The Iron Women

Brittney Bruno, MD, MPH OB/GYN resident, University of Arizona College of Medicine - Phoenix Drexel University College of Medicine Class of 2020

I was a fourth-year medical student when I crossed paths with the Iron Women of Uganda. We met on the labor and delivery unit in Kawempe Women’s hospital, Kampala. It did not take me long to garner an immense respect for the women who become mothers here.

They came in with their own delivery supplies packed in large backpacks, plastic buckets, or suitcases, walked up the hospital’s swirling ramps to the waiting room. Those who were admitted were assigned to beds. The ones who weren’t far enough along in labor waited on a wooden bench or took a seat on the floor.

There was no modesty here. The best way I can describe it is that their bodies were… “open.” Open to be examined, open to assistance, and open to trust. Initially, it was quite a shock for me – seeing so many women so freely “open.” However, I quickly understood that they weren’t on “display.” They were there for assistance through one of the most painful and natural processes known.

The mother I was to deliver, Afiya*, was a 19- year- old prime gravid. I had watched all morning as she handled the intensifying phases of labor. She began by pacing, bent at the hips, back and forth beside the bed, tethered by her IV line. When the contractions grew stronger, she moved to the floor, repeatedly hitting her thighs, desperately trying to distract herself from the pain. Her cries moved from a sort of rhythmic chant in her native Lugandan to full-bodied screams she tried to stifle.

I had seen women on the floor endure the process silently, with pressed lips and beads of sweat on their skin. Others would cry out with stretched arms, reaching for something I could not see. Some women would tremble uncontrollably with their eyes wide open. They slapped their thighs, backs, the wall, anything to draw their attention elsewhere.

They felt each and every contraction, as they received no anesthesia, except if they were going for surgery. The only anodyne they have is whatever mental strength they can muster.

“Mi-sa-woah!,” they all eventually called out, desperately. At first, I thought it was a cry for God. But it is the name for medical personnel. The moment came when they would call for a doctor, nurse, midwife, or a medical student, —anyone to help them. With over thirty women in one labor room, and little the staff could do for their pain, the women were often silenced, and told they would have to endure the pain. I watched as Afiya became increasingly restless, rocking back and forth on her hands and knees as sweat dripped from a face that grimaced with every contraction.

Finally, it was time and the midwives called me over. With careful hands and a pounding heart, I delivered her baby boy! Headfirst, he slipped into my hands. Vigorously wiping him down, I placed him into his mother’s waiting arms. Not realizing I was holding my breath, I said “Happy birthday,” knowing that neither the baby nor his mother understood. Afiya smiled back at me, and that was enough.

After the delivery, Afiya was moved to a mat on the floor to begin recovery. She lay there, calmly, with her baby. It was such a transformation. She had gone through one of the most natural and painful experiences known and looking at her now, so quiet and reposed, no one would have guessed what she had just gone through.

I often reflected on my time spent with the Iron Women of Uganda. As my admiration for their perseverance continued to

grow—so did my desire to be a part of their journey. What an incredible experience, bringing someone into the world. It is immensely painful, terrifying, and at times prolonged. My hands ached to do more for women, helping them through this phenomenal undertaking. I wanted to ease the discomfort of the process in any way possible, coach them through the difficult moments, and walk them through undesirable outcomes, should they occur. More importantly, I wanted to be the one in the room to catch babies as they enter the world.

After medical school, I started training in family medicine. I hold immense respect for this extraordinary discipline, but it became clear to me that my passion lied elsewhere. As a result, I recently made the difficult decision to change specialties and start training in Obstetrics and Gynecology. Beginning the journey through residency yet again as an intern, my heart is full, knowing that I am on the path I was always destined for. I intend to pursue my professional goals by working in global women’s health and eventually be of service to the Iron Women.