It’s a cold autumn evening, and you've just put your young children to bed. The fire in the stove is warm, and a pot full of yah butter tea is boiling on the stove. There is a rushed knock at your door. It is a husband of a woman in the next village that you visited a few months back, she is in labor. He thinks she has been laboring, "too long, will you come?" You tell your husband of the news, poor a thermos of tea, wrap yourself in your thick woolen coat, and join the worried husband on the back of a borrowed motorbike.

As you ride through the valley, you wonder how this birth will go? The last time you attended a women in this village, the baby was dead when you arrived. You did what you could for the mother, but you know that sadness like that does not go away. BUMP! The motorbike slid out from underneath you as you drove through one of the many mountain streams you have to cross. Oh well, you both pick yourselves up, no harm was done to you or the bike, and you both climb back on. As you settle into the seat behind the anxious husband. You place one arm behind you gripping the steel bar for balance, as your other arm hangs down at your side. In your loose hand, you hold your Mala (Buddhist prayer beads), sliding one bead at a time between your forefinger and your thumb, you pray: may this birth be joyful, may she be free of pain.

When you arrive at the village, the husband of your friend leaves you at the main gate. He is going to collect more yak dung for fuel, he anticipates a long evening. You know your way; you were here a few months ago to visit the woman when word reached you that a woman here was pregnant. At that time, everything seemed to be as it should be. You advised her to eat more Yak meat, you learned in your midwifery training that this can help to stop the bleeding in women after they give birth.

As you walk through the village, you find yourself looking around you at the mud walls dividing home from home. You think to yourself that there has been a lot of construction since you were here a few months ago, and how nice the walls looked with their fresh layers of mud; so smooth and fresh. You remind yourself to talk with your husband about tending to your own walls, as it’s been since before the summer festivals that you applied new mud.

You've arrived at the home of your laboring friend, and you gently knock as you push open the heavy wooden door. The house is as you expect it to be: warm and dark. On the floor on a pallet, you see your laboring friend and her mother. The rest of the family has gone elsewhere to sleep tonight, as is custom here. The mother is sitting next to her daughter, as she works diligently on a woolen rope. The young woman labors, mostly silently, and looks up as you come in the room. As you approach the women, you inquire about the family, the livestock, and how many attended the festival that summer. You slowly sit down next to them, placing a hand on your friend's knee. You can see that she is nervous, and her discomfort is growing. You look at her and say, "Its ok, we are here with you."

Your friend goes through a few contractions, and you watch and listen closely. You see that she writhes a great deal, trying to relieve pressure from her abdomen. You ask her to lie still, if she can, during the next one so that you can feel her belly. As the contraction comes, you feel for the position of the baby. You learned in your midwifery training classes the way a head and bottom feel differently, and you are concentrating hard to feel for them right now. Your breath is short and your heart starts to beat quickly, you feel a bottom where the head should be. This, you think to yourself, is not how it should be. You tell the mother that your friend, her daughter, needs more attention than you can give her. They will need to go the hospital. You see fear for the first time in the eyes of this old woman, they are a poor family and it is not likely that they can afford the $3 for a tractor to take her to the hospital, and they can definitely not afford the $60 it will cost to have a hospital delivery. She slowly climbs off the pallet, turns to look at you, and says she will go find her son-in-law to discuss this. She pushes the door open, and sighs heavily. She has seen this before, and knows that the outcome is not likely to be a good one.
Stay tuned for the conclusion....