A faint “ko ko ko” roused me from my slumber at 3:45 a.m. one October morning, not yet one month after I had arrived at my post. I turned over in bed, and defiantly held my eyelids closed. It was not uncommon for patients to come to our doors in the middle of the night if they needed urgent care. (In Benin, rather than physically knocking on the door, one often announces their presence verbally: “ko ko ko.” The response, an invitation to enter, is “may may may.”) Because I live between two other nurses, I often correctly assume that the “ko ko ko” I hear is directed at their dark windows, not mine. These pleas may momentarily awaken my curiosity, but the rest of my body lies decidedly dormant.

This morning, however, the “ko ko ko” was followed by a meek “Tata Rachelle?”

Oh, dear.

I liberated myself from my mosquito net and shuffled blindly from my bedroom, mumbling, “may may may,” as I fumbled with the locks and bolts on the front door. As my eyes adjusted to the darkness I saw one of the nurse’s faces, barely an inch away, on the other side of my screen door.

“Il y a un accouchement.”

A woman in labor!

“Je viens!”

I was wide awake. I walked more confidently back into my room to put on a shirt and a pagne (a large rectangular piece of Beninese fabric that is used as a wrap skirt), and then out the door to cross the several yards between my front door and the health center. A discordant symphony of toads accompanied me and I marveled how sleep could mute such boisterous sounds.

Our health center consists of five rooms, arranged side-by-side in one long rectangular building. From left to right there is the hospitalization room, the delivery room, the pharmacy, the consultation room, and a storage area turned break room for the staff. I went directly into the delivery room – a small space painted a pleasant shade of pale yellow with nothing but a crucifix and a clock hanging on the wall. On the bed in the middle of the room was the woman, naked, already in labor.

Two nurses were busy on either side of her: one, Cidonia, with her hands on the woman’s stomach, checking the status of the child, the other, Amélie, sterilizing instruments at the sink along the wall and preparing an injection. I had nothing to offer the pregnant woman besides a nervous smile and sympathetic eyes beneath a furrowed brow. She didn’t seem interested, or even mentally present.

I was about to ask the nurses how I could help when I bumped into the solar powered battery that was providing light in the room, upsetting some of the cables and plunging us all into absolute darkness.

“Desolée! Desolée!”

Well done, Rachel.

Amélie effortlessly navigated the maze of wires and switches, and I decided it was probably best if I stayed somewhere near the wall with my hands clasped in front of me.

But I was utterly enthralled. I wanted to understand everything the nurses were doing, and I wanted to be the one doing it. I watched wide-eyed, completely devastated by my ignorance, not wanting to distract or annoy them with too many questions. The woman in labor looked stoic and practically disinterested as she grabbed her ankles and told Cidonia she was ready.

Seriously?! Already!?

She could not have arrived at the health center more than thirty minutes ago. Without uttering a single cry or sound, she gave birth to a baby boy who was placed unceremoniously on the mother’s stomach while Cidonia clamped the umbilical cord. I breathed an audible sigh of relief and began congratulating the mother when Cidonia informed me: “Not yet… she has twins.” The mother was already pushing again as Amélie began washing the baby boy with perfumed oil and something resembling Vaseline. Her daughter was born quickly, albeit in the midst of some confusion as the water sac broke and the woman started peeing in the middle of delivery. With blood, urine, and a pleasant assortment of other amniotic fluids on the floor, Amélie placed the now-swaddled bundle of baby boy on the scale (1.8 kg) and turned her attentions to his sister. She had not started crying yet, most likely because when the water sac broke she got some fluid in her lungs, Amélie told me.

While Amélie employed a variety of rudimentary tools (I cringed as she pulled one in particular straight from a dusty windowsill and placed it directly on to the infant’s mouth) to extract fluid and force air into this incredibly small person’s organs, I stared at her tiny clenched fist. Everything about her exuded weakness – frail limbs hanging limp next to her body, loose skin, eyes swollen shut, a ribcage at the mercy of someone else’s breathing – and yet there was her fist: the culmination of all her life, and power, and energy. A condensed epitome of humanity – perfect fingers, perfect fingernails, perfect joints and knuckles. She held her life in her own tiny, powerful hands, so sure and determined. And her lungs soon followed suit. Her eyes stayed shut the entire time we bathed and swaddled her (Amélie let me help this time), but she was breathing, and her precious hand finally relaxed.
Meanwhile, Cidonia had been helping the mother. There was too much bleeding, and there seemed to be a complication with the placenta. When it finally came out, it was promptly placed in a plastic bag and carried away. The nurses began cleaning the floor and bed as the woman still lied there, exhausted, her eyes fixed on some point on the ceiling. The bleeding had stopped, but Cidonia still had to make sure there wasn’t anything left in the uterus. Donning a long, pink plastic glove that covered her entire arm up to her shoulder, she apologized profusely to the woman and began cleaning out some remnant clots and bits of bloody tissue from her womb. The mother squirmed each time Cidonia’s hand entered her, but she never made a sound. Once Cidonia was done, she placed a heavy bag of sand on the mother’s stomach, which stayed there for at least fifteen minutes while the nurses continued cleaning the room. Cidonia prepared a pseudo-tampon out of gauze and helped the woman to hold it in place using torn pagne which they wrapped and tied around her like a diaper. Once this was done, the woman slowly sat up, clothed herself, and walked to the hospitalization room where she could finally rest.

Cidonia and I followed, each carrying one of her children, swaddled in matching pagne. I was carrying the baby girl, and she squirmed slightly in my arms, eyes still closed like she was trying to return to a pleasant dream. I have never felt so much life condensed into such a small package, and I was overwhelmed with joy and love and tenderness and fear. We placed the twins on the bed right next to their mother’s head and left them.

As I walked out of the health center and back to my house, I could just barely see the sun beginning to rise behind the thick, heavy clouds in the sky. The toad cacophony had been replaced by the sounds of newborns testing their lungs, and family members muttering praise and congratulations. A final image was burned into my memory: the faint glow of an oil lamp casting a warm yellow light over the mother and her children in a moment of absolute peace and calm. The mother’s eyes were smiling.

Read Rachel’s first Dis­patch from Benin about rain and an impul­sive decision.

Read Rachel’s third Dis­patch from Benin about communicating without words.

Read Rachel’s fourth Dispatch from Benin about traveling in the country.