With her ears as a foetal doppler and her palm as a transducer, Domitila Aoko Nyalego is ready for her first client.
She gently massages the stomach with her palm before leaning close with her left ear to hear something.
“The baby is in a wrong position. How many months?” she asks.
“Eight,” responds Irene Atieno, almost holding her breath. She writhes in pain trying to turn to her side.
Nyalego,74, touches her once again. The baby is not ready to come out yet. But it is healthy and breathing well.
Atieno leans back, letting out a loud sigh she seems to have been holding.
Inside the dimly lit back room in Nyalego’s house is a bed, draped with a plain polythene bag and white bed sheet.
A pack of blankets and sheets are neatly arranged on a cupboard near the bed. Two red basins packed with a few clothes stand next to the pile.
Nyalego is the doyen of midwifery in Mathare 4A, Nairobi. Her name commands around here. It is easy to find her house in the congested slum.
For 60 years, Nyalego has been massaging pregnant women and up until a few years back, she would help them give birth.
“Today, I still help women deliver but only in emergency cases. Thereafter, I refer them to the hospital immediately with a note indicating I helped them. The hospitals around here know me,” she says.
Leaning close to listen to the foetus inside Atieno’s belly, Nyalego says she started helping women give birth when she was only 14, under her grandmother’s direction.
“My grandmother was a midwife and in some spiritual revelation passed her powers over to me. After her death, I saw her in my dream and she handed me a white bright light which I believe was the power,” she says.
She continued to help women deliver in their village in Alego, Siaya, until she got married at 17 and moved to Nairobi.
“I continued with the job and also gave herbs to sick people who would visit from very far. My expertise was known far and beyond Mathare,” she says.
Before free maternity was introduced, Nyalego would get up to three women coming to deliver at her home.
“After the introduction of free maternity, health professionals trained us on how to handle our clients better and hygienically. They advised us to refer women to deliver in the hospitals,” she says.
Even though she lost many customers, Nyalego was quick to adapt to the changes and started working with the hospitals to help pregnant women.
“The first thing I ask of my clients, who mostly come for belly massages, is their clinic cards. I check if they have done HIV and other tests before attending to them,” she says.
Nyalego still gets up to 15 women coming for a massage, especially in the morning hours.
She rented another single room opposite her house which she used as her clinic for general pregnancy checkups and massages.
Inside the room, two beds stood adjacent to each other each leaning onto the wall. Three heavily pregnant women squeezed together, legs apart leaned back and hands rested.
“By midday, I am done with most clients and I go on with my house chores, and preparation of my herbal drugs,” she said.
Nyalego said some of the women who she helped deliver their babies brought their pregnant children to her and plead with her to help them but she said she had completely held off deliveries, especially during the Covid pandemic.
“If I put myself at war with the government, you and I know who will be the loser yet this is how I fend for my children,” she said.
For the massages, Nyalego charges Sh50 and between sh1500 to Sh3000 for normal deliveries.
The septuagenarian said during the massage therapy, she can tell if the child is breathing properly and if it is lying in the right position.
“If it is in breech, I apply a massage technique that makes them turn around, head facing down,” she said as she moved her palms gently on Atieno’s belly.
“Right now, the baby’s head is on the side but after this, it will move to the right position.”
After a few minutes, she confirmed the baby was facing down.
“I cannot tell the gender or weight of an unborn baby, but I can tell multiple pregnancies from three months. I can tell if the baby is not breathing properly, readjust the umbilical cord if it is on the baby’s neck or refer you to the hospital,” she said.
Nyalego said after years of practice, she can identify the parts of the body by touching the stomach but sometimes, she is guided by the heartbeats.
“I give the woman traditional medicine to subside the pain and prevent infections. I learnt about herbs at a very early age,” she said.
“My grandmother would take me around the fields to show me the different types of herbs and their uses”.
Family doctor Wilberforce Lusamba said even though the traditional belly massage has been normalised and practised for generations, it has no known positive impact on the pregnancy but is purely for relaxation.
If the massage is done on a risky pregnancy or by someone who is not an expert, it could have a detrimental impact on the pregnancy, the mother and even stillbirths.
Massaging certain acupressure points, he said, might trigger a miscarriage or preterm labour. Sometimes these points are massaged to induce labour.
Lusamba said when the pressure is applied to the wrong places, like around the umbilical cord or where the uterus attaches to the placenta, it detaches it, leading to bleeding and death of the baby as the oxygen supply is cut off
“If the placenta is low-lying, the traditional birth attendant may not be able to know this and if they massage the placenta, it would easily detach,” he said.
The massage could cause high blood pressure to the mother, therefore, causing complications with the pregnancy.
The doctor said many women say they go for the massages to check if the baby is okay and if they are in the right position or need to be turned around.
“The foetus can turn around in the womb up until at least 34 weeks. I advise pregnant women to wait till then,” he said.
Concerning the herbal drugs, the doctor said the amount of a particular drug in the herbal cup given is not measured.
“Most drugs come from plants but the quantity of maybe paracetamol in it is known. This is not the case for herbal drinks the midwives give. This could pose a risk to the pregnancy,” he said.
Edited by Kiilu Damaris
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