Birth Traditions

One of the interesting facts about pregnancy and birth are the traditions and beliefs regarding it. Some might call them lore or old wives tales or witchcraft. All cultures have them about all sorts of things but pregnancy and birth have some of the most fascinating, at least to this midwife. For example, how do you tell if you are having a boy or girl without an ultrasound or waiting until the baby is born. Some will say it is based on what part of the day the baby is active or how they lie in the uterus or possible what way a necklace swings when it is held over the stomach of a pregnant woman. Just Google it sometime for a little fun (and funny) reading.

Indonesian culture because it is made up of so many people groups has many different traditions and beliefs related to pregnancy and birth. Here is a story that a missionary serving in West Kalimantan shared recently in one of her blog posts about how the spirits have given instructions to the tribal people they work with about birth. 

Another aspect of the culture I’ve been trying to go a bit deeper in is the spiritual belief system.  There are so many different spirits/ghosts beings that they mostly fear but often call on for help, healing, wisdom, and protection.  One in particular is a spirit that the stories claim, taught them how woman have babies.   Supposedly way back when, when a woman was pregnant and about time to have the baby, they would cut the stomach open to “get the baby out” and then both mother and baby would die.  Well a ghost put a man in a type of trance by a certain tree and told a story of how it should be done - with people pushing from the top and sides and letting the baby come out naturally.  Well when the time came for that man’s wife to give birth that is exactly what he did.  And to his great surprise it worked and was then the new way to deliver babies.  This is still the traditional way they deliver, with people pushing from the top and sides during delivery.  

Andrea Ullum

New Tribes Mission 

http://www.ullumhome.com/

I can just hear the gasps from my midwife and OB friends after reading this, but it is better than how they did it in the past :) I know there will be beliefs and traditions that I will find fascinating about birth in Indonesia and probably ones I find scary too.

National Health Day in Indonesia

Did you know that 134,000 kids under that age of 5 die each year in Indonesia? That means a child dies about every four minutes, many from preventable causes. For me, the picture above represents that statistic in a very personal way. She is Katarina. She was a patient at Bethesda during the summer of 2006. She had tuberculosis (TB) and other problems. We tried for several weeks to save her life. We inserted a feeding tube and gave her medication for the TB. In the end though, she passed away. There are almost always kids like Katarina being cared for at Bethesda. Being a child under five is hard in Indonesia, especially in the rural areas as the statistic above shows.

Today, November 18th, is National Health Day in Indonesia. This year the government is using the day to promote the health of women and children across the country. They are partnering with organizations like World Vision and other NGOs to try to reach the Millennium Development Goals and save the lives of moms and kids around the country.

Birth Story from West Kalimantan

This is a birth story from West Kalimantan, where I will be serving. A big thank you to Nicky Poarch, who serves with New Tribes Mission who shared this story with me and now you!  

I knew that Biet's mom was going to give birth any day.  I have become close with her three daughters and little by little have been building a relationship with their parents.  Her husband is one of the head shaman in the village, holding close to the animistic ways and making sure these ways are followed especially in their home.  Over the course of Biet's mom's pregnancy, I had bought her some prenatal vitamins, taken her blood pressure, and visited with her.  

Finally the night came when she started her labor pains.  A friend came and told me.  A big dilemma went on in my mind...should I go, should I stay (I'm easily grossed out!)?  Finally, I decided to go.  When I got there, I was surprised at how many people were in the home, in her room, giving her advice, rubbing her feet, rubbing her back, making sure incense was burning, and finally...feeding her a bit of porridge (they say) to help her have strength.  After an hour of sitting there sharing birth stories with the other ladies in the room, Biet's mom's water broke.  After this happened....everything changed!

People started yelling - "OPEN ALL THE DOORS, PULL OUT THE NAIL OUT OF THE DOORWAY!"  They were walking quickly back and forth in front of the room where her Biet's mom was starting serious labor.  They started chanting.  The old lady next to me told me to take the batteries out of the lantern and put them back in.  I knew what she asked me to do and I knew the reason why, but I just acted like I was involved in seeing the birth...

Opening up all the doors, taking out the batteries in the lantern, pulling out the nail in the top of the doorway assures a smooth birth and the child wouldn't tarry in coming out.  Chanting is a way of asking or summoning the spirits.  

The final act was when the mother in law came and broke a glass jar right in front of Biet's mom!  CRASH!  I knew this was also an act done to appease the spirits.  

Finally the baby was born.  Another girl for the family!

If you weren't there praying for me...

were the words I was greeted with when I went back to visit Biet's mom and her newborn daughter.  I discovered then that Biet's mom had a hard time delivering the afterbirth.  I had left the house the night of the birth, soon after the baby was born, I had already been there for three hours.  Before I left I had told several people that the reason I wanted to see the birth was so that I could pray the whole time.  I also told them that I'd continue to pray after I went home (I was leaving early according to them, but I was tired).  

After I left that night, trouble started with not being able to deliver the afterbirth.  They even started down river (in the middle of  the night) afraid Biet's mom would bleed to death.  But almost immediately after getting in the boat, she passed the afterbirth and was able return to her home.  

When I went the following day to visit, she told me that she knew because I prayed that she was alive and the baby too.

Remembering the Little Ones We Have Lost

Trevor, Cooper, Hudson, David, Bethany Joy, Eliana... these are just a few of the babies who I have known who have been lost - some before they were born and some shortly after.

In my work as a nurse and midwife I have had the opportunity to walk alongside several families as they dealt with the loss of their baby or child. For many they walked into their 20 week ultrasound expecting to find out that they were having a boy or girl and some fun pictures to share with everyone. They came out knowing that their child would never live outside the womb. Others came to the hospital or the office expecting to hear the beautiful sound of their baby's heartbeat but instead it was silent.  

I wrote this in my journal after one those experiences:  Today I helped a woman give birth to her fifth child… but instead of tears of joy there were tears of sadness… instead of laughter there was crying… instead of hellos there were goodbyes. This was their fifth baby but he like all of his brothers and sisters was born still. He was perfect but too small to live. He weighed four ounces and was five and half inches long. His hands and feet were tiny and perfect as I made impressions of them in ink and clay. Together his mother and I gave him his first and only bath. We wrapped him in blue and placed the tinniest blue hat on his head. We took pictures. He will be remembered forever in his parents hearts. 

This touching and sad radio program tells the story of another midwife helping her patient through the loss of her baby and the impact it had not only on the family but the midwife.  

It has been said that when a child loses their parents, they are called an orphan. When one loses their spouse they are a called widow or widower. When a parent loses a child, there isn't a word to describe them. Every day approximately 145 babies between 20 weeks gestation and one year of age die in the United States. October 15th has been designated as Pregnancy and Infant Loss Remembrance Day. Today around the world people will light candles and release balloons to remember those who have gone too soon and their families. Today and every day please remember them in your thoughts and prayers. 

National Midwifery Week

Did you know that this week in the United States is dedicated to midwives? 

For me it makes me think of my fellow midwives. So many memories of long study sessions with fellow midwifery students both on Skype and together during Clinical Bound. We kept track of each other as we caught our 40 babies and completed the 675 hours of clinicals required for graduation. Then we sweated and worried our way through a comprehensive exam and then our board exam. Finally, we were able to add master of science in nursing (MSN) and certified nurse-midwife (CNM) after our names. Today our class cares for women and catches babies in several states and soon Indonesia. 

A late night study session at school during Clinical Bound

Yep we all passed the test of catching the mannequin's baby

 As I have traveled this journey and shared with others that I am a certified nurse-midwife, I have come to realize that many have questions about midwives. Did you know that midwives are critically important in providing care to women from adolescence to beyond menopause, but their expert knowledge of women’s health is often overlooked? Even though the general public often associates midwives exclusively with maternity care, many women visit a midwife for a range of services before and after pregnancy. That means whether you’re ready for your first pap test, planning for pregnancy, or experiencing menopause you can choose a midwife to provide your care.  

Check out this web page for more information about midwives and to hear stories from and about them: Our Moment of Truth

Breastfeeding

It is hotly debated topic in the Western world. One that usually revolves around what is most nutritious for the baby and works best for mom. In places like Indonesia though it can be a matter or life and death. One reason using formula instead of breastfeeding can be deadly is because it must be mixed with clean water, which can be hard to find or expensive to buy in Indonesia. Formula is also expensive, so parents sometimes dilute it so it will last longer, which leaves the baby malnourished. 

Research shows that 1.4 million child deaths around the world could be prevented each year by proper breastfeeding. In Indonesia between 400-500 children under the age of five die each day. In addition, less than a third of babies are exclusively breastfed until the recommended 6 months of age. It is estimated that the simple intervention of breastfeeding would save an estimated 27% of those children.

Things are changing though. New laws are being enacted which prevent formula companies from targeting advertising at parents of babies less than a year old. There are also new fines and even jail time for those who prevent moms from breastfeeding such as workplaces and public places. 

In addition, many hospitals that previously only passed out samples of formula and did little to educate new moms about breastfeeding are now adding programs that encourage bonding and breastfeeding in the first hours after birth. The hope is that these new laws and programs will help turn the tide and reduce the number of babies dying from very preventable causes.  

If you are interested in reading more, there was an article by PBS Newshour that you can read here, including a photo essay. 

Prematurity

The baby was born premature. 

What do you think of when you read that sentence? Does it make you ask questions like who and where and why? What happens if I show you this picture...

They say a picture is worth a thousand words. In this case I would guess it is at least more emotional. Really though does it answer any of your questions about who and where and why?

So let me tell you a little of his story. This little baby is David Anugerah. He was born two months early at 32 weeks. He was Natalia's third baby. For about a week, we at Bethesda Hospital struggled to help him survive. We helped him breathe, eat, and stay warm. We tried hard to protect him from infection. It was his immature lungs however that we couldn’t help. There were none of the newer drugs such as surfactant available. So we wrapped him in warm blankets and in his final moments his mom held him. He passed away just 8 short days after his life began. This left his mom, Natalia, with just one child. I don't know why he was born early. His death was one of those that helped me realize that there was more that I could do if I knew more and had more training. This led me to return to school and become a nurse-midwife. My hope is that as a nurse-midwife I can help prevent women like Natalia from having their babies so early.

In recent years, there has been an increasing focus on preterm birth and its effect on countries around the world, rich and poor. A recent report by 50 international organizations is shedding new light on the topic and giving us current research. Here are some of the fascinating facts I found when reading the report:

• Preterm birth rates are increasing in almost all countries with reliable data.
• Prematurity is the leading cause of newborn deaths (babies in the first 4 weeks of life) and now the second-leading cause of death after pneumonia in children under the age of 5.
• Half of the babies born at 24 weeks (4 months early) survive in high-income countries, but in low-income settings, half the babies born at 32 weeks (two months early) continue to die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties.
• 15 million babies are born too soon each year. Over 1 million children die each year due to complications of preterm birth. 

The map above shows which countries are struggling the most with high rates of preterm birth. Indonesia is in red, which indicates that for every 100 babies born more than 15 of them are born early. There are several known causes of preterm birth and many that are not fully understood. There are several simple interventions that can help decrease preterm birth, even in places with less resources like Indonesia. For example:

• Decreasing the rate of adolescent pregnancies and increasing the time interval between children.
• Prevention and treatment of infections such as malaria and HIV before or early in the pregnancy. 
• Improve the health of women suffering from chronic illness like diabetes, asthma, and thyroid disease before they get pregnant. 
• Improve the nutritional status of women before they get pregnant and early in the pregnancy by helping them gain or lose weight as appropriate. Help those with nutritional deficiencies like iron-deficiency anemia get the nutrients they need.

There is a lot of work to do in places like Indonesia, but also in places like the United States. You can read a lot more and the report here, if you are interested. 

Mother's Day

This weekend here in the United States we are getting ready to celebrate our mothers. I remember once when my dad was working for the phone company he told me that one of the busiest day for phone calls all year was Mother's Day.

Our mothers hold a special place in our hearts and memories. What do you think of or remember when you think of your mom? I remember notes in my school lunches signed with her distinctive heart signature. I remember her letting me talk through my options and listening to her words of wisdom as I considered where to go to college or get a job or one of those other "big" decisions of life. I remember when the tears would come she would let me have a good cry and then tell me to go wash my face and brush my teeth and go to bed because everything looks better in the morning. The first time I shared those same words of wisdom with a patient, I am pretty sure I could hear the echo of my mom's voice.  

This Mother's Day as we celebrate and remember those moments I want us to also remember that this day and every day there is a tragedy happening to mothers around the world. This Mother's Day, 1,000 mothers will die. They will die not from old age or cancer but because of complications during pregnancy or childbirth. 90% of these complications are preventable. The line at the end of this video says it all... "because out there, there is a mother that needs you, right now." So get more information and get involved. Organizations like Every Mother Counts and White Ribbon Alliance are a good place to start.

  (For those reading this in your email or via RSS you might need to click on the link to the blog to be able to watch the video)

International Day of the Midwife 2012

I love May! Flowers are blooming and we get to celebrate nurses, midwives and mothers!! Tomorrow, May 5th, is International Day of the Midwife.

No mother should have to risk her life or that of her unborn baby by going through childbirth
without expert care. The consequences of this are tragic. Over 350,000 women die each year as a result of preventable maternal causes. Millions more suffer infection and disability. Families are devastated.

Every year over 800,000 newborn babies die during childbirth, and more than 3 million babies die
before they are one month old. More than 7.6 million children die before the age of 5. Almost all
of this is readily preventable with proper midwifery care.

It is why the world needs midwives now more than ever. Midwives save lives.

Today and tomorrow those passionate about midwifery will be meeting both locally and virtually to celebrate and learn. One of my favorites is virtual and it starts shortly and runs for the next 24 hours. It is hosted in New Zealand, so it starts at 3 pm PST. Each hour brings a new topic by different speakers. With topics ranging from "Birthing at Home Regardless of Risk: Educated Choice or Extreme Sport" to "Nuchal Cords: Ritual and Routine" and "Working in War-Torn and Post-Conflict Countries" there is a topic for just about everyone. You can find out more by watching this YouTube video or by checking out this web page for the schedule and times where you live. The presentations are also recorded and will be available afterwards to watch if you aren't able to attend the live conference.

 

(For those reading this in your RSS reader or email you might need to click on the link to the blog to see the video)

Worldviews and Latrines

I spent last week in Florida attending a Health, Agriculture, Culture, and Community Workshop hosted by ECHO and MedSend. This workshop was a requirement as part of my grant from MedSend (more on that soon on my other blog). I will be honest I had no idea what to expect of this workshop but I have to say I learned a lot and met a lot of great people. 

The workshop brought together nurses, physician-assistants, physicians, nurse-practitioners, a midwife, and a veterinarian who have all dedicated to serve in an area of need around the world and in the United States. We came from a variety of backgrounds and are serving with several different organizations, so it was great to compare notes and learn from each other. It was amazing to hear their stories and about the ministries God has planned for them. 

The workshop was led for the most part by Dr. Dan Fountain. He served as a doctor in the Congo for several decades. We covered a lot of topics in the five days we were together. Much of it was practical information and ideas that we can adapt and apply to our own work. We heard lots and lots of stories from Dr. Fountain about his years of service. One of the important things I have been learning is the importance of not just importing my culture and worldview but instead using a Biblical worldview. We also spent several hours each day hearing from the experts at ECHO. They taught us about plants, animals, and appropriate technologies we can use in our respective areas of service to improve the health and nutrition of the people we are serving. I really consider myself pretty much lacking a green thumb, but they provided numerous simple resources and ideas for us. Here are a few pictures from the week...

Learning in the Classroom

Learning on the Farm

Learning about appropriate technologies we can use to improve community health

Hands-on learning about practical techniques to use in community health

Our Group (minus one)

Break the Silence

Many of you reading this post are women who have given birth. What do you remember about that experience? Most women remember it for the rest of their lives. Just ask any mom out there about her births and she can pretty much recount them moment-by-moment. That is one of reasons it is so special to be part of that time in a women's life, because they remember you and your care forever.

Throughout the world today however many women are not experiencing the care you would want for yourself during those special moments. This happens in poor countries as well as rich. A number of organizations, including White Ribbon Alliance have recently started a campaign to highlight the need for respectful maternity care around the world.

I have experienced situations both here in the US and in Indonesia where women were not respected during those very vulnerable moments. One moment sticks in my memory from Indonesia. I was present at a birth (not at Bethesda) where the midwife slapped and yelled at the women giving birth about not getting prenatal care or coming to the hospital when her labor started. The situation was made all the worse by the fact that the women was delivering her baby who had already died at the time.

Here in the US jaded by those we see as "unfit mothers" (including those frequently abusing alcohol or drugs during their pregnancy) we don't treat every woman with the respect she deserves. I cannot tell you how many times I have gotten report and been told "she is one of those patients" or we picked you to be her nurse because "she and/or her family needs lots of patience." I know I have said some of the same things before during a long 12-hour shift. In reality though, that is no excuse and I have to admit reading through the charter and watching this film was convicting for me.

The 7 Universal Rights of the Childbearing Women

1. Every woman has the right to be free from harm and ill treatment. 

No one can physically abuse you. 

2.  Every woman has the right to information, informed consent and refusal, and respect for her choices and preferences, including companionship during maternity care. 

No one can force you to do or do things to you without your knowledge and consent.

3. Every woman has the right to privacy and confidentiality. 

No one can expose your or your personal information.

4. Every woman has the right to be treated with dignity and respect. 

No one can humiliate or verbally abuse you.

5. Every woman has the right to equality, freedom from discrimination, and equitable care. 

No one can discriminate because of something they don't like about you.

6. Every woman has the right to healthcare and the highest attainable level of health. 

No one can prevent you from getting the maternity care you need.

7. Every woman has the right to liberty, autonomy, self-determination, and freedom from coercion. No one can detain your or your baby without legal authority.  

International Women's Day

Today, March 8th, is International Women's Day. This is the 100th year the world has celebrated International Women's Day. It has grown to become a global day of recognition and celebration across developed and developing countries alike. There are thousands of events scheduled around the world, some big and some small including everything from photos to petitions.

One of the events that caught my eye will be held in England during the Women of the World Festival. It is a series of photographs from around the world highlighting women with the theme Dreams for My Daughter. This theme was chosen after Hadhya Yahya Mohamed Al‐Zawm from Yemen said the following at an event highlighting the issue of early marriage... 

“Every mother in the world dreams that her daughter will have a better life than she has. My mother was married at age 9 and had her first child at age 13. She wants more for me”

This video includes many of the photographs that will be displayed as well as quotes from mothers around the world about the dreams they have for their daughters. 

Maybe it is because I am one of four girls, but it made me start to think about how moms have so many dreams for their daughters... dreams for a better life, an easier life, more than what she had. This is especially true in the developing world where so often girls face a life with little education, early marriage and a higher risk of maternal mortality. There are things we can do to change this though. Simple things like helping girls stay in school, getting them good health care, and helping them support themselves. Each small change effects the next generation, with each generation building on the progress of the previous generation. Check out this video about "The Girl Effect" for more information. 

 

(for those of you reading this in an RSS reader or your email you may have to click on "read more" to make the videos visible and play them)

 

Every 52 minutes...

... an Indonesian woman dies giving birth. That is from the latest statistics published in the State of World's Midwifery report late last year. That means about 10,000 Indonesian women will die this year alone, many from complications that could have been prevented or treated.

There is good news though too... in the last twenty years Indonesia has significantly reduced their maternal mortality from 620 maternal deaths per 100,000 women giving birth to 240. The goal is to reduce that number even lower to 155 maternal deaths per 100,000 women by 2015. Compare that to 24 women in the US.

In urban areas they have also done well at educating and providing resources to their maternity care providers including doctors, midwives, and nurses. Unfortunately, there is still a large gap in care for those who live in urban versus rural locations. Many who leave their villages and communities to attend school to become nurses and midwives do not return to those home areas, which are in desperate need of skilled birth providers. Life in the city is different with easy access to many amenities and level of living not available in the villages. There is also the allure of financial gain by practicing in the city.

Babies in Indonesia also struggle with 19 of every 1000 babies born dying in the first month. Compare that to 4 in the United States. In addition, 15 of every 1000 babies born are stillborn. It is thought that many of those born still or that die in the first month could be saved by a simple form of neonatal resuscitation by a skilled birth attendant. Finally, 41 of every 1000 babies born die before they reach their 5th birthday. In the US that number is around 8. Many of these children are dying from disease preventable by immunizations, clean water, and treating dehydration.

Finally the last statistic that caught my eye was that Indonesia needs 3,560 additional nurses, midwives and doctors trained as skilled birth providers so that 95% of all of births in Indonesia can be attended by a skilled birth attendant.

As a trained nurse-midwife hopefully I can help meet some of those needs in my small area of Indonesia, but more importantly I hope I can train and teach others as I work at the nursing school near the hospital. Many of these young people return to their villages and communities and some have committed to serve in other areas of need.

This video from the World Health Organization has some of the latest statistics from around the world as well as information on preventing and treating many of the problems associated with maternal, infant, and child mortality.

2011 CNN Hero of the Year

Her name is Robin Lim or Ibu (Mother) Robin to the community she serves in Bali, Indonesia. She is an American midwife who has given her life to serving families, women, and babies in need through her Bumi Sehat clinics.

In Indonesia, the average family earns the equivalent of $8 a day, according to the International Monetary Fund. But a baby delivery costs about $70 at a hospital, and a Cesarean section can cost as much as $700. Lim believes Indonesia's high maternal and infant mortality rates are caused in part by these costs, which many women cannot meet.

She made this impassioned plea during her acceptance speech, "Today on our Earth, 981 mothers in the prime of their life will die -- and tomorrow again and yesterday," she said. "And I'm asking you to help change that. We don't even know how many babies are lost, but all of us can help change that." She also said that, "health care is the right of all people."

You can read more about her and watch several videos of her work on the CNN web page here.