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.

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.

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