Birth pangs: strangers in a strange land: Bangladesh is a long way from Whitechapel - never farther than in the maternity ward. Esther Oxford reports

ROUND and along the backstreets of Whitechapel she walked, past the barred 'fashion shops' - saris displayed; past the sawdusted butcher's stalls - whole chickens hanging. Suzan Quilliam, a midwife at the Royal London hospital, Whitechapel, was looking for a house in Fashion Street.

It was off Brick Lane. A woman - let us call her Monwara Ashi - was waiting for her with her three children. Six days ago Mrs Ashi and her new baby had left the Royal London. Now the baby was sicking up all the time: breast milk would just slide out of its mouth. For several days Mrs Ashi had been waiting for a doctor. No one had turned up.

'The doctors are like that you know,' said the midwife. 'When they find out a client is Bangladeshi they just don't bother. We call our Bangladeshi clients The Uncomplaining Ones. They would rather stay at home in the hope that someone turns up than go to a telephone box, call the hospital and complain.'

Mrs Ashi belongs to Whitechapel's hidden population. Although they make up 49 per cent of the maternity ward's clients, Bangladeshi women are the easiest sector of the population to forget: language problems, fear of racial abuse and domestic tradition keep many behind closed doors.

Before 1986 the turnout for antenatal clinics at the hospital was low. The women feared nasty comments on buses, the waiting around at the hospital when there was so much to do at home, the embarrassment of bringing a man in to translate. 'We found that Bangladeshi women were just not registering themselves,' said Margaret Anthony, head of Women's Services. 'Consequently, the number of stillborns was higher than it should be. We decided that if the women were reluctant to come to hospital it was up to our midwives to go out to them.'

Seventeen 'drop-in' antenatal clinics were set up across Tower Hamlets. Maternity aides were brought in to translate and midwives taught how to adapt medical practice to accommodate culture and religion. Practices in the hospital changed, too: an all-female staff is assured wherever possible; families can bring in home-cooked meals.

But despite the Royal London's tremendous effort, there were some needs that staff found hard to cater for: poverty in the homes, in the quality of life for the women, and in the absence of support from close family and relatives. A walk around the ward and this poverty is manifest: few flowers and fruit on the tables, threadbare dressing gowns, second-hand baby clothes, loneliness. Kohl-eyed, the women hug themselves and wonder.

In the waiting room of the Spitalfields community clinic, women wearing colourful swirls of silk sat around. Hanging in the corner was a bucket for condoms. It had been emptied. 'The prostitutes,' said a passing maternity aide. 'They come in here and clear out our stocks in a flash.'

Compared with the usual turnout, the maternity clinic was quiet. It was Ramadan. They were probably too exhausted to come in, said a health worker. Most would have spent the night cooking in preparation for the pre-sunrise feast.

Parveen Quader, 35, a volunteer community health worker for eight years, supports and advises women who have just arrived in the country and tells them of the services available to them. Many, she says, find the array of technology overwhelming. In Bangladesh natural is the norm and facilities are basic: most often the floor is earth; sometimes it has straw on it. The mattress is a binliner stuffed with plastic bags. Asprin is used to dull the pain.

After the birth, the placenta is buried deep in the earth to protect the spirit of the baby. For the next 40 days the mother and mother-in-law clean, cook, shop and tend the baby.

In London the 40-day respite is impracticable: the relatives and friends of many couples are still in Bangladesh. Men rarely help: housework is deemed 'unnatural'. Home conditions are often poor - with overcrowding, inadequate sanitation and nowhere for the children to play. Furthermore, there is little loose earth in which to bury the placenta. Ask the mothers what they plan to do with it and they look resigned. They will let the hospital deal with it, they say.

To encourage their clients to adjust to the hospital system, the Royal London tries to involve them in as many decisions about their health and the health of the baby as possible, says Mrs Anthony. 'If a woman says she would prefer a home birth we try to accommodate her wishes. A woman's medical history is the only criterion for a home birth. We don't worry about the lack of a phone or the state of the house. After all, there's no point in being precious about it: the baby will be home in three days anyway.'

Despite staff efforts, hospital continues to be distressing for many Bangladeshi mothers-to-be. Some women complain that there is not enough privacy. Others feel uncomfortable in the presence of passing males - cleaners or doctors - and would prefer an all-female staff.

Many of the women rely on their husbands to translate for them, and visiting hours are restricted. It is not uncommon for a woman to be left confused and upset for 12 hours or more waiting for a maternity aide to translate a particular worry. Most of the aides have children of their own; duties at home do not allow them to work at night. During the day, there is only time for a quick chat.

Apart from the odd family visit, the women are left alone. Some sit listlessly, eyes huge, body rocking. Others sing to themselves, knees drawn under the chin, or else lie still, enveloped between crisp white sheets.

Staff are divided as to how best to meet the needs of these women. The maternity aides, whose job it is to talk to the women and comfort them, say the mothers should be kept in hospital for as long as possible: they need the rest, they need support, and for a short time they can enjoy the luxury of being cared for.

Others, mostly the older midwives, argue that it is best to make the hospital stay as brief as possible. 'The best thing is to have them in and out. It is the nearest thing to a home birth - which is what these women are used to. They don't expect all the fuss,' said a midwife.

'In bending over backwards the hospital is not helping them. Year after year, they come back. They recognise you but they can't understand anything you say. Instead of encouraging the staff to pick up Sylheti, the authorities should teach the women English.'

A baby woke and mewed pitifully. The midwife went over to the mother, a fragile girl of about 16, and shook her awake. Dazed, the girl sat up, frightened. 'Your baby is crying,' signalled the midwife. 'Feed her.' The girl pulled her body out from between the sheets and, stumbling, went to her baby and picked him up. She did not know what to do with him. She just looked at him and looked at him and bit by bit other women stirred, wakened by the crying.

'Some of these girls have been producing since the age of 14. Some of them don't even want the baby,' said the midwife. The mother came over, miming with her hands that she needed a teat. Then: 'I don't want to look down on them. But something has to be done.'

It was near midnight when I first saw her name on the board in the labour ward. She had been in labour for 12 hours but had only just admitted herself, said a midwife. She could not speak English but her husband was with her. Could I see her? 'One minute,' said the Nigerian midwife and poked her head round the door.

It became clear listening to the conversation through the door that the woman, whom I shall call Monwara Rozi, did not speak English. But the door to her private labour room was thrown open and I was ushered in.

Mrs Rozi was sitting upright, her legs open, her vagina gaping. When she saw me she gasped and tried to cover herself, her body slithering over the plastic sheet in her efforts to pull a sheet between her legs. Beside her stood her husband, stiff, still with his overcoat on. I thought back to an earlier conversation with another woman who had said how embarrassed she felt when her husband had been forced to watch the birth - just so that he could translate. Her husband was embarrassed, too: birth was supposed to be an all-female event.

I felt Mrs Rozi's humiliation. Half a minute later she flung her arms over her head, eyes white, head rolling; from between her skinny legs eased the head of her baby. With a muffled yelp, she tensed again. The rest of the baby slid out.

The student midwife held the infant up. 'Its a girl]' she said delightedly. Mrs Rozi's husband was silent for a moment, then he translated in a low voice, monotonal, short. His exhausted wife screwed up her face in what appeared to be the worst agony yet. Silent tears poured down her face.

'They prefer boys,' explained the student under her breath. Then speaking slowly and loudly she asked the husband if his wife wanted to hold the baby. He shrugged his shoulders then shook his head. No. He looked bewildered. 'That's because it is their eighth,' whispered the student and, pulling the sheet over the woman's legs, she cut the cord, wrapped the baby up in a sheet and tenderly wiped the mucus off its face.

Later the trainee midwife excused her partner's behaviour. The midwives were usually very careful to consult the woman if a stranger or a student was to be present, she said.

'But some midwives get impatient - especially when they have been doing the job for 20 or 30 years. Their better intentions just drop away.'

Mrs Quader from the community centre saw the situation from a different perspective: 'I get a lot of complaints from our Bangladeshi clients about the rude behaviour of the Nigerian midwives - especially those from agencies. They say things like: 'Shut up, cow' to the women.

'It upsets them but they feel helpless to do anything. They come to me for help, but by then it is too late. I just tell them the midwives are overworked and get fustrated when there's nobody around to translate at night. But we are getting more and more complaints about racist remarks and unkind behaviour.'

The contents of a skip had been dumped at the entrance to the house in Fashion Street, where Monwara Ashi, the woman with the sick, new- born child was still waiting for her doctor. The colourful packaging of the rubbish was the only indication that we were in the twentieth century.

Monwara Ashi answered the door in a thin dress covering her thin body. Only her stomach was swollen. Her feet were bare. Mute, she let the three of us in. Suzan Quilliam, the midwife, started talking; Anwara Halim, the maternity aide, translated. We're here to check up on your health and the baby's, said the midwife.

In a low voice she started talking as she undressed the baby - talking, talking. 'Homes like this - crowded, dirty - are common. One time I visited a building in Brick Lane and tried to turn on a light to walk up the stairs. The switch had been disconnected: the landlord wanted his Bangladeshi tenants out. I rummaged in my bag, found a torch, turned it on and shone it up the staircase. There was a gaping hole - three or four steps were just missing.

'We are supposed to encourage home births but sometimes the conditions are just too bad. And sometimes there isn't the space. In a Bangladeshi village an expectant mother can clear her children and the men out. But here there is nowhere for the children to go. Only the street.'

Monwara Ashi had given birth to three children without a break, all girls. When she went home from hospital six days ago she found there was no home to go to: the in-laws wanted her out. Exhausted, depressed, with no money and three children, Monwara Ashi went the only other place she knew: her parents' bedsit.

'Can't you do something to help us?' said Monwara Ashi's old mother to the midwife, to the maternity aide, to me. 'We have no room here for my daughter. My grandchildren have no space.' She went on and on, begging in Sylheti and smiling at the same time. Meanwhile the two toddlers danced around the bedsit - round the pile of clean nappies, round the pile of dirty nappies and round the table with 11 saucepans on it - each containing a different dish.

'Because we are white, she thinks we have the power to make things better for her,' said the midwife. 'But unless Monwara Ashi makes herself homeless, the chances of getting a council house are minimal.'

We left a few minutes later. 'Daughters,' said the midwife, closing the door thankfully behind her. 'They're like that. They go running back home at the drop of a hat.'

Esther Oxford was highly commended in the Cecil King Young Journalist of the Year award at the British Press Awards yesterday.

(Photographs omitted)