I am the Ambulance

I'm hoping for a phone call. 

My friend Jana is due with her second baby and hopes to deliver a 15 minute drive from here at the hospital.  She has been selling bananas so that she can afford to do so.  (My family will be eating A LOT of bananas in the near future as I have been buying them.) 

The thing is, that only the very rich here own cars.  (We do not own one but we can rent one) There is public transportation....but not between 6pm and 7am.  So if a woman goes into labor during the night and things progress quickly...she has no way to give birth under the supervision of a skilled birth attendant. 

That is why I am expecting a call from Jana.  She plans to call and have us drive her to the hospital if she goes into labor during the night. 

Unfortunately for most the women in this country, transportation is not even the issue.  For most, there is no access to skilled birth attendants unless they hike for a couple days to find one.

I'm excited to be a part of her birth.

Classy Doulas and Lifeless Babies

Today I stepped in a pile of poop and then tracked it all the way around the hospital bed before I realized it.  It was really very classy.

With in minutes of arriving, my doula friend and I each stopped to talk to a couple of laboring women.  With in a few more minutes, there were 2 baby heads emerging. (from 2 different women, not the same one - in case you were worried.)  The race was on! Two first time moms yelling, "It's coming!"  The foot of their beds had only about 10 feet between them. 

Anya's baby was coming, but slowly.  She was pushing well and just wanted a hand to hold and someone to give her sips of water.  She had been completely alone for many hours.

Julie was HIV positive and her bag of waters was still intact.  Her baby was coming very quickly! Before I knew it, the baby's head, inside the water bag was completely out.  It was soon followed by the rest of the baby girl.  She splashed into this world as she slipped onto the bed and her water cushion broke simultaneously.  What a blessing that she was protected from the vaginal fluids on her way out.  I didn't get to hear if she was born HIV positive or not.

Meanwhile, Anya kept pushing.  She gently delivered a baby girl about 10 minutes later.  No tears, even thought the baby was delivered with a fist by her cheek. It was a very peaceful birth. 

The entire rest of the day was spent with Mikal.  She was also there to meet her first child.  She dilated quickly, but once she hit 10 centimeters, she grinned at us and basically fell asleep for three hours.  For awhile we encouraged her into a position that would move the second stage of labor along, but she was just not into it, so we let her sleep.  Eventually she awoke, crawled down off the bed, and squatted noisily.  The grunts became screams and I guessed that she was crowning.  Sure enough a peek proved my suspicions were true.  Within the next few minutes, a tiny,. white, lifeless little baby boy emerged.

After about 20 minutes of prayer, oxygen, and CPR, he was breathing, struggling...but breathing.  At that point we all breathed a sigh of relief.  I'm glad he wasn't one of the majority of babies in the county who are born out in the jungle and left for dead if they do not breathe immediately on their own.  The midwives did a great job on that one.

In the end, everybody was doing great...and we headed home after another awesome day of loving the women God loves.

Child Mortality in the News

FACTBOX: Fighting child mortality around the world

Source: Thomson Reuters Foundation - Fri, 13 Sep 2013 11:58 AM

Author: KatyMigiro                                                                                                                                                                                                                                                                                                                                                                                                    

More on: Health and Disease

A woman feeds her malnourished child at a paediatric ward in Banadir hospital in Somalia's capital Mogadishu August 7, 2011. REUTERS/Omar Faruk

 

   

NAIROBI (Thomson Reuters Foundation) – Eastern and southern Africa are reducing child mortality faster than any other regions in the world, the United Nations children’s fund (Unicef) said in a report on Friday, but more than 18,000 children die needlessly every day.

The report, 'Committing to Child Survival: A Promise Renewed’, highlights the extent of child mortality globally and discusses what steps need to be taken to prevent babies and young children from dying.

Below are some facts and figures from the report:

• 216 million children died before the age of 5 between 1990 and 2012 – more than the total population of Brazil, the fifth most populous country in the world.

• Half of all under-five deaths occur in just five countries: India (22 per cent), Nigeria (13 per cent), Pakistan, Democratic Republic of Congo (both 6 per cent) and China (4 per cent).

• In sub-Saharan Africa, one in every 10 children dies before their fifth birthday, nearly 16 times the average rate in high-income countries.

• Globally, the leading causes of deaths among children under five include pneumonia (18 per cent), pre-term birth complications (15 per cent), birth-related complications (10 per cent), diarrhoea (9 per cent) and malaria (7 per cent).

• Immunisation is among the most successful and most cost-effective health interventions, saving two to three million lives globally every year.

• The 24 hours around the time of childbirth carry the greatest risk. Each year, more than 1 million babies die on the day they are born.

• If a mother is under 18, the risk of her infant dying in its first year of life is 60 percent greater than an infant born to a mother older than 19.

• To end preventable child deaths, women must be provided with good quality maternal care and nutrition and newborns need a safe delivery. Insecticide-treated mosquito nets, vaccines, proper breastfeeding, nutritional supplements, rehydration treatment for diarrhoea, safe water and sanitation are also important.

• In Rwanda, community health workers are using SMS to track pregnancies, report on danger signs during pregnancy and to send alerts to health services to ensure women can access emergency obstetric care quickly.

Is He Dead?

I thought he was dead, but I prayed and prayed that he would be okay.

 I had been attending his mother as her labor support person for many hours.  There was no sign that there would be a problem, but when he was born, he was grey, limp, and he did not start breathing or crying on his own.  There was a cord around his neck that was not removed by the student that was delivering him.  Maybe that was the problem, I don't know.

After a couple of minutes, the student realized that this baby needed more than a little stimulation.  I had run and gotten the ambu bag thingy for them just in case.  Sure enough, they started to try and resuscitate him and after what seemed like a very long time he started to cry.  Soon he was nursing. 

I thanked God for another little one that lived.  It was the 2nd close call in one day.

In the tribe I lived with for years, they do not stimulate a baby after it is born.  They just watch and wait to see if it is alive or not.  They never pick it up or touch it unless it cries.  So many of their babies were "stillborn."  In reality though I wonder if they could have lived if they were helped along a bit to take that first breathe. 

Whatever the case, I hate that 50% of children there never have the chance to grow up.  I want to help see that change.

Fishing in the Toilet and Interrogations.

Yesterday I witnessed a one hour interrogation of laboring and post partum women.  The nurse wanted to know which of them had tried to flush a pad down the toilet.  It ended in a very weak mother, who had delivered only an hour earlier, being forced to fish the pad out of the toilet.
 (These women have rarely seen flush toilets or used disposable pads...so it is a hard thing to get used too)

I see things in the hospital here that are very hard to see.  Interesting though, the women are NOT complaining.  They are thankful.  At the end of an awful delivery (one that would surely bring a lawsuit in the USA) she is saying..."I'm so glad I was here!  Who knows what would have happened if I had been in my hut alone."   She isn't saying this because she has been brainwashed by the medical community.  She has seen firsthand friends and relatives who died in childbirth.

It costs them one month's wages to spend the night on the floor in the hospital filled with rats and cockroaches.  They stand barefoot in a shower (if there is water) where 30 other ladies stood and bled...in a country where HIV is rampant.

The hospital situation here can be gross and sometimes even abusive.  Oh, and did I mention that you have to bring your own toilet paper?  There is often no running water for days at a time...I would like to see it changed.  I  am glad though that less women and babies are dying here in the hospital than they are in the jungles....although last weekend 3 newborns died in the hospital in a 24 hour period....so I wonder about that too sometimes.

The funny thing is that I believe the hospital staff is really trying hard to do a good job. (Except for the Nurse Interrogator)

I personally have some horrible stories about American hospitals....but I never had a nurse make me fish things out of a community toilet.

She Decided to Help

I know someone who wasn't afraid to step forward and be a part of the solution.  The following is a guest post from a woman named Jamie Dellesky.  Look her up on her website: http://www.dellesky.com/

Jamie in the Philippines

1,000. I still remember the day that number broke my heart. Shattered it into a million tiny pieces. That’s the average number of women & young girls who die each day because of pregnancy & childbirth related complications. That’s the equivalent of the number of passengers in 4 jumbo jets crashing everyday. Experts say that 80 % of these complications can be prevented if there were simply a trained birth attendant present.  

About two years ago, as I was reading about birth in developing countries, the above statistics were what I found. Alarming. Heartbreaking.  I had spent the past 11 years serving women in my community as a doula & I could see first hand how skilled + knowledgeable care helped to protect the lives of mother’s and babies. I had no idea that my sisters in other countries, specifically developing countries, were losing their lives giving birth because of a lack of care.

As this began to pierce my heart, I then began to ask God about how I could help. Surely, there was something I could do. But what could one family do that could make a difference?  The more I researched, the more I kept finding that the world needed roughly 300,000 new midwives. Midwives that are trained in life saving skills, midwives that can go to where the women live to make accessibility possible, midwives that can give safe, kind & loving care, the kind of care that every mother and baby deserve.

A simple equation began to work itself out in my mind. If what is needed are midwives + I am capable of learning =then I need to train to become a midwife.  After much prayer and leading from God, that’s exactly what I did.

Last year, my husband & our 3 boys gave up our home, our jobs, sold most of our possessions & packed up the rest and moved to the Philippines to train with a non-profit organization that runs free birth clinics for women in poverty. I spent the year learning how to care for high-risk women & provide life saving skills for those who needed it.  We worked hard to learn more about the problems of resource poor countries & the issues that affect women and children. We witnessed not only the problems that create this global health crisis, but also the solutions. So many women that we served in the birth clinic could have very easily died during or after their births had they not had the life saving care we were able to give.  Excellent care that is free & accessible as well as loving and kind, this is what we see to be working.  This past year of training built a foundation for us that will help us to go into other areas of need in the world.

For us now, that place is Africa. Of the 20 worst countries to be born, 19 of them are in Africa. We are moving to Tanzania to partner with a local church in Dar es Salaam. We will be working on developing an outreach to mothers & babies in a very poor area of this city. This outreach will include aspects of health care that are needed such as health education, nutritional support & baby care. The life- time risk of a woman dying in childbirth in Tanzania is 1 in 23. Our long- term goal is to eventually start a free birth clinic in this neighborhood. 

We also hope to start our own non-profit that can reproduce a healthy model of care within resource poor countries.  A model that offers loving care from local midwives with life saving skills.

We have come to realize that if a lack of midwives means high maternal/infant mortality, then the answer is to provide more midwives. Its not hard to do, there’s enough money & resources in the world, it’s simply a matter of redistributing it.

 

*This family is raising funds to go to Africa.  If you feel you would like to help with that, their website is listed at the beginning of this post.

Survival

"Well, those women are just used to it, they see death all the time.  I'm sure it doesn't bother them like it would bother us."

I have heard this response so many times from Americans when I tell them that where I lived, 50% of children die before five years old.

 Just about all my friends in the bush had lost half of their children.

It is a hard thing for us to wrap our hearts and minds around.  When someone in our close community loses a child, we see it as absolutely devastating, as we should. Why then, just because a person eats differently, believes differently, and celebrates differently - do we assume that the loss of a child does not HURT?

If you held that woman as she wept, even months after the child was gone,

if you could look into her eyes,

you would know that those mothers mourn and feel the deaths of their children the same way you and I would.

They smile, they keep going...not because it doesn't hurt them as much as it hurts a middle class white lady....it is because these women have to keep going in order to survive.  Her life is hard and she does not have the luxury of shutting down.

A Breech Nightmare

This story is one I've hesitated to write about. 

It has been a couple of weeks and the images are still haunting me...beware.  If you are pregnant, please don't read this.

My heart in sharing this is to open your eyes to state maternal care around the world.

I walked into the labor and delivery ward one morning to find a teenage mom surrounded by midwives and nurses.  Something was dangling between her legs.  I attended to some ladies who were asking for tea.

After a few minutes a midwife stopped yelling at the girl and explained to me: "Her baby was breech, and she was not fully dilated when she pushed the baby out. We kept telling her not to push, but she did anyway and the baby got stuck at the head.  Now the baby is dead and it is all her fault.  It's dead and stuck there."

That is when my brain made sense of the baby's grey body that hung there.  I asked if  I could talk to the girl.  They said sure.

I held her hand. I prayed with her. She asked me if it was a boy or a girl.  I had to lift the dead baby's leg to check. No one had told her that it was a baby girl.  At this point the medical staff were mad at her and just leaving her alone with her baby half born.  She asked me to get the baby out.  I explained that I could not do that.

Finally they hooked her up to pitocin and started yanking on the baby...and yanking and yanking and yelling at the poor girl.  All the while I stroked her head, trying to be the presence of kindness in a horrific situation.

After about ten minutes of this, another midwife walked over and showed them how to hook the babies mouth with her finger and tilt the chin down while putting the other hand on the mom's belly.  The dead baby popped right out.

This poor girl was terribly damaged "down there."  While they stitched her up they gave her a lecture. It went something like..."This happened to you because you got pregnant out of wedlock, you deserve it and this is all your fault."

I came behind and tried to undo the damage.  It was just awful.  She wrapped up her dead baby, got dressed, and hobbled home a few hours later.

This has not been the "norm" here, sometimes I see a lot of kindness and skill.  But this was downright awful and disturbing  I wish that all women could be treated kindly and that all births ended happily.  But, they don't. 

CBS News

Just saw this article from CBS news


CBS News/ May 12, 2013, 9:14 AM

Where not to be a mother in 2013

Maasai mothers hold their babies as they queue to vote in Kenya, on March 4, 2013, during the nationwide elections. / Getty Images

The most dangerous day to be a baby is its first day on Earth, regardless of where that baby is born. As many as one million one-day-olds die annually, according to a report from the non-profit organization Save the Children. Additionally, as many as three million newborns die in their first month of life every year, almost all of them from preventable and curable ailments.

The annual State of the World's Mothers report highlights the critical importance of a mother's health and nutrition in preventing such disasters.

The report also highlights a sadly familiar roster of countries where moms are most vulnerable, as all of the worst places to be a mother are in sub-Saharan Africa. The bottom 10 in descending order on Save the Children's list are: Ivory Coast, Chad, Nigeria, Gambia, Central African Republic, Niger, Mali, Sierra Leone, Somalia and DR Congo. The report ranks 176 countries on five indicators: risk of dying during pregnancy or childbirth, under-5 mortality rate, education, income and female political representation.

South Asia still has the highest number of newborn deaths annually, with as many as 423,000 dying every year on the day they are born.

Some of the reasons for the poor country rankings include women getting pregnant at younger ages, undernutrition and poor medical care. Sub-Saharan Africa has 11 doctors, nurses and midwives per 10,000 people -- less than half the 23 considered necessary to deliver essential care, according to The Economist.

There is some hope in the worst corners of the world for mothers though, as some governments take notice of the problem. The report highlighted Malawi, which has reduced its newborn fatality rate by 44 percent since 1990.

With 98 percent of newborn deaths occurring in the developing world, the top 10 countries to be a mother are mostly in Europe and largely very aggressive in delivering equal opportunity and state-funded care to mothers. The top 10 in descending order are: Finland, Sweden, Norway, Iceland, Netherlands, Denmark, Spain, Belgium, Germany and Australia. The United States was ranked 30th.

While there is an interest to improve the situation for mothers globally, Save the Children CEO Carolyn Miles writes in the report that "what is lacking is the political will and the funding to deliver these solutions to all the mothers and babies who need them."

© 2013 CBS Interactive Inc. All Rights Reserved.

But isn't Birth Normal and Safe?

Now I realize that in North America we are fighting hard to tell women that birth is normal and safe.  This blog may bother some of you. 

It is true that in North America and many parts of the world, there are too many medical interventions which are causing harm to women.  So that is why we have to tell women..."your body knows what to do" and "birth is normal unless proven otherwise."

Now look at a woman in a developing country. (I'm not saying these things don't happen elsewhere, or that they happen to everyone here.)  Add pregnancy to these possibilities:  smoking, unclean water, a husband who beats her, severe anemia from malaria, a poor diet, and maybe some HIV and TB and a couple of STD's.  All this with no birth control, little education, and no prenatal care. These factors cause major issues for women and babies.

That is the difference between here and there.  If you are a pregnant woman reading this, please don't let it frighten you.  These stories are not applicable to mothers in North America, except to raise awareness so that you can help. Yes, I do believe that birth is usually safe and  an absolutely wonderful and NORMAL experience for a healthy, well fed, woman.

I found this list of countries and how many women in each have a skilled birth attendant when they have their babies. I thought it was interesting.


Here is the Link: http://kff.org/global-indicator/births-attended-by-skilled-health-personnel/


A skilled birth attendant can be a nurse midwife, a direct entry midwife, or a doctor.

Lost in the Jungle

Have you ever wondered what you would do if you were really lost in the wilderness?

One night, about two years ago, I discovered what I would do….

"Hka hka hka" I could hear the familiar cough in place of a knock outside my door. I went outside to investigate.

There was a middle aged woman with one blind eye, two teenage girls, and two young men at my door. I hadn't seen any of them before. They had come to get my friend and I.  A woman with twelve previous children had given birth to twin girls the night before. Both babies were fine, but the woman was bleeding a lot, had a retained placenta, and they feared for her life. They wanted us to come and help.

It was a four hour hike to where she was in her banana leaf garden shelter. I got what I might need and we all started out. It was 4pm and our husbands weren't going to expect us back until the following day.

It is a treacherous hike. It seemed to be either straight up or straight down most of the time. Now it is the custom here, to yodel messages back and forth between the mountains.  About 2 hours into our hike we heard yodeling from the mountains across from us. The woman had died.

We told them to go on ahead, as it was their mother and sister who had died. I had a nine month old baby and wanted to get back.

Our guides would have led us back…but we figured we could find our way back through the jungle. (Don’t ask me why two California girls thought that) So after about a half hour on our own, we could not find the trail. We went up…all we could find was thick bush.  We went down and it was the same. So here’s what we did.

1. Sit down

2. Pray

3. Yell/scream really really loud.

4. Shine our flashlights to the mountain villages across the valley.

What did we yell? Well, we perfected our yodel (The way they yell from village to village). We yelled “the white ladies are stuck in the bush!” in 5 different languages. (Spanish and French were just to mix it up for our sakes) We figured as long as we were making noise, it could attract help.

We yelled once or twice that we didn’t have any toilet paper so someone really needed to help us.

Eventually (a couple of hours later) two young men from the next mountain range over (yes we had been that obnoxious) came to get us and lead us home.

So we were home before 1am and slept safely in our own beds.

If this woman had a skilled birth attendant with her, she would still be alive today. One of the twins died a week later.

 

Midwives Needed!

Every minute 60 babies and 2 pregnant or birthing mothers die in the developing world. Every minute. All day. All night. Without stopping. 

Between the time you ate breakfast and the time you ate your lunch...that would be 600 women dead, and 18,000 babies dead.

I have known some of these mothers and seen the bodies of their babies.

Most of the deaths that I have been writing about could be prevented if a skilled and trained birth attendant was available. 

This is a link from the World Health Organization on the need for midwives:

http://www.who.int/mediacentre/news/releases/2011/midwifery_report_20110620/en/

They Are More that Just Statistics

This is a true story from when I lived a two day hike from any roads or maternity care. Warning: this is graphic; it may not be suitable for everyone to read.

Limaka and I sat together on the dirt, our machetes by our sides.  I twirled a piece of grass in my fingers and watched as my sons climbed trees and cut trails in the jungle.  We had been clearing the weeds around my house to keep the snakes away. 

 “My husband is dead and I had nine kids, but only one is still alive, I want you to meet her.  I’m so excited, she is pregnant and I am going to be a grandma!”   Limaka was bursting with pride as she spoke of her only living daughter, who had recently married and moved to a village 2 hours away.

I told her I would love to meet Lisi, her daughter.  But I never got the chance.

A few days later I heard that Lisi died.

This is what I gathered as to what had happened:

~ She went into pre-term labor (it seemed she was around 30 weeks)

~ The baby was a footling breech who slipped part way out.  It was stuck that way due to the cervix which was not completely dilated.

~ She tried to push for days, and she bled.  They offered to cut the baby.  She refused to let them hurt her half born child.

~They left Lisi and her baby under the house to die.  And they did.

I attended the funeral.  I sat in the smoky hut for hours with her dead body, and joined in the death wail. 

I found out the next day that I was pregnant with my fourth child.  I went to the USA where I had a doula, a midwife, a hospital that stopped my pre term labor, newborn photography, and a baby shower.

Here are some links to World Health Organization on infant and maternal mortality.

http://www.who.int/mediacentre/factsheets/fs333/en/ - infant

http://www.who.int/mediacentre/factsheets/fs348/en/index.html -maternal

 

Pitocin? Nah, just go belly jumping!

I lived way out in the middle of the jungle for three years.  It was awesome.  We lived with a very isolated group of folks who became like family to us.

Four days after we arrived I overheard some village gossip.  I could communicate in the trade language and eventually discovered that a lady named Melila had given birth the day before.  Loving all things birth related, I pressed for details. I discovered that:

-She had delivered alone in the garden with her husband and kids

-She had delivered a baby girl

-Her husband had pulled on the cord and broken it

-It had been 24 hours and the placenta was still inside

Hmmm...  not good from the sound of things.

Now, the closest medical station is a little shack that sometimes has a staff person in it, and sometimes it doesn't.  It is about a 6 hour walk over mountains on jungle trails.  It is located in a tribe that is at war with the one we lived with.  The community health worker from there just happened to be passing through.  We hiked with him an hour to see Melila.

She was laying in a dark thatched hut.  She was on top of rags with her 2 and 4 year olds snuggled up close.  She was scared.  I asked where the baby was.  A neighbor brought her over.  The baby's umbilical chord was still 8 inches long and attatched.  She was naked and cold.  I tried to encourage Melila to put the baby to her breast as that would cause the uterus to contract.  The health worker guy started her on antibiotics. 

The next day the baby died, and the ladies took Melila down to the river and jumped...yes jumped on her belly and they said the placenta came out.

Melila is still doing well, she grins her toothless grin and keeps an amazing sense of humor even though her life is incredibly hard.

Three out of ten of her babies are still alive.