking. Rumi has had 4 children, 2 of which she had at home and 2 in a village hospital. The two she had at home sound as if they were easy, straightforward and, most interestingly, the things she says and advice she gives to Sofia are spot on. Like walking and squatting cuts the pain and how hot water makes the milk flow from the breast and the baby flow from the body. She talks about those births with so much instinct and control. She describes how she knows that when the pains come close together the baby is close as well and that she removes her knickers just at the correct time.
“Woman’s rights in childbirth just did not exist, let alone basic compassion or respect in many places.”
However, as soon as she talks about her hospital births (don’t read “hospital” as anything you may have seen in the west) her whole manner changes and instead she talks about what she was allowed to do and what they told her was happening. How “they” know best because she knows nothing. It upset me to hear that they make the women remove their clothes and they are kept naked from as soon as contractions start. They are given no privacy from male hospital workers and if they refuse to do what they are told they are often slapped! I later discussed this with Dr Azra and she confirmed that woman’s rights in childbirth just did not exist, let alone basic compassion or respect in many places.
Sofia had to visit an aunt for lunch today and so I was left for a couple of hours to my own devices, which being a lover of my own company, I quite enjoyed. I am never completely alone because the house is always a bustle with the staff cooking or cleaning, or visiting from upstairs. The upstairs chef bought my lunch on a tray and I knew, as Sofia has previously told me, that he has a tendency for his dishes to be slightly spicier/hotter. I had buttered chicken, which is a curry in a creamy sauce, a fish dish, also in a green sauce of some kind, aubergines in a yoghurt dressing, a salad, which I love because the lemon dressing they add make them taste so divine, and to round it off and to mop up at the end, one of the light breads he makes called roti, similar to a naan but not so stodgy or large. It was lovely and watching the telly as I ate (or in this case my laptop) what could be better?
Sofia was back by 3.30, then it was off to the beauty spa we go. Sofia had received a gift voucher for treatments and at the rate of £3- £4 per treatment, I was not going to pass up a chance like that. I had chosen a leg wax, manicure and blow dry, and the leg wax was first. Being dark skinned most women here are hairy and hate it, so they are obsessed with hair removal. My hairs are fine, blond, and hardly visible, but still I dislike the odd stray ones on the bottom half of my legs so decided to get rid. After getting me to put on a very (not) flattering elasticated skirt I hopped up onto the table where she proceeded to apply the hot wax… With a knife! Yup I kid you not, a typical stainless steel knife you would eat your dinner with and she certainly was not gentle. Ouch! Putting the wax on hurt more than stripping it off and the ouch factor was not from the heat. But not only did she wax my legs, she waxed my TOES! I have not even ever seen any hairs on my toes!
Next came a very relaxing manicure. The manicurist sat me in a great big lazy boy recliner and turned off the lights while she made my short nails look as best she could. The blow dry came next which I loved best because I hate blow drying my own hair, well actually I CAN’T do it myself without a few heated rollers to help me. All finished and now to pay the bill, grand total of £10.32 (1600 Rupees). Bargain!
“Home is what you make it and this is where Sofia grew up and where her heart is.”
Yesterday I wrote quite a lot about the pollution and poverty and last night showing Sophie, my daughter, some of the pictures via email she asked ” why do they live there”? Knowing that Sofia has a British passport I have often wondered the same. However, home is what you make it and this is where Sofia grew up and where her heart is. To be honest it’s not all doom, gloom and dirt. As the days have passed I can honestly say I have grown to love being here despite all the issues. The shopping mall I went to was modern and bright and the beauty parlour and restaurants nice too. The beach was wonderful even if unlike western beaches where life is mostly vibrant and exciting. The area where Sofia lives might be a bit of a building site now, but that’s because it’s area 8 whereas area 7 is finished and looks very habitable with nice roads, big individually designed houses, clean streets, flowers and greenery (even though there are still beggars to remind you of the horrors not far away). But life is not all about how something appears on the outside or the difficulties we face, it is about how you feel on the inside and overcoming difficulties to see the positives. I feel very comfortable with this group of people, I feel happy to be here, I feel positive vibes, I feel almost at home… Almost!
Day 11 – Due Date
It’s is Sofia’s due date today so the day called for keeping busy with a fun activity.
After our impromptu visit yesterday to the pretty grotty local beach, the plan was a trip to a “lovely beach” far different apparently from what I had already seen, and about an hour’s drive away.
The journey to this much further afield beach was worth the trip alone for the sights on the way, for if I thought I had seen Karachi at its worst in regards to dirt, pollution, rubbish poverty and grey, grey, grey, then I had a rude awakening. It truly was unexplainable but I will try. First a stop at the baker shop with sausage and chicken pastries – to supplement the picnic Muna had already prepared. Knowing Muna the picnic would consist of a tasty variety of foods fit for a king that she had “just thrown together”, so any purchased supplements, however delicious, I am sure would not be a patch on what we already have. While Muna shopped and the rest of us waited outside, we discussed the armed guard outside the fruit shop opposite, and I had them all in stitches with laughter as I did a John Wayne impression of ” your money or your apples”.
As we left the criss-cross, busy streets and huge billboards of Karachi behind we started to drive along a straight, quieter road with low concrete buildings either side. With no greenery or other scenic colours, it reminded me of driving through a cement works. Further driving and we were going through shanty towns of indescribable filth and decay. I took so many pictures from the windows of the car because the written description could never suffice.
Soon the grey gave way to vibrant colours as the roads began to be filled once more with huge colourful trucks. Muna explained that there is big business in customising the trucks, and we did see some pretty impressive decorations to the huge vehicles all around us. The vast, busy road we were on was a dual carriageway, and on the central reservation I noticed that someone had attempted to bring colour the landscape by planting palm trees in the middle, although sadly they had all died through, I am pretty sure, the dust and pollution. Most were now fallen black stumps of rotten vegetation. The few that were still standing had no trace of green left on the branches. They, like everything else, were a grey dust covered mess on the landscape.
All along the sides of the road the piles of garbage were smoking as if fires had been lit, but I am pretty sure it was the mixtures of gases produced by the waste and the heat of the sun that caused the ignition. I was dismayed to see the ever present scooters with families riding on them in amongst the trucks. One had a baby of around a year sitting ahead of daddy, and although a helmet would have been good, a face mask against the dust I sure would have been a better health protection.
"There are huts on the beach that are owned by the upper classes so that they had sun protection and somewhere to change.”
Eventually the roads started to clear and get wider, although by now this picture of a beautiful beach with palms trees had become a myth in my mind. After travelling through such awfulness how could a beautiful beach just appear? Sofia had told me that there are huts on the beach that are owned by the upper classes so that they had sun protection and somewhere to change, cook etc. and that we had managed to borrow one such hut from a friend. By now having seen the views from the car and knowing we were close to our destination I didn’t expect much. However, I was not disappointed when we finally arrived. About ten minutes away from our destination and the air suddenly began to get fresher and the landscape cleaner.
When we finally arrived I felt excited that this indeed would be a lovely day at the beach. The huts turned out to be concrete bungalows, although the owners had tried to individualise then with colourful doors, wooden window shutters and fenced off garden areas. The one we had use of had lovely Mediterranean blue shutters and doors, and although it was basic with concrete floors, it did have a terrace directly on the sandy beach and clean modern garden furniture.
The inside was as basic but again clean. It had 2 bathrooms and a kitchen, so all in all it was a nice place to spend the day. The surrounding areas was probably the nicest, cleanest place I had seen so far but still would make Leysdown on Sea look like paradise in relation to luxury, or even any amenities because there weren’t any! Sofia explained that very few Pakistani people would go to a beach for recreation.
The small cove had clean, soft sand and a warm blue green sea. Not in any way like the crystal depths of the clean Mediterranean Sea, but certainly on par with the cleanest of beaches in the UK. Muna, as I suspected, had packed delicious foods including a chicken drumstick casserole in a barbeque sauce, homemade couscous with mushrooms and all the pastries and fruits to supplement. By the time we arrived we were all ravenous and dug in deep. Sofia had been eating loads in the last day or so and saying she could not believe how hungry she was. Now I noticed she was walking around with a chicken drumstick stuck in her mouth even before she got Ebo settled on the terrace with a plate of food, such was her hunger. Hmmm… due date and suddenly starving hungry? Was this a sign? By now I was looking for signs in every action and word she said!
After we had eaten I sat in the sun (the first time since I had arrived) in shorts and a vest and gazed out at the wondrous view of the Arabian Sea. The place was deserted so getting our arms and legs out was of no concern and it was bliss. The sea just a few feet in front of us and the sky a beautiful deep blue. Finally, something pretty to look at! Of course Ebo, Sofia’s little boy, was mega excited and wanted to walk along the beach, so as soon as we were stuffed to the brim we all went paddling in the sea. The lack of beach culture means that, not only do Pakistani people pretty much avoid the beach, neither do they swim for fear of the sea. So it was with great hilarity that Sharif waded in up to his knees shrieking with exaggerated trepidation.
I left this lovely family to their hilarity and fun and wondered further round the picturesque little cove. I always have a deep sense of aloneness and loneliness when I am on a beach. The gentle sounds of the waves masking other sounds allowed me to go deep into my thoughts about my family and friends so far away right now. With the faces in mind of my darling Sean, the children I am so proud of, and the grandchildren I love so as my heart could break, I wrote a message in the hard packed wet sand to home. I took a picture of “I miss you” so I could send it to them and wondered what they were all doing at that exact moment.
As I tell women in labour, everything ends eventually, so as the lovely day drew to a close we fed the local dogs our leftovers and packed up our belongings. As the sun was getting cooler in the sky we all bundled back in to car and headed back home.
“On this same journey a friend of hers had been held up in her car at gunpoint and robbed.”
Sofia’s due date was drawing to a close and it didn’t look like baby was going to be born today. A little way down the road Sofia spotted an ice cream seller and we stopped for ice cream. I asked if was safe to get out of the car, Sofia said “no” but Muna said “yes” so being the person I am, I jumped out and did a little bit of videoing of the surroundings and the very funny little ice cream sellers bike. After Sharif had purchased the ice creams he called me back to get into the car. “Yes” said Muna “we don’t want you kidnapped do we”? Apparently on this same journey a friend of hers had been held up in her car at gunpoint and robbed and that is why they never drive themselves.
By the time we got back to Karachi rush-hour was underway and it was like a mixture of banger racing, donkey derby and whacky races with every man for himself. After going the wrong way round a roundabout (us and several other vehicles) and being waved on as if it was fine and dandy by the traffic police, I commented that there was no notion of lane observation. I burst into laughter when Muna, in her ever positive way replied “Oh no, the traffic here is very fluid.” I think if Muna was inspecting s**t she would only see the sweet corn…
So still no baby, but hey, I am a midwife… I have patience!
Day 10 – Sightseeing
After a slow start, today turned out to be quite an adventure. Drugs are cheap and everything is apparently available to purchase here, so Muna took me downtown to see if I could replenish my supply at a fraction of the cost from prices in the UK… a very cute helpful little Pakistani pharmacist is looking into my order and will come back to us tomorrow. The journey there saw the usual parade of beggars but also a few transvestites, who are generally ostracised by their family and society, so need to beg for a living. We drove down tiny streets the type of which I hadn’t previously seen and it appeared that the shops were all spilling into their neighbours. The types of shops ranged from those selling fruit and groceries to fixing bags and selling bicycles. There were elderly and deformed old men and women sitting at the curb side and a poor dog with a shocking, festering wound on it is haunches the size of a tea plate just walking along the road. I wonder if you eventually become immune to such atrocities?
The search for Entonox continued, but finally we appeared to have a breakthrough with a company that will rent us a cylinder, although they needed us to to meet the agent at a hospital on the other side of town. They were also renting us the equipment to use the Entonox and I was delighted that it was an identical set to that which I have in the UK, only brand spanking new! I was happy. So now if Sofia needs pain relief in labour it will not be a matter of giving up her dream of a home birth and instead transfer to hospital to get it.
“Huge and vast with the dark, dirty sea on one side and the concrete Jungle of crumbling buildings of Karachi on the other.”
On the journey home Muna decided that a trip to the beach was on the cards. As I have said before Munas’ dedication to Karachi is commendable and she appears to overlook the horrors I see on a daily basis and instead points out “beautiful this” and “beautiful that”. I have yet to see anything that I could in all honestly attribute the adjective “beautiful” to, except maybe the wonderful array of flowers at the Golf Club or planted around the ‘oasis houses’ as I have begun to regard them as. And so as we pulled up at the beach she was pointing out the beauty all around but all I could see was a beach like no other. Huge and vast with the dark, dirty sea on one side and the concrete Jungle of crumbling buildings of Karachi on the other. I wondered at the many families all around who were obviously enjoying the sunshine and cool breeze. I have to admit at least it had lovely light, sparkly, soft sand. However, I would not have wanted to walk barefoot on the sand for the visible rubbish atop it made me wonder about what dangers lay beneath!
We started to walk towards the hard, packed, wet sand nearer to the far out tide. We were instantly approached by a man plying his trade. His trade was a huge, brightly decorated, saddle carpeted camel. I had no desire to ride the beast but took a few pictures instead.
Next came what I can only describe as truly my worse ever nightmare. A man carrying a cloth bag across his back and a musical instrument held in front which appeared to be some sort of trumpet. I stopped to take a picture and Sofia, not knowing what an impact her words would have said “he is a snake charmer he has cobras in that bag!” My horror showed on my face. Did I run? Did I scream? Did I break out into a cold sweat? Oh yes all three because my real snake phobia is the only thing in life that can completely disarm me. As my feet peddled the sand I felt like I was trying to run in one of those dreams where you get nowhere fast. Sofia fell about laughing as she chased after me to give reassurance he wouldn’t be getting those slippery blighters out of the bag to do his snake charming unless I paid him! I thought how my darling Sean would have laughed had he seen that little episode.
Further down the beach we went to find horses waiting to be ridden, more camels along with quad bikes and beach buggies for hire. Many food sellers with rickety barrows of wares or trays of goods slung around their necks. The ice cream man with his half bike-half trolley and tinny music was such a funny sight to see. The ever present, lovely Sharif, the trusted family driver, asked if I wanted to try the food but the last thing I wanted was Deli belly so I politely declined. Nothing looked new or well-kept, everything had a feeling of old and decaying but it was clear that families, like they do the world over, were enjoying the fun relaxed atmosphere. Muna, Sofia and I resorted to acting like silly school girls as we pointed, nudged each other, and giggled at one of the stallion horses, who was keen to show us his particular type of wares. Woah big boy!
One the way home we stopped in a supermarket and, although it was messy and dusty underfoot, I have to say the products available had many English brands and they even had guys packing the bags at the checkouts…they don’t even have that in Sainsbury. It’s such an oxymoron of a country!
Day 9 – Bling
Corruption is big business in Pakistan, and Karachi sees its fair share of it. It was one of the first things Muna had told me about when she collected me from the airport. Corruption and the complete lack of accountability. Earlier in the week I went to the cinema. The trip was more for the experience rather than the film itself. I wanted to experience normal life for the Pakistani people who could afford such luxuries. The auditorium was much the same as any other worldwide and the nachos just as delicious, but as I sat there munching away, waiting for the film to start, to my horror the lights suddenly came up bright, the loud booming sounds of what obviously was the national anthem started and everyone commenced to stand. I was embarrassed and every part of my anarchistic personality (OK, not quite as bad as that) wanted to stay seated, however I did not want to draw even more attention to myself. I was already the only white, western, lone female in the auditorium, so nachos in hand and frantically wiping my chin of cheese sauce, I stood and listened to the stomping sounds of the song which, although I knew the ethos, I certainly could not understand the language.
“Sofia had already told me that the best way to earn a living from corruption here in Karachi is to join the police force.”
At its conclusion I quickly sunk back in to my big comfy seat, relieved when the lights dimmed and I once more had my anonymity. I presumed the film would now begin, but no, first we had the adverts and I was surprised and pleased to see an advert calling for Pakistanis to reject corruption. I supposed that the Government funded such an advert but I also had a sneaky suspicion that within that same Government, corruption was rife. Sofia had already told me that the best way to earn a living from corruption here Karachi is to join the police force, where you will be paid such a poor salary (hardly enough to feed your family) that you have to make it up to a living wage somehow. What better way to supplement your earnings than by using a bit of extortion on the 100’s of moped riders? Pull them over, threaten them with prison for some actual or invented driving misdemeanour, or hand over a fine which went straight into the policeman’s pocket!
I just thought I would mention that because day 9 has been pretty uneventful. Sofia went out this morning to sort out some banking issues, so I spent the best part of the day feet up and watching movies until around 5pm when the typical and usual trip out was decided upon, and I once again became the centre point for the excursion.
Oh yes, and Muna sent me an email with a link to the write up about the comedy at the Literary festival. If you click on this link you can see from the photo just how packed it was and read about all the satire comedy that was going on ( I am sure I can see the back of my red head down at the front on the left hand side).
I had noticed some pretty shoes in the shopping Malls earlier in the week which, unlike the expensive ones made by Sofia’s cousin, were within my budget. Muna had told me she would take me to some other cheap but nice shoe shops and today was the day!
Arriving at the street where the many shoes shops were I was no longer surprised to see the armed guards outside, but still took the obligatory photo to prove it.
I entered what felt like an Aladdin’s cave of bling. The shoes were beautiful. All manner of styles and all manner of coloured beads, stones and designs. I wanted sandals and I was spoilt for choice! With padded innersoles they felt so comfortable on my feet, unlike the hard flat bottoms of most of the UK sandals.
It was so hard to choose from the vast array of pretty styles. They made me wish I could buy lots and take them all home, but I calmed down eventually and settled on 3 pairs. The final price made me smile with delight, for who doesn’t love a bargain? Three pairs of well-made comfy pretty sandals for £30! Result.
Then home to, as usual, a delicious dinner of several new foods I had never tried, and that was end of day 9. Pretty mundane day really; still no baby and just a bit of sparkle to ward off the homesickness…
Day 8 – Home Comforts
Last night after my usual indulgence of a caramel egg accompanied by an episode of Game of Thrones I settled down to sleep. I had been asleep a while, but was aware that the night was early when I heard Sofia’s small 2-year-old boy crying loudly. The crying went on for some time and I could also hear Sofia’s raised voice and that of her estranged husband Azaan. I learnt this morning that Sofia, at the end of her tether with her 39 plus weeks of pregnancy, an unwell child and a horrible cold, had an understandable meltdown when Ebo was restless and unwilling to sleep.
“She was fast becoming a much loved surrogate daughter and I wanted her to feel better.”
In desperation she had called Muna to come for support. Azaan had seen Muna arrive at the house from his location, visiting his mother upstairs. He had come into the house and taken the little boy from Sofia in a supposed answer to her stress, which upset Sofia even more and she had spent a first ever enforced night away from little Ebo. She looked tired, drained and sad, and instinctively I put my arms around her and held her close. She was fast becoming a much loved surrogate daughter and I wanted her to feel better.
As an outsider I could see the dynamics of everyone’s feelings and points of view when personal issue came up for discussion. Of course my 100% sympathies lie with Sofia, but when a young couple meet in their teens, parenthood is also hard on a young man of 21.
“Often the beautiful melodious sounds of him singing his favourite Adele songs can be heard echoing through the building.”
So today Sofia understandably wanted to spend as little time as possible in the house where Azaan works and her in laws live in close proximity. As well as being a film producer, Azaan is an accomplished musician and singer, and often the beautiful melodious sounds of him singing his favourite Adele songs can be heard echoing through the building. Add problems of love to the situation and I could empathise with Sofia’s desire to escape. So at noon it was off to Muna’s house we went. A nice picnic on the grass in the garden discussing all aspects of post-natal care whiled away the hours of a quiet Sunday. I had taken my laptop, thinking that a quiet afternoon may mean I would watch a movie of some sort, but I kidded myself that they wouldn’t have something planned, and by 4pm we were in the car being driven to meet yet another family friend who “would love to meet Virginia”.
Auntie Arlya was a lovely woman who had lived a lot in USA. She and her husband had 4 kids ranging from 19 to 5 years old. All dressed very western and in a lovely big house behind yet another high wall, I was intrigued by the accomplishments of the children of parents who encouraged them to be responsible entrepreneurs. One of the boys of around 13 kept chickens and made chicken feed that he sold, one kept a vegetable patch, and the 16-year-old daughter made exquisite high end sandals. They showed me her workshop in the basement and the shoe collection. All very beautiful with amazing decorations and adornments of glass stones and beads in various colours and designs. All the different kinds and colours of leather was spread out on racks, as every pair of shoes is hand made. The prices however were not cheap for being made in Pakistan. A pair I very much liked were £30, and in Pakistan that’s a lot of money, so asked why they were so expensive? The answer was that they were being sold to high end Pakistanis and they could afford it! Fair play to her I suppose.
Accompanied with our tea we were served delicious homemade cottage cheese. Delicate mounds of mouth-watering softness with added herbs, spices and flavourings. Look out family of mine; I will be trying the recipe myself because it sounds very easy to make indeed. Whilst chatting about food the topic of sweets came up, and I happened to mention one of my favourites is liquorice. Oh boy I should have stayed quiet! Cue driver and we are off on a mission to the imported sweetie shop to find Virginia her home comforts. In a little side street, typical with small higgledy piggledy shops (although surprisingly free of the usual rubbish and filth) we came to a brightly lit modern shop, the contents of which made me long for home and my sofa in front of the TV.
Full from ceiling to floor with every confectionary Sainsbury has to offer, even Sainsbury’s own brands. Every chocolate biscuit and sweet I could very wish for filled the shelves. Unfortunately, the much craved for liquorice was nowhere to be seen, but knowing Muna as I have come to, I suspect it won’t be long before she tracks some down.
And so after a day that had an emotional start we ended on a high and a fun evening chatting and laughing. Little Ebo thought it would be hilarious to use the air pump needed for pumping up Sofia’s birth ball for pumping up mummy’s tummy instead… a tummy my enquiring hands and eyes noticed had grown considerably in the week I had been here!
Day 7 – Literary Festival
Today I finally woke at a reasonable time and found at 09.30 Muna was already here and wondering if I would like to accompany her to the Karachi literary festival, where she excitedly said I would meet lots of feminist and free thinking woman like me! It was being held in a Hotel and we had to go through the usual security checks. There are armed guards at every establishment, but anywhere where groups gather they also search your bags and you go through metal detectors. This event also had armed guards looking down on us from the hotel rooftops. Far from making me feel safe it hits home about the daily dangers.
Once inside however it was awash with exhibition stands and stage/seating areas inside and out. I was astounded at the amount of presentations going on. There were many scholars running sessions and talking about all sorts of issues, but the one that caught our attention was “laughter, the best medicine”. The speakers were 2 Pakistani men and one Indian, who were stand-up comics. They were here to discuss the place of satire comedy in the life of a Muslim. I have never seen such a packed audience. The auditorium had a seating capacity of more than some west end shows, and still people packed in to stand.
The place was in uproar with laughter and I was frustrated that I didn’t understand more. One joke went along this line: “I was robbed a while ago in Karachi. I was sitting in my car when a man approached and held his gun to the window, he was saying “mobile phone arsehole mobile phone arsehole”, but quite honestly I didn’t know if he wanted to rob me or have a relationship with me.”
This was from a comedian named Saad Haroon. He was asked by the audience how he knew he was successful and he answered that the death threats on YouTube gave him great confidence about that! You must watch this parody to Pretty Woman he performed called “Burka woman”; he certainly had me laughing!
And so it was home once again through the dirty, decaying mess that is Karachi. We stopped for some fruit from one of the many street sellers and once again I was approached by a dirty shoeless boy of around 7 begging for money. The 100 Rupees I gave him will feed him for a week as long as a corrupt policeman or other adults doesn’t take it from him.
It breaks my heart to see all the beggars, but the ones that hurt the most are the deformed and maimed who beg at the cars that are stopped in traffic. Muna opened the window an inch at one such stop and handed a note out of the window to a man who had a bony useless arm hanging from his body. There is no welfare or help for such people. Seeing such extreme sides to society is so hard and so confusing. The roads are full of expensive, nice cars and yet overflowing with disease ridden rubbish, debris and filth. Most houses and buildings are decaying and grey on barren, sandy building site landscapes, and then there are odd new ornate building with high walls and surrounded by greenery and beautiful bougainvillea.
A conversation with Dr Azra left me heartbroken about the plight of pregnant women in Pakistan. Whilst around 50% of babies are born at home they are not the happy, planned, safe home births of the West; they are women who cannot access health care. With one of the highest infant and maternal death rates worldwide, the poorest, the least healthy and those far away from any clinics of hospitals have no choice but to suffer in silence. “Half the babies die” said Azra and my stomach felt heavy with the lack of power to change such a situation. “However good job they can’t all come to the hospitals, because we couldn’t cope if they did” she added. My thoughts at that moment were how lucky we were to be able to get health care free at the point of delivery in the UK.
Once back home we found Sofia having had a nesting day of sorting out all her baby clothes in preparation for her baby daughter, who we all hope will put in an appearance soon. We are still trying to source Entonox, but strangely enough in a country where you can purchase just about any drug over the counter it is proving quite difficult. The gas companies will only sell it to clinics and hospitals. I have emailed Dr Azra, who is going to try and pull a few strings, so fingers crossed.
The day is drawing to a close now, I enjoy this part of the day; when I go to my room get into bed, eat one of the caramel eggs I bought with me from the UK (my comfort food) and watch Game Of Thrones on my lap top. I have 5 eggs left….is that a sign of how many days before this baby finally puts in an appearance?
Day 6 – Cultural Differences
Late last night, when I was just about ready to check into my bed, Muna arrived! The culture here that the day starts late and ends even later. While that fits in with my current jet lag, it’s hard to get my head around. I still feel terribly guilty getting up at 10.30 when I hardly ever sleep in beyond 8am at home. Can you believe Azaan, Sofia’s estranged husband has just left to go to the dentist and it 9pm?!
So, back to Muna’s late arrival, because I just have to mention that once again she arrived with food! This time it was desert. Typical/local delicious sweets made from carrots, honey and nuts – a strange combination but no more so I suppose than our carrot cake. Sofia was in a restless mood and I did allow myself to hope it was the sign of something to come, but it was her 2-year-old Ebo who put paid to that by being unwell and keeping her up all night. Suppress that oxytocin and call in adrenaline!
I managed to finish the first series of Game Of Thrones by 2am and then had a bumpy night of sleep awake cycles of 2 hours until 10.30. The culture of servants continues to amaze me. I have learnt in some households it very formal, and the lady of the house would be addressed as Ma’am, however in Sofia and Muna’s house they appear to be more like family and have been employed for many years. Many of them live in and have their own quarters at the back of the house in the basement, although I have yet to see it. Sunia is going home tomorrow as it’s her day off. At seventeen years old, she must go to take her salary home to her family. On Fridays the servants cook food enough for 80 people and take it to the local homeless shelter. I only learnt that last night and, if I am still here next week, that’s something I would like to see!
Today Muna took us to the sea front (not the beach) where locals fish for crabs. We walked along the sea wall watching the fishermen, all the time being aware of the strange looks we were getting. With no woman other than us around, the sight of 4 in one go consisting of one Pakistani (maid Sunia), one white woman dressed as a Pakistani (Muna), one westerner (me) and one very pregnant woman, made for quite a picture… Literally, as we did see a group of young men taking a picture of us as we headed back to the car. As usual the area was littered with rubbish, but certainly not as bad as the piles of it in other areas of down town Karachi.
Then it was on to lunch at the golf club and as we entered the grounds you could be forgiven if you thought we had stepped through a time warp back into colonial India in the days of the British rule. Pristine road and beautiful gardens. Only the signs “ladies parking”, “ladies swimming pool” and “ladies gym” gave it away that we were still in segregated Pakistan.
On the way home they stopped to show me the local supermarket where you could pretty much buy everything you wanted including imported goods with names I recognised. The isles were narrow and the shelves stacked high but the thing that fascinated me the most was the armed guards at the entrance and exit…..yup armed guards at the supermarket!
Soon it was time for the highlight of my day; I had planned to go to the cinema! Although I was going alone I was driven there and back and Muna came in to show me the ropes. She need not have bothered, it could have been a cinema anywhere with its multi screens, nachos, popcorn and coke, I was well at home. The theatre was large and the seats big and comfy. I settled down to watch my movie but nearly jumped out of my seat when the soundtrack began, why was it so deafeningly loud? I soon realised why…forget the niceties of people being quiet, throughout the film they were arriving late, leaving early, chatting away and using mobile phones…. lucky it was very dark and very loud and I could easily absorb myself in the action.
And so another day ends here in Pakistan. I am committed to Sofia and to helping her to achieve her dream birth and they are treating me like royalty, but the homesickness is creeping in around the edges and I am longing for familiar sights and smells of home and the faces and love of my family.
Day 4 – Food, Glorious Food
I am not sure if it is jet lag or just insomnia but I managed at most around 5 hours sleep last night and woke this morning feeling very tired, muggy and with a thick headache. I wondered if I could get through the day!
Sunia served me a lovely mushroom and cheese omelette, fresh orange, and peppermint tea in my room, which went a long way to reviving me before Sofia came in to have a girly chat. Sofia has a lot of life’s difficulties to bear right now, and although she does not want me to go into detail, due to personal circumstances her husband and she are estranged and he lives elsewhere with his aunt. Sofia has a deep sadness about her situation, but wears her pain with a quiet and mature dignity. She never raises her voice or lets her pain turn to bitter nastiness. My admiration for her and how she is dealing with her situation knows no bounds.
So, full of my lovely breakfast and following our chat, Sofia informs me that Grandmother (who was born in the caul) had said it was important that I had a meal to make me feel at home, so later this morning we are off to Munas’ house for a roast chicken lunch! Oh my goodness, lunch? Breakfast has not even gone down. I also knew that the plan for the evening was to go out for an evening meal with the whole extended family. At this rate I will be going home needing bigger clothes.
So to Munas’ for lunch, and following the delicious roast chicken with many different traditional accompaniments, I could easily have slept for a week. To keep awake instead I asked to be shown a hairdresser to get a blow dry. Typically, all the plug sockets in my bedroom were nowhere near any mirrors, and blow drying my own hair is not one of my few accomplished girly tasks let alone doing it without a visual guidance.
Like most “nice” shops, restaurants etc. the hairdresser shop was hidden behind high walls and greenery rather than being on the typical streets with shop fronts. It had everything you would expect of a beauty parlour and superficially was clean, although like most buildings I had been in, with the exception of the very western shopping mall, was a little battered, grubby and rough round the edges. However, the experience was great and the prices dirt cheap. I had a full pedicure and blow dry for the amazing price of 3800 Rupees (£18).
Muna had left me in the hairdresser with assurances that Sharif the driver would be waiting for me outside when I was ready to come home. He wasn’t, and for a few minutes I had a few cold feelings of dread; here I was alone in Karachi, a very unsafe city, it was dark, I was a westerner (so stood out like a sore thumb) and I was alone! Dark thoughts of kidnap had, once again, just started to creep in around the edges.
But a few minutes later the lovely Sharif pulled to halt right next to me. At this point I realised that the doorman, who were ever present at all establishments, had been keeping an eye on me and rushed forward to where I was standing next to the road, and opened the door for me with a reassuring nod of his head. My fundamental belief that most people are good was restored.
Unable to communicate with Sharif I sat and watched the night lights of Karachi pass by. With the dark of the night hiding the dirt, rubbish and decaying buildings it actually looked pretty and just like any other city in the world. We drove through wide brightly lit streets and then onto the sea front road, where vibrant coloured lights lit up the fun fair, and the night hid the appalling lack of safety precautions!
Now back home to get ready for the night out and yet another meal. Into my lovely Pakistani outfit, with my brightly painted toes and a preened hairstyle. The only thing missing to make me feel like a queen was my king by my side.
The restaurant we went to was a typical Pakistan meat feast establishment. Huge and over 4 floors it was obviously very popular with the locals. Alcohol is banned in Pakistan, which is a shame, because the varieties of meat consisting of chicken, lamb and goat in varying degrees of hot spice were so delicious that a glass of red would have complimented it no end. With many women covered up in Burkas and the rest in traditional dress I was glad of my outfit, because this was not a restaurant with western attitudes. Although I felt I blended in well my white skin and red hair still afforded me many a curious glance.
Finally home to bed, well fed well socialised but a little culturally shocked. Maybe a baby will come tonight!
Day 3 – A Trip to the Shop
Thinking I had escaped it, jet lag hit hard last night and, following a period of insomnia, I struggled to wake this morning at 10.30 and did so with a muggy head. Mornings in this household are late and unhurried, so it compliments my current cycle and, after a lazy cup of peppermint tea and some freshly squeezed orange juice served to me of course by one of the maids (I could get used to this), I felt a little better. Sunea and Rumi the maids are so lovely. Sofia has explained to me that they would otherwise live a very poor existence. Suneas’ family live in one room and without her salary and extra benefits (toiletries, education, food and clothes) life would be very different. That aside I find it very strange indeed to be waited on!
So today our first adventure was lunch in a French restaurant. I cannot say it was ‘posh’ by western ‘posh’ standards, but it was nice, clean and the food was absolutely delicious. I had a Rocket, strawberry and feta cheese salad and found lots more besides those ingredients in it to make it scrummy….. Muna and Sofia said we always need to keep fingers crossed about Deli belly, but so far so good.
I couldn’t help but to take more pictures of the shocking and amazing things I saw on the journey; like the spaghetti junction electrical wires and the children begging at the car as we stopped. Sofia always gives them Rupees and as she handed out hundreds of them to a gaggle of around 20 beggar children she did a quick calculation and converted the money to sterling for my information. Each child was receiving 80 pence which would feed each kid for a week. I couldn’t help but join in and spent a massive 200 Rupees myself to those grubby little hands.
Next, a trip to the local shopping Mall where, guarded by gun wielding security men, I felt safe and at home, especially when I saw shops that had home written all over them: Debenhams, Body Shop, Mango, Mothercare, not to mention all the normal food chains. I was not really interested in those shops, however, because (when in Rome and all that) I just wanted a Pakistani outfit. So bought a beautiful outfit consisting of silk trousers, a long floaty top and a scarf to finish off the look. Everyone speaks perfect English with a Pakistani singing accent, (except Sofia and her family who look and sound completely western) and so I was delighted when trying on my outfit two young women told me I looked lovely in it!
Home from the shopping Mall we followed the route along the sea front and I saw the beach. Although it was crowded with locals, camels, food sellers and even people swimming in the sea, it didn’t look very inviting for, as like the rest of Karachi, a day out at the beach would mean fighting with the rubbish for sand space. We were not close enough to see it but Sofia informed me that the romantic sounding Arabian sea was in fact black with pollution.
“A woman’s life and decisions here are run by committee.”
Home for the evening and I thought to relax and rest but, oh no, I had a difficult night ahead. Remember I said a Pakistani woman marries the family? Well a woman’s life and decisions here are run by committee, and the whole family came around for a discussion about Sofia’s plans for the birth of her baby. They are not party to the home birth plan, and rather they think Sofia will be staying home “for as long as possible”. So that we could even persuade them that was safe I sat them down to a showing of “The Business of Being Born”. Poor Sofia, I just want to pick her up and run for the hills.
Day 2- Birth Plans
I woke up this morning wondering what the day ahead would hold as I was going with Sofia to consult with a doctor. Sofia wants a home VBAC but her extended family are not supportive due to worries about safety. Pakistanis, no matter how westernised, are very patriarchal, and when a woman marries into a family she becomes a daughter of the in laws, to the extent that official and medical forms often ask her to document her husband’s father's name. The family were causing Sofia, and indeed themselves, quite a lot of stress due to Sofia’s birth choices. It appeared that the worry had little to do with the previous caesarean section, and more due just to them being ill informed about birth in general and knowing Sofia did not have a doctor involved. I was keen, for obvious reasons, to know the procedure should a problem occur in labour, and where we would head to. So Sofia found a female obstetrician who said she would like to meet me and supported Sofia in her plan for a VBAC.
The system in Pakistan is archaic to say the least. There is no simply turning up at a hospital, because if she is not booked with a doctor the administration would turn a woman away even in an emergency! One hospital even turned away an unmarried women. Later the baby died, but their view was that at least their reputation remained intact, because they had maintained honour in not condoning pregnancy outside of marriage.
Ok, so birth plan A) is that Sofia has a home VBAC with no problems, and then following the birth, she tells the family if need be that baby came too soon to get to the hospital. Plan B) is that, in case she changes her mind at any point, she needs to book a doctor who will be supportive of a physiological VBAC in hospital as well as being on hand for plan C) which is an emergency trip to the hospital should we need help. We are accompanied by Sofia’s mother Muna, who is in fact a Dutch woman married to a Pakistani. Muna knows the system very well and is fully supportive of her daughter, and the only other person in the household who knows about plan A (other than the two maids Sunea and Rumi who I will bring into the story a bit later).
Before heading off to the hospital we went to Muna’s house for lunch, and while there I was introduced to Sofia’s grandmother who is 88 years old. While frail of body her mind is sharp and we began to share a few stories. I told her about one of my clients in UK who has had 10 babies, and I told the story of the biggest baby whose birth I attended who weighed 12 lbs 120z and was born at home, and she shared stories back with me.
She told stories of German doctors who were prisoners of of war in WWII and working in the military hospital near to where she was living with her soldier husband. She told me about her year-old first born son, who had died during the migration from India to the new country of Pakistan after the war. Finally, she told the story of her own birth, which she had heard being told many times when she was a child. When she was born she was contained in the membrane sac and the midwives of the village were scared of what they could see. They had never encountered such a thing, presumed it to be some sort of deformity and thought the baby was dead. You can just imagine that the baby may have not been initially moving and was not yet breathing. One midwife apparently wanted to throw the baby in the garbage, but another midwife who they all knew as being the brave one came forward and said they should investigate further. She pulled a reed from the roof and proceeded to pierce the sac with the sharp pointed end. Of course lo and behold a healthy baby girl was within, who instantly breathed and lived long healthy life to now be telling me this story. I was delighted to hear it, and told her that was known as being born in the caul and is very rare. It is said by fisherman folk lore that those born thus would not experience death by drowning.
After this fascinating insight we went off to the hospital though down-town Karachi. We had deliberately chosen the busiest rush hour time of day and we told Sharif to put his foot down. I wanted to know how fast we could reasonably expect to get to the hospital in an emergency.
Past all the colourful buses, swerving and horn-tooting through traffic like you have never seen it before we drove. Past shanti towns and crowded streets, past schools and other official buildings only just visible behind high walls with barbed wire atop, and closely guarded by armed men outside. Shops all crowded together, their wares spilling onto the streets, and high poles dotted everywhere with so many electrical and telephone wires attached, spiraling up and around, that it was impossible to see where one ended and the next one began. But most fascinating of all about this diverse and strange place was the huge wide piles and piles of rotting, stinking and decaying rubbish left absolutely anywhere and everywhere. I don’t think I will ever complain about UK streets again because of a few empty water bottles and crisp bags.
We finally arrived at the private hospital in well under 30 minutes, which was perfectly acceptable to me. There are ambulance services but really they are no more than taxis, as the drivers are not medically trained and the culture of hooting and tooting that goes on gets largely ignored so, Muna informed me, no one gets out of the way for ambulances. I reasoned, therefore, that I trusted Sharif to drive us in an emergency rather than wait around for a dubious ambulance.
The hospital was a bit like an old, scruffy NHS one, only dustier. Everywhere there was a brownish yellow décor with an atmospheric sense that a smoking ban had not long been enforced. This was not the hospital Sofia had used for the birth of her first baby, nor was it the doctor who had given the advice which led to the resulting caesarean section, but a female obstetrician who Sofia knew to be more woman-centred. Sofia’s story was that, at 38 weeks pregnant, her doctor had concluded the baby was not growing and advised induction of labour. Sofia had not put up any objection as she was not fully informed and had absolute trust in the advice she had received. The induction had failed, because of course at 38 weeks her baby and body were not ready, and after many hours of pain and distress and no progress into active labour, fetal distress had been diagnosed and a caesarean section performed. Her baby boy was born well, healthy and a whopping 7lbs! Sofia was traumatised and distraught. It does not take an expert to know something did not quite add up!
The Sofia of today is a whole lot different; she is educated in birth issues and is strong in her determination to do things different and retain control. The evening before Sofia showed me a birth plan she had written. It was a typical birth plan to be found on many an advisory birth internet site, with references about no CTG monitoring required and no cutting cords, amongst other issues, but it had lots of “unless necessary” written everywhere in it, so I encouraged her to re-write it in a firmer way. “I do not consent to …” gives less leeway to anything being done without consent because it was deemed “necessary” at that time.
When we were finally shown into the doctor’s office and the birth plan was being read I wondered if my suggestions or a firmer birth plan would be met with hostility. Once she had read the plan Dr Azra slid the piece of A4 paper back across the desk to Sofia, and basically said there was nothing in it that she had a problem with.
“There is nothing in there that can’t be found in text books or good evidence papers” she said and I slowly let out my tightly held breath.
She went on to say that as long as Sofia was taking responsibility for her own decisions she was supportive of her choices. Whilst Sofia did not tell Dr Azra directly she planned a home birth, she did say she was planning on staying home for as long as possible with me as her home support, and may come in at the end of the labour. Muna did not say much, and I was aware that she was uncomfortable not discussing plan A with the doctor. Muna had already spoken to Sofia’s previous doctor from her last pregnancy and so was well aware that support for a home VBAC was virtually impossible. I felt that this lovely doctor was truly supportive. We discussed a plan should Sofia require a repeat caesarean section and we discussed how we could achieve all Sofia’s wishes including me going into theatre. I sometimes have to fight to achieve such continuity in the UK, and yet here was this doctor offering it to me as a professional courtesy and in Sofia’s best interest.
We were finally shown the labour rooms, which were an exact replica of UK labour rooms (except with more pillows). It was almost time to leave, but not before Dr Azra asked me if I would like to come and speak to the doctors and nurses (and Alvera, the one midwife at the hospital) about practice in the UK. She told me she had trained in the UK, and she certainly appeared to be aware of all current evidence. She explained that Pakistani women still demanded their enemas and shaves, and would freak out at being given their baby for skin to skin without it being cleaned and wrapped. I responded with my usual response when women are blamed for the current poor practices which continue in childbirth: “We professionals introduced all these procedures, so now we must find a way to undo the status quo… never blame women”.
I think Dr Azra liked me!
I felt comfortable and reassured as I could possibly be with the safe birth plans we had put into place.
Once home, Sofia and I discussed with her two maids how her labour and plan A) must remain a secret from the rest of the family and from her mother in law, who lives in an apartment upstairs, to save stress and worry all round. The maids are loyal to Sofia (there is rivalry between the upstairs staff and downstairs staff) so they were delighted to be in on the secret and be part of such excitement. Rumi told us that she had two of her four babies at home and that she loved being at home. She told us about a special plant that is used in labour. It is called Bibi Maryam ka phool, and consists of a bundle of closed knot roots that are put into water. The flower is a help to the labouring women, and once the baby is about to be born the flower opens up.
“When the pains get fast the Dai must go and sit down in the corner and be quiet.”
I told Rumi, being the knowledgeable midwife I am, that it is important a woman is not disturbed in labour. However, it seems I am not the only one with knowledge because speaking in Urdu and Sofia translating she replied that when the pains get fast the Dai (village lay midwife who has been taught her trade through the generations) must go and sit down in the corner and be quiet! Yes, that told me!
Following such a fascinating day, when I thought nothing more could happen, I was served a delicious meal cooked by Rumi. However, I didn’t look close and proceeded to eat what I thought was a green bean atop some tasty buttered chicken. What happened next invited looks of astonishment as they all watched me run to the fridge, grab yoghurt, and greedily pour it into my inferno of a mouth, while Sofia laughed her head off at me. I had eaten a very hot chilli!
So no baby yet and feelings of homesickness coming on. But I was also feeling that this place was growing on me, and these wonderful people were a long lost family.
DAY 1 – Touchdown in Karachi
It is not one but two flights I was about to embark on, and although I usually love travelling, on this occasion I wasn’t looking forward to the long journey ahead. The journey and adventure I was about to go on was not without worry and trepidation especially having to read the travel advice on the UK Government about westerners in Karachi. It highlights dangers such as kidnap, ransom and random terrorist cells. Yikes! Winter 2016 is not exactly a great time for anyone to travel to an Islamic country especially a lone western woman.
So how did the possibility of this trip even happen? It came about through my reason for living of course! My vocation, my passion: midwifery.
A young woman, Sofia, had reached out to me in need. She had researched and researched and come to the conclusion that a caesarean section she had 2 years ago, and at the young age of 19 (an age when healthy women usually have babies with ease in my experience) was unnecessary, and she did not want to put herself or her new expectant baby at risk again. Her research had led her around the world to me. A vaginal birth after caesarean section (VBAC) is rare in Pakistan and a home VBAC absolutely unheard of, and definitely unsupported by the medical profession.
I, on the other hand, like a challenge and adore supporting women who make informed choices. So, having no booked clients for the time in question, checked the legalities, obtained my visa and agreed to go and help Sofia achieve the birth she so desired.
I now found myself alone and about to start a journey with no knowledge of how it would end. After spending a couple of hours in the lounge at Heathrow, eating and drinking my fill of the last western food I may have in I didn’t know how long, I walked to the gate just as the flight was boarding. Being last on I could see that the front cabin was empty, but as I approached my seat near the back I could see I was sitting between two men. Being a Middle eastern airline I played the ‘woman’ card and got away with it, so following take-off I was moved to the front cabin and into in a whole row of seats to myself. Result! I was able to stretch out, sleep, watch movies and kid myself that the tummy rumbles were not little sparks of fear of the unknown.After 7 hours we landed in Darfur. The airport was amazingly plush and western, but I only just had time to get to the gate where I boarded my second flight to my final destination; Karachi. Although only a three-hour flight, the passengers consisted of almost all men. Just 4 women on board including me, the only westerner abroad. It was from that point that a few sneaky feelings of unease entered my mind, and I wondered as I listened to the strange accents and language, and as different strange smells wafted around, if I had made the right decision in agreeing to come half way around the world to a 3rd world country, to stay with strangers and attend a birth, a VBAC even, in a place where I knew nothing of the medical system. Oh birth angels what am I doing? I thought.
Karachi airport is primitive, dusty and old, but it was very early on a Sunday morning and quiet, so I had no problems getting through the legal requirements and finding my bags. As I finally exited the doors I scanned the crowds of dark faces and, as promised by Sofia during the arrangements stage of this adventure, found the large white frame of Muna, my new client’s mother, with frantic hands waving, waiting for me. The drive to Sofia’s house was a blur as I listened to Muna try to explain to me where we were and point out various land marks. I laughed out loud at the truck art, the wild and psychedelic decorations covering all the buses and large vehicles. I didn’t know where to look next as the completely shocking sights kept my eyes glued to the roads. I kept hoping the sights would get better, but when we turned into a wide dusty road the landscape changed to resemble at best a building site and at worst a bomb site. I now worried at what lay ahead. We finally pulled up at what looked like a nice house, as much as I could ascertain anyway, sat behind its seven foot walls, and I let out a sigh of relief to be entering this oasis of niceness in a desert of grey.
Sofia was waiting on the door step and was delighted to see me. The house was big and airy with huge ceiling fans and air conditioning. Although onlyearly inthe morning the sun in the winter blue sky was already hot. Sofia had made “my” room nice and welcoming with a jug of fresh water and a tin of Godiva biscuits next to my big comfy bed. I had my own bathroom in which she had put all new toiletries for me. The house had lots of strange unfamiliar smells going on that I would have to very quickly either ignore or get used to, however the internet was good which was to me the main thing for it meant I could keep in touch with home and social media and not feel cut off or isolated. What did we used to do without the internet? After unpacking and doing a bit of getting acquainted and chatting about the journey Sofia suggested a walk around outside.
We walked around the local roads of the housing development, which was mostly a building site, while Sofia explained that this was a safe area to stroll. It passed through my mind that, if this was a safe area, why we were accompanied by an armed guard? I couldn’t help but to keep looking over my shoulder waiting for a car to draw up and bundle me into it in preparation for asking the UK Government or my family for huge amounts of money to let me go. Would they pay it?
When we returned to the house we had a lovely breakfast cooked by the servants and served to us on trays. There were so many servants, cooks, drivers, guards. I lost count of them but they are treated really well and are really willing to please. They are all from the really poor part of society so they work for next to nothing or food, lodging and education for example. I began to feel a bit excited and was looking forward to learning more about this strange and different culture. It seemed it was only minutes after breakfast that we went to Muna’s house for a lovely lunch. Her house was a was a short drive away, and just next door there was a huge swarm of massive birds that looked like eagles (called little eagles) and Sofia took me onto the roof to take pictures of them as they swooped and flew all around our heads.
Following lunch we went for a ride in the family’s little Rickshaw. The family driver, Sharif, who has been with the family for 15 years apparently, was delighted to be asked to go out as he loves driving it. No one was more delighted (other than me) to be experiencing this new type of vehicle than Ebo, Sofia’s little 2-year-old boy, and he whooped with delight as we pootled along in the soft warm breeze. I can’t say I was impressed with the dry dusty littered, scattered landscape scenery but it sure was different… On our drive we saw a public bus like no other I had seen before.
I was amazed at it and its crazy truck art.It was so colourful with bright coloured decor inside and out. We stopped and took pictures and the bus driver invited me to look inside and then pose in the driver’s seat. All the time under the watchful eye of Sharif the trusted driver!
Back at the house the lunch was to die for. Muna is an amazing cook and had put many dishes on the table with foods I had not even heard of, let alone eaten. Of course I tried them all! We chatted all afternoon about all things births, but also about the country and its problems and culture. It appears that corruption, suppression and no accountability are the worst problems and difficulties. Yes, it’s been a lovely day but right now I am feeling that I would not want to stay here any longer than need be. Maybe that will change in time but I feel a long way from home. Once in bed I was ready to watch Game of Thrones on my laptop then sleep. It is Sunday evening and I haven’t been to bed since I got up to begin my adventure from home on Saturday morning.