People may think giving birth is the same wherever you are in the world.

But not always in Old Fangak, South Sudan, where I recently worked as a midwife for Doctors Without Borders (MSF).

In most places, first time mothers will come to the hospital early. But in Fangak, they arrive only when they’re fully dilated and ready to give birth, and want to leave straight after. So even trying to get patients to stay an extra 24-48 hours to be monitored for complications is a challenge.

In Fangak, mothers-to-be also bring many people with them — usually a room full of aunts and grandmothers who help them through the birthing process. And instead of laying on their backs to give birth, women prefer to kneel on the floor, squat down and then deliver their babies — not a common method seen in the western world, but quite similar to the way that Turkana women in my home country Kenya prefer to deliver their babies.

Patients in Old Fangak usually have to walk or row for kilometers to reach a health center. It’s very remote, and there are no cars, just a few boats. But despite the challenges, the women there are lucky in one sense: they are tall in stature, and their build has a hip and pelvic ratio that benefits them during childbirth. In all my time there, most deliveries we did were easy natural births. There weren’t many complications that required us to do a caesarean section — which was good, because culturally, the community dislikes C-sections and it’s often difficult to get families and patients to agree to the procedure.

Read the full article about life as a midwife in South Sudan by Judith Elavian at Doctors Without Borders.