Birthing stool: A simple seat, a grand difference
A small stool is creating a big change in Turkana, where women now have a safe, culturally respectful way to bring life into the world.
By Lilys Njeru
Chapter 1
For many outsiders, the journey to Kaikor village in Turkana County begins in Lodwar, the region’s bustling hub. Nestled over 150 km from the town centre, the route is a true test run, demanding meticulous planning and unwavering endurance.
The road network is rough and unpredictable. It winds through Turkana’s dry terrain, often disappearing into vast dry river beds, which locals call “Laga.” When it rains, the river beds flood making the roads impassable. Sometimes, it splits or ends abruptly, leaving one to find one’s way forward.
As you approach the village, it could be easily mistaken for a forgotten place, a “middle of nowhere” in the true sense. And, mystical even. The quietness that renders the air is almost palpable, broken only now and then by the plaintive bleating of a goat from a distant compound. It may seem almost uninhabitable, yet life endures here. People navigate the harsh terrain, herding goats, and are constantly on the move in search of elusive pastures.
Without needing to be told, any outsider will quickly notice one striking feature: the vast distances between homestead—clusters of huts made by women using dry twigs, with nothing but emptiness between. The same can be said for social amenities such as learning institutions and health facilities — few and far between.
The stories the locals tell often reflect a tapestry of struggles and resilience, offering glimpses into their challenges and hopes — from devastating droughts and floods that keep them moving from one place to another to limited access to healthcare. Residents of Kaikor navigate the same terrain to Lodwar town whenever there is an emergency.
As infrastructure developed elsewhere, residents here were left in the shadows, forced to endure long, exhausting treks under the blistering sun just to access the nearest health facilities.
Confronted with these challenges, they adapted in their way, relying on indigenous knowledge passed down through generations. This knowledge became a way of life; their culture became ingrained even in the sacred act of child delivery.
Chapter 2
At this time of the year, the sun and temperatures rise together at dawn, each setting the stage for another scorching day ahead. Around 9 am, we find Apuwa Longor inside her hut. One of her relatives attends to the many strands of colourful beads on her neck.
“I have had some of them since I was a girl. It is part of our culture. The more, the better,” she remarks. “ These, plus our livestock, are our lifeline.”
Apuwa is about to be a grandmother. The previous evening, her daughter, Alim Longor, was not feeling okay. “We cannot leave her alone,” she mutters to the young girl attending to her necklaces. She nods.
Apuwa and her daughter, Alim are more than a decade apart. In those years, the world around them has shifted, and so too have their birthing journeys.
The child delivery experience, in her telling, went like this. “We the Turkana didn’t rely on anything. In terms of pregnancy and delivery, when the time comes and you want to give birth, you’ll give birth anywhere. Just support yourself on anything. There was no designated place. We used to rely on ourselves. There were no hospitals to go to,” she narrates.
To those who could afford to part with a goat as a form of payment, traditional birth attendants (TBAs) were their lifeline. They would tend to the women with compassion throughout the process. The TBAs, she explains, guided women to give birth while crouching.
“We saw our mothers delivering on the ground. This was a custom for all Turkana to deliver on the ground,” explains Apuwa, with a smile on her face recalling how well the TBAs cared for expecting mothers.
Data from the County Government of Turkana show that in 2014, only 23 per cent of deliveries were attended to by skilled deliveries, with many women choosing to give birth at home. Although the distance to health facilities was the most significant factor, according to multiple studies, many still chose traditional birth attendants, valuing their deep-rooted knowledge and presence in the community.
Yet, this reliance on home deliveries came with a heavy cost — high maternal and child mortality rates. Traditional birth attendants, while trusted within the community, often lacked the training and experience to manage emergencies or complications, putting both mothers and babies at greater risk.
A 2020 Maternal and Perinatal Death Surveillance Report shows that between July 2019 and June 2020, Turkana County lost 352 children and 20 mothers due to pregnancy-related complications. On average, a child died every day during that period.
Apuwa remembers. A woman who died while giving birth, a child that the community never got to ululate for. “But, what could we do?” she poses. She is happy that her daughter will be attended to by a professional health worker.
Chapter 3
Over time, various stakeholders, including the government have introduced a range of interventions aimed at reducing maternal mortality and achieving universal health coverage.
It is through such initiatives that Maryam Itukon was brought on board by the government to serve as a community health promoter, commonly known as a CHP. Through her role, she became a bridge between the community and healthcare services, playing a crucial part in improving maternal health outcomes.
Whenever Maryam receives a report that a particular woman is expecting a child, she visits them as soon as she can and sensitises them on prenatal care. Sometimes, it can also mean talking to their husbands who are the family’s decision makers.
“I oversee dozens of households in this village. I ensure that all expectant women attend antenatal clinics, and children are immunised and check on the general well-being of all households. Every month, we organise outreach programs to reach those living far from health facilities. This allows us to monitor their health, address issues like malnutrition, ensure children are vaccinated, and catch any signs of illness before they escalate,” she says.
Maryam is now caring for Alim and other pregnant women in her village. While many women now prefer to go to the hospital, going by her encounters, many still want their culture honoured. For them, the decision of where and how to give birth is deeply personal.
The CHP understands this intimately, having gone through three distinct experiences. The first time, she gave birth at a health facility using the delivery bed. “I struggled a lot. I tried pushing, but the baby wasn’t coming,” she recalls. “By the time I was having my second child, given the difficult experience I had the first time, I decided that I would rather give birth at home and face whatever consequences. Then they brought the birthing stool so I gave birth to my last two children at the health facility, using the birthing stool.”
Chapter 4
At Kaikor Sub-County Hospital, we meet Callistus Nawet, the medical superintendent. This is the serving of hundreds of households in this locality. The facility, he shares, mostly runs through support from the government and non-governmental organisations, like the one that donated a birthing stool in 2021. Kaikor health facility offers basic healthcare services, including routine maternity care and simple deliveries. However, for more complex medical emergencies—the centre must refer patients to the larger Lodwar County Referral Hospital, more than 200 kilometres away.
The medical superintendent takes us into a room at the corner of the hospital building and there are— a delivery bed on one side of the room and the birthing stool on the other corner. It’s the first time we’ve seen one in this setting, and at first glance, it might seem like a small thing, almost insignificant; a story that might slip through the cracks.
But, in his telling, it carries profound weight. “A game changer,” he calls it.
“ Before I was transferred here, I was working in another health facility. When I saw the birthing stool, I thought to myself, ‘This is really good. The issue of choice- delivering over the bed and down here crouching was evident everywhere when you are working in facilities outside town. For example, where I used to work, these issues usually came up and because of the lack of a bathing stool in that particular place, sometimes we could go ahead, take up the bed, put it on the floor and allow them to do it,” he explains.
The number of home deliveries used to be high, Nawet admits. “ Some of the information that used to come over from our community health workers was that some of the reasons as to why those deliveries were so, were because of some perceptions mothers were giving outside there. When they come to the hospital, some of them are used to their normal way of delivering, crouching. But when they go to the hospital, they are subjected to delivering in a high coach, which they are not used to,” he pauses, then continues.
“And because some of these hindrances were identified and some interventions brought on board, like, for example, the birthing stool we have over here.”
In September 2024, the hospital had nine deliveries. “In August we had 16 and 15 in July. More than half of them preferred using the birthing stool. So we are having scenarios whereby people from outside villages are coming to deliver here because of the birthing stool,” he explains.
The use of birthing stools, he says, has improved the attendance of skilled deliveries in hospitals situated outside towns.
FACT BOX:
How the birthing stool works
- The birthing stool has a number of components.
- There’s the stool itself and a small couch, the receiving couch
- It has handles on both sides.
- During delivery, the expecting mother uses the handles to hang on, to be able to crouch over the receiving couch and deliver as the health worker sits on the stool.
Chapter 5
As the village sleeps, Alim lies outside her traditional hut, the cool night air surrounding her. It is around 10 pm. It is dark, and the world is still, with everyone else fast asleep.
She gazes up at the sky and quietly says, “I am waiting for the new moon.” Here, the calendar holds little sway; it is the moon’s movement that guides them. In a place so removed from modernity, they have learned to make do with what they have, finding ways to observe and measure time, to navigate life by the rhythm of the natural world around them. It is a practice born of necessity.
Notably, things are gradually changing now, and we saw glimpses of it — people with smartphones in hand, solar panels perched on roofs and a television flickering in a small pub at the village’s centre.
Alim’s first delivery at home was a storm she barely survived. She was alone at home when the baby came. “When I gave birth to my first child at home, the placenta stayed inside and I bled heavily. I was taken to the hospital and lost consciousness because
no one was home at that time,” she offers.
By the time her fifth pregnancy came, she knew the stakes had changed. This time, she was resolute — she would not face it alone at home. The risks were too great, and the memories of her first delivery too vivid. She understood now that her safest choice was the hospital, where skilled hands and modern care could offer the protection she had once gone without.
“I prefer that stool, I’m not used to lying on a bed. I usually give birth on the floor. I’m used to the floor so I can’t lie on a bed,” she says.
Interventions like the introduction of the birthing stool, Nawet believes, is what has seen the number of skilled deliveries go up in recent years.
In 2022, births delivered by a skilled provider in Turkana County were at 53 per cent against the national average of 89 per cent; An improvement from 23 per cent reported by the county government in 2014. This is according to data from the Kenya Demographic and Health Survey 2022.
“I would even maybe say that it’s what is improving the numbers of deliveries in facilities that have it than those that do not have it,” he opines.
He, however, admits that there are limitations to the usage of the stool. “I think one of the things critics would say is that it doesn’t offer you that opportunity to receive that kid most formally, control and be able to prevent a tear. Also, with civilisation and education, I see that in the future probably there will be a reduction in using it,” he says.
After weeks of waiting. A new moon appears, a sign that is due for delivery. She walks into the facility and walks out holding her baby, Lilys Carolyne.
“I thank God for the safe delivery. I am happy,” she says.
Chapter 6
At the heart of Nairobi city, Pumwani Maternity Hospital, one of the largest maternity facilities in the country, delivering 16,000 to 24,000 babies every year has two birthing stools.
“When mothers come to the hospital, the traditional way of delivering has been on their back, otherwise called the lithotomy position,” explains Dr Roy Mwenda, deputy medical superintendent at Pumwani Maternity Hospital. “This has been a conventional practice, but we are now shifting toward what we call dynamic birthing positions.”
Dynamic birthing positions, he offers, allow mothers to deliver in a way that feels most comfortable for them. “If they want to squat, they squat. If they prefer using a birthing stool, they have that option,” he adds. “This approach gives the mother autonomy in choosing how she delivers.”
The push for dynamic birthing positions aligns with a broader shift toward patient-centred care. “Medicine is moving to a patient-centred care approach,” says Dr Mwenda. “Where you do not look at it from a position of the midwife’s perspective or the healthcare provider’s perspective. You look at it from the perspective of the mother receiving care. This shift will encourage more mothers to choose hospital deliveries, ultimately improving maternal and newborn outcomes.”
This article was written as part of the OWM’s Health Solutions Programme, alongside the short documentary The Birthing Stool, produced by Nick Wambugu & Lilys Njeru. See project details here.