Being Pregnant in Post-Colonial Nigeria
I have much to be thankful for as a person of privilege in Nigeria. Including my over-medicalized birth plan.
Throughout my life, I never imagined that I’d be living in Nigeria. Even though I am the daughter of an Efik man who grew up in Lagos, I was raised solely by my white American mother without any contact with my father, his family, or Nigerian culture. My childhood in liberal, semi-cosmopolitan Seattle was a far cry from life in the bulging metropolis of Lagos.
And now, many years later, I have surprised myself: I live with my Yoruba husband in Ibadan, a large but laid-back city in southwest Nigeria.
In my adopted home, few people know my given name. Among Yorubas (the ethnic group to that my husband belongs) I am called Iya Ayo, Mother of Ayo. My identity and place in society starts by being the mother to my daughter. It’s a simple yet profound statement of the deep value Yorubas place on childbearing and parenthood. In local movies, one of the most popular subjects is the childless family and the sacrifices they will endure for the opportunity to have a baby. Culturally, couples without children are looked down upon and even couples with one or two children are asked by friends and relatives when they will be having more.
Within the context of this cultural outlook, one would think that Nigeria would be a great place to be pregnant. With the joy and high regard that children bring, it seems reasonable to assume that those feelings would be matched by a wealth of doctors ready to provide excellent, patient-centric birthing services. After all, pregnancy is a time when most women here — even those with limited means — find a way to receive formal medical attention.
And while it’s true that many hospitals specialize in prenatal and birthing services, what I’ve encountered in the past months of my pregnancy are services and philosophies counter what I would ideally seek for myself and my child.
Two-year-old Ayo was born in Seattle, an organic, free-range mecca where yoga studio memberships and commuter bicycles are status symbols. While I never quite fit the overall stereotype of a Seattleite, my low-key personality and preference for nature-based health options made me pretty typical when it came to my choice of birth setting. My daughter was born in a comfortable birthing suite where I was allowed to labor, deliver, and recover in the same room. The nurses and the doctors barely interfered, mostly monitoring while letting the labor progress naturally. I was allowed to walk around freely and stretch, and later delivered with the aid of a Pilates ball in my own improvised positioning. I was grateful for the ease of the whole experience, the ability to choose what was most comfortable for me, and, by God’s grace, that neither my daughter nor I experienced any complications.
Now that I’m pregnant again, it goes without saying that it has become important to me to understand how such an event might take place in Nigeria. At the middle class, private hospital that my family goes to in Ibadan, which specializes in family and maternity care, a proper delivery means a doctor-directed back-birth followed by an oxytocin injection to release the placenta and contract the uterus after delivery. For women over the age of 35 having their first pregnancy, a Cesarean section is virtually required.
Envisioning this scenario started to produce a great level of anxiety for me. When I first learned about it four months ago, I immediately began fearing physical restriction, unnecessary pain, and arguments with nurses and doctors at a time when I should be focused on the health and wellbeing of my new child and myself.
My maternity doctors here find the circumstances of Ayo’s Seattle birth hard to believe. They scoffed at my personal preference, all things ideal, being a home birth. To their ears, the idea sounded backwards and contrary to world-class medical standards.
I began to realize that my birthing experience in Nigeria would likely be framed by the enduring legacy of colonial-era thinking, my doctors’ guiding desire to match the elusive standards of the West above alternative or culturally relevant birthing practices.
As current birthing trends move towards a preference for de-medicalized and traditional birthing methods in the West, it’s clear that Nigeria is following outdated conventions.
UNICEF’s current data reveals that the chances of a woman in Nigeria dying from pregnancy and childbirth are 1 in 13. Only 35 percent of births are attended by skilled birth attendants. While the data is skewed by the extreme conditions of underdevelopment in the North, well-heeled Nigerians are known to leave the country for childbirth, heading to the homes of relatives in the U.K. and U.S. In a recent high-profile case, former governor Godswill Akpabio flew to the U.K. to seek treatment after suffering injuries in a car crash — even though he had recently completed a so-called “world class” hospital in his home state with the specific intention of reclaiming money spent on healthcare abroad.
In this reality, it is easy to imagine why a highly medicalized birth in a specialized hospital facility would be considered ideal, and why my own previous experience might sound like medical negligence to Nigerian ears.
It is also inside this cultural context that I’ve come to understand a greater truth behind the success of Ayo’s birth. Behind the calm that I enjoyed were ample personnel, equipment, and facilities to make any necessary intervention possible. Even my fantasies of a home birth are underpinned by the knowledge that in the United States, an ambulance would arrive at my door in minutes should anything go wrong.
I’ve realized that I should be quick to question my own desire to plan such an immense — and to a degree uncertain — life event down to the minute. Planning had nothing to do with the success of my first birth experience. I didn’t take any birthing classes and hadn’t written a birth plan. Labor started over two weeks earlier than expected. As well as the experience went, there’s nothing about it that I could have predicted or now duplicate.
Proverbs 19:21 of the Bible reads, There are many devices in a man’s heart; nevertheless the counsel of the Lord, that shall stand. In more colloquial terms, “man plans, God laughs.” In the face of fear and uncertainty, medical or otherwise, the only proven antidote is gratitude.
While the US is where I’m from, Nigeria is now my home. I’ve made a life here and the prospect of relocating and managing the logistics of birth in the U.S. while trying to organize my family here in Ibadan seems daunting.
In this situation and in all others, I have much to be thankful for as a person of privilege in Nigeria. My circumstances are enough to erase the reality of this country’s maternal mortality statistics. We have the access and the means to afford the best of what is available here.
When I consider childbirth in Nigeria, my greatest consolation is to be grateful for all that I have, including another child to come, and the presence of mind to recall that this baby’s story will be its own. And I’m excited to experience it when the time comes, be it in the U.S. or Nigeria.
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