When the screams of women in birth pangs die down, you can hear the subdued cries of those babies who made it alive into the chaotic post-quake suffering of Port-au-Prince's general hospital.
The women lie atop mattresses on gravel in the sweltering heat of tents erected in the hospital courtyard. Some have limbs amputated, others pelvic fractures. In Haiti, the joy of parenthood must wait, sometimes forever.
"Women give birth after being pulled from the rubble, their legs or arms amputated, some have deep wounds," Jean Herby Lafrance, a Cuban-trained Haitian doctor who flew in with a group of Cuban medics last week, told AFP.
Before the January 12 quake, thought to have killed 150,000 people, the impoverished Caribbean nation had the highest rate of maternal mortality in the western hemisphere -- 670 deaths per 100,000 births.
Fifteen percent of births involved hemorrhaging or other complications requiring operations, according to the United Nations Population Fund (UNFPA), with an estimated 63,000 pregnant women among Haiti's affected population.
Doctors, nurses and mothers alike labored long. Parents cradled newborns in their arms, some nursed. Most faces were expressionless, stuck between awe at the destruction and the joy of survival. Others smiled in spite of it all.
So far Lafrance had delivered 20 babies, including five by Cesarean section and two premature births brought on by stress from the earthquake.
"We've had eight women miscarry, some three or four months pregnant," said the 33-year-old, who has two children of his own at home in Santiago de Cuba.
"We have problems with equipment, particularly for Cesareans," said Lafrance. "The situation for operations is very critical, we don't have the material, but we operate anyway. It's very difficult."
He said there were no doctors in maternity when he arrived. Today, with volunteers from around the world in Haiti, he said there were enough doctors, but almost everything else was lacking.
"We have nothing to prepare the women, no compresses, sometimes no anesthetic and the operating tables are incomplete. We need material."
Some women can't make it to hospital and give birth without assistance in the many makeshift camps that have sprung up in and around Port-au-Prince. Conditions beyond the capital can be much worse.
"Around 7,000 women are expected to give birth in affected areas over the next month, with another 1,000 expected miscarriages," the UNFPA's Jemilah Mahmood told AFP.
The UNFPA is trying to get basic "reproductive health kits" containing a plastic sheet, a sterile blade to cut the umbilical cord and a clean string to tie it, plus a blanket for the newborn, to pregnant women in Haiti.
"Midwives and health centers, when they see someone who is visibly pregnant and about to give birth, they hand this out to them so that if they deliver in the middle of the street, they have a clean delivery kit," Mahmood said.
More advanced kits are being distributed to the hospitals and health centers that survived the earthquake. Some contain emergency Caesarean section equipment, others things ranging from kidney dishes to gloves.
But while the kits might be a step towards providing slightly more sanitary conditions to women as they give birth, they do nothing to preserve something else that was also taken from Haitian women and girls by the quake: dignity.
Joane Kerez, 20, gave birth to her first child a week and a day after the quake struck in the middle of a square in Port-au-Prince where thousands of displaced Haitians have made their homes, a CARE worker wrote on the NGO's website.
Kerez had only a tarpaulin for privacy, her mother to help her through labor -- and a crowd of onlookers gawking as she brought her baby into the world.
"I would have rather been somewhere else, in a cleaner place without all those people looking at my body," Kerez said.
"One of the things that is talked about very little is dignity," said Mahmood, explaining that UNFPA has begun distributing "dignity kits" to Haitian women.
The kits contain sanitary towels, hygiene materials, underwear.
"Women and girls are still menstruating, in spite of living outside in very horrible conditions, and having your clothes soiled could mean you are unable to get to food or water distribution points. And that can really impede survival and recovery," said Mahmood.
"Put yourself in the same position -- going to a supermarket and your clothes are soiled" by menstrual blood, she told reporters on a teleconference in the United States.