Showing posts with label needs. Show all posts

Friday, 13 September 2013

Life's Not Fair with HIV

* Names and details were changed...but the story is true

When I first saw Khalia, she was sitting with her mom on the hard wooden benches outside. Her mother made me promise to take care of her girl. There were tears in her eyes as she pleaded with me. Mom's aren't allowed past the heavy, paint chipped door of the labor and delivery ward. I told her I would be her daughter's "watch mama."

The nurses took Khalia back to take a cold bucket bath in the filthy shower stall.  Her mother then pulled a very used Coca Cola bottle full of water out of her colorful string bag. She whispered to me that I needed to take this to her daughter to drink. It was from Khalia's village where she had grown up. All the women had "outed" their "heavies" (issues, grudges ect.) and blessed the water. Now if the laboring mother drinks it, it shows that they are all at peace. They believed it would make the labor go quickly and easily.  The wrinkled little mother was thrilled that I understood and was familiar with the beliefs from my years in the bush.  I gave it to Khalia, explained what her mom had said, and Khalia drank it up quickly.

Khalia is 17 years old. Last year her husband bought her for about $3000. She then went to live in his village as his fourth wife. She spends her days tending the large gardens and cooking food. Probably caring for the kids of the older wives too. Her new husband  gave her HIV on her wedding night. She is now HIV positive and has TB and herpes to go with it.

Now, here she was delivering her first baby. The medical staff was standoffish about her medical conditions. (The herpes had done some awful looking things to her) They warned me not to be around her. I did consider just helping the other 8 ladies in labor but I felt that God would have me to love on Khalia. It was the right thing to do. It is what Jesus would do. I spent the next 8 hours with her. (and I did take precautions with fluids)   She is a sweet and beautiful girl who labored very well.

She begged me not to leave, even for a minute. I held her, massaged her, prayed with her, and encouraged her.

Once she was ready to push, she pushed for almost 4 hours. They never checked the babies heart tones.

She got so exhausted. Her babies head had been slightly in view for two hours. No amount of squatting or position change was helping. I finally was able to convince someone to come help us. I was shocked at how she "helped."   She grabbed a razor blade and cut Khalia four times. Four large episiotomies on her herpes enveloped skin. A beautiful baby girl emerged over the HIV infected blood.

Khalia had more love in her eyes as she looked at her new daughter than most of the mom's I see here. The baby latched on a nursed just fine. It was hard to say goodbye to her. I am privileged to have been able to be with her on that day.

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

Monday, 8 July 2013

Double Doula-ing

I have been mastering the art of double doula-ing. No, I am not talking about mom's having twins. I'm talking about two moms moving into one space so that I can support them both at once. I would never ask them to do this, it's their idea.

It is much easier if their contractions are opposite of each other in timing. Then I can support through the pains one at a time. Unfortunately this is not usually the case, which leaves me trying to massage/focus on two women at once. It reminds me of trying to pat my head and rub my stomach at the same time.

I feel rather silly looking, rubbing two backs at once, but I'm glad to be there for them. I think it is time to train some more doulas to come along with me.

Thursday, 30 May 2013

Breech in the Jungle with a Cigarette

Underage Smokers

She squatted, she smoked, she grimaced as the contractions came and went. She wore only a ragged loincloth. Under her was dirt and above her were the stars.

This is where she was going to have her baby, The neighbor kids giggled as they lit their jungle "cigarettes." They weren't allowed to have the tabacco until they were at least 12, so until then, they wrapped random jungle plants in dried banana leaves and smoked them.

I was with my friend Kira on the night her 4th child was to be born. I had awakened to a rapping on the bamboo walls of my house by her husband telling me it was time.

We headed out to a little spot her husband had cleared in the jungle. He lit a fire, stuck a stick (to hold while pushing in the squat position) in the ground, and they laid down some banana leaves. Now the baby could come.

The wind was strong that night and we were all cold. In this tribe, there are no birth specialists. A woman in labor is attended by whoever happens to be around. Tonight it was me and her mother in law and a bunch of kids. I had brought a clean razor blade, a baby hat, and clean baby blankets. I was hoping for a good outcome, as it seemed that a lot of births here ended in tragedy.

Kira grunted and repositioned herself, then lifted her homemade cigarette to her lips again. She smoked almost constantly throughout her labor. The contractions kept getting stronger and then they pretty much stopped.

She was tired and we all decided to go back to the village and let her rest until the contractions started again. When they started again they came fast and hard and out popped a big boy. Bottom first.

She rested and lit another banana leaf/tabacco cigarette.

Tuesday, 28 May 2013

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.

Friday, 24 May 2013

Midwife/Doula Opportunities Overseas

So I have been talking about the need for more midwives. (see post "Midwives Needed.")

There is no use talking about a problem unless we also talk about a solution. I mentioned the need for more midwives in my post "Midwives Needed." If that piqued your interest, here is a list of overseas opportunity links for doulas, midwives, or aspiring midwives.

*I have known people who have good experiences with Mercy in Action. I don't have any personal experience with the others. If anyone knows of programs which I have not included...I would be
interested in hearing about them and adding them to this list.

http://www.mercyinaction.com/midwifery-doula-internships/ - In the Philippines

http://www.bumisehatbali.org/ - in Indonesia ‎

http://www.midwifeschool.org/application_internship.html Another Philippines

Thursday, 23 May 2013

Dangerous Doula-ing Strikes Again

(Warning, don't read this while eating)

The Facilities...

As a doula here, I get to haul water, a lot. I also get to try not to mix up the babies. Not something you learn at a doula training.

A lot of women here hemorrage, even though they are all hooked up to pitocin as soon as the baby arrives. Out of the last twenty births I have seen, six hemmoraged...I'm not sure how that compares to other places.

Many of the women are very weak after giving birth, and within an hour they are usually asked to get up, pack up, and bathe. Bathing includes filling a five gallon bucket with cold water and carrying it 15 feet to the shower stall. That is where I come in, the water bucket carrier.
Once to the shower, the woman then squats and washes. This one shower is rarely cleaned and women file through there all day and all night. As you can imagine, it is GROSS. (Think blood clots)

There is also only one toilet, which is rarely cleaned. But I will spare you the description on that one.

Did I Give Her the Right One?

During one post partum hemorrage, the midwife was getting pretty worried and asked me to grab the woman's baby so that she could nurse it and cause the uterus to contract. I walked to the little table where three babies were wrapped like little burritos side by side. Hmmm....no identification....how was I supposed to know which baby was hers? I ran back to the midwife and explained my dilemma. She replied, "the big one is hers." So, this being an emergency situation...I grabbed the biggest looking burrito baby there and brought it back to the woman.

She stopped bleeding and fell in love with her baby....at least I hope it was hers...she seemed to think it was.

Tuesday, 21 May 2013

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.

Wednesday, 15 May 2013

A Little Girl in Labor

She was twelve years old. She had been in labor for two days and was HIV positive. As I held her and rubbed her back through the contractons, it was hard for me to wrap my mind around the fact that this girl was only two years older than my son.

A smaller clinic 3 hours away had sent her to this larger hospital because they felt her labor was taking too long. None of her family came with her. She was so scared, and very much alone. She kept calling out for her mom.

I encouraged her to walk if she could, and she did. She walked and walked and walked. Eventually she had a baby boy. When he started to nurse for the first time, the look on her face made me want to cry. Her expression was that of joy and amazement and love for this new little miracle that had been inside her only moments ago.

I don't know her whole story, and I don't know what life will look like for her as she heads home. I doubt it is pretty. All I can do is pray for her.

Left: you can see a woman walking away with a bag of firewood. Right: the next generation of little women

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."

Tuesday, 14 May 2013

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.

Monday, 13 May 2013

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/

Sunday, 12 May 2013

Kindness and an Answered Prayer

It was a Saturday, and I was at the hospital helping the women who were in labor. They said I was the “watch mama” to all of them, since their own mothers are not allowed there.

I was running back and forth between two ladies when I noticed Hati. The midwives were yelling at her. “You aren’t trying hard enough! What is wrong with you! Your baby is going to die if you don’t listen to us!” She looked so tired, barely even conscious.

I asked what was going on with her. They told me that she had labored at her house and had been trying to push out her baby for close to two days. Her family was concerned that the baby had not been born, and brought her to the hospital. When she arrived, she was fully dilated and they hooked her up to Pitocin.

She had been there 2 hours and nothing had happened. She was too tired, and she seemed to have given up.

I asked if I could talk to her. They said yes. I held her hand and spoke kindly to her. I told her that she was a good mother, and that I knew she loved her baby. I talked to her about how to push, and I asked if I could pray with her. She opened her eyes briefly and nodded.

I began to pray that God would give new strength to Hati so that she could push this baby out and that it would be born safely. About ten seconds after I started to pray, she sat up and started pushing with all of her might….and the tiniest bit of the head appeared!

I called out to the midwife. Within ten minutes, a healthy baby girl was born. It was an answer to prayer.

Saturday, 11 May 2013

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

Thursday, 9 May 2013

Cross the river and get on the bus...we're gonna have a baby today!

If you were a mom in labor here in my neighborhood on this island nation here's how your baby's birthday might play out:

1. Get your clothes, baby blankets, chord clamps, and food together.

2. Get on an innertube and cross a river that is 60 ft. from side to side

3. Walk a half mile and then stand on the road to wait for public transportation

4. Pile onto the back of a flatbed truck with 40 other people.

5. After traveling 20 minutes you will arrive at the hospital. Now walk past 6 security guards with clubs and up to the maternity ward.

6. Here you sit on a bench for a couple hours (unless you are really making enough of a ruckus that the nurses fear imminant birth)

7. You pay the equivalent of $15 USD and are escorted into the delivery room, alone. Try not to slip and fall on all the "birth fluids" all over the floor.

8. You are one of 14 women and there are 7 beds. So, you are shown where a bucket is, told to fill it up and go take a "bucket bath."

9. Now there are 3 chairs and if those and the beds are full, you get to walk or sit on the floor. Happy laboring!

10. If a bed opens up, there will be a cervix check. Then you will be free to walk, sit, lay and just get through labor. You are not allowed though, to be noisy.

11. Every few hours you will be checked on.

12. "Let us know if the head starts coming out!"

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.

Wednesday, 8 May 2013

Shut up and have a baby

Three months ago:

I stared at the floor. It was nasty dirty. My islander friends beside me all chit chatted about their labor stories from years ago in the local dialect. We were waiting to check 18 year old Astria into this third world hospital.

She was in early labor and her mom and aunties thought it would be best if she delivered this first baby here instead of at home in the bamboo hut that they shared. Afterall, they all had family members who had died in childbirth.

Astria sat up straight on the wooden bench and moaned as the pains returned every few minutes. Behind the curtain, we heard screams as babies entered this world head first, bum first and feet first. Then we heard the midwives, exhausted, responding with "shut up and have a baby" (in another language of course.)

The nurse came and got Astria and we had to leave. She was terrified, left alone in a strange and unkind environment. Hospital rules forbid anyone to stay with her while she has her baby. She looked at her mom longingly and then disappeared behind the curtain.

I believe a woman needs support in labor. I wanted to make a difference...

Stories of a Doula Faraway

Pages