A Tale of Two Babies

I returned last weekend from a trip to the island of Java where I got to be present for two births. I am definitely convinced after these experiences that every mom deserves someone to be with her, to be her support person, her advocate, her defender. Let's just say I think doulas are awesome and every women should have one! And while I like being in that role, catching babies is still more fun :)

Back to those babies... One of my teammates had baby number four. A boy to add to their three girls. Then I got an added bonus and got to catch a baby at home for a mom whose really quick labor made it difficult to get to the hospital.

So first baby born was David. Remember this birth story? Well that is David's big sister and after her birth we were glad to be very close to the hospital this time instead more than an hour away. Once again though this baby made us wait past its official due date. I arrived the day before her due date figuring that would put me early enough but hopefully not too early that I was in the way for too long. We had some fun days getting out and about to see things in the city of Jogya where they live now.

Her parents arrived almost a week after the baby was due and we were still waiting. Her mom went to a doctor's appointment with us and baby was looking good on ultrasound (albeit big compared to an Indonesian baby) which had the doctor a bit freaked out. So after reviewing the good results he was ready to schedule her for a c-section. We put that plan on hold until for another week, figuring waiting until 42 weeks was ok, since mom and baby were both healthy. That afternoon we tried a couple of induction tricks at home but went to bed expecting a full night sleep as she had never gone into labor in the middle of the night. But shortly after 4 am there was a knock on the door with the word that she was contracting. So we got ready to head to the hospital.

It was a small hospital where she planned to deliver and the doctor lived and worked across the city, so we wanted to give them plenty of time to get things ready and call him in. Unfortunately, because it was a small hospital they only had a one nicer delivery room. The other was smaller, the bed was more uncomfortable and there was no place to sit except the bed or the toilet. We tried to be moved to her postpartum room for labor as she was not dilated much yet but that was on a different floor and they didn't like that idea. So in the end she spent most of the time on the toilet propped up with pillows. We did a couple of dancing contractions and she did try to rest on the bed for awhile but all in all it wasn't the most comfortable place to labor. And she has rip roaring labors so not much time to rest between contractions. The other room opened up so then we moved there with a more comfortable bed and a place to sit but we didn't really get to enjoy it, as her water broke shortly after we moved while she was hanging on me during a contraction. The urge to push came not too much later but no doctor yet so they wanted her to wait, which as many know is next to impossible. Thankfully as she got to work of pushing, the doctor showed up. It was at this point I quickly realized I hadn't talked through some of the things Americans do and don't do that are sometimes still done in Indonesia. So as I stopped the nurse from pushing down on her fundus (top of her uterus), the doctor pulled out the episiotomy scissors (definitely not normal for a 4th baby anywhere I know including our hospital here in Indonesia). Thankfully little David came quickly, was much smaller than they expected and did well.

A few hours later they were moved to a postpartum room and we all got to catch a nap. Then it was time for the big sisters to meet their little brother...

That evening the parents stayed in the hospital, so grandparents and I did dinner and bedtime. I think the kids were glad when parents came home the next day :)

So our newest teammate is David Allen, born just after 9:30 am (five hours of labor) and he is a cutie...

After a few days of hanging out with them I headed north by a car to the town where I did language study to enjoy some time with friends there. I figured it was also a good place to celebrate Thanksgiving and I also knew of two fairly new arrivals to Indonesia with New Tribes Mission who were pregnant and either already late or were due soon were there so I figured it would be good to check in with them. So that first day there I met with both of them. They had a good support team and plans for people to go with them to the hospital etc. This was however back to the situation where the hospital was an hour away and one mom in particular had a history of really fast labors. So all week I kept the phone close but as the week drew to a close I planned to go to a Thanksgiving potluck on Friday around and then catch an evening flight back to my island.

Friday morning though one of the ladies called me to tell she was having stomach problems. Many moms know labor frequently starts with some diarrhea but this seemed like more than that and having just moved to Indonesia a few months ago there were other possibilities. So we talked about hydrating etc. We also talked about how this could start labor so her team including childcare and driver should keep their phone close.

She called me back around 11:30 to tell me contractions had started but were 5-10 minutes apart. She was huffing and puffing though so I told her it was time to go to the hospital. Then half an hour later I got a call from the person in charge of driving them to the hospital (part of the org's leadership) to say she was contracting hard and fast and they didn't think they could make it to the hospital. So instead I went over to their house. I had minimal equipment with me (doppler, gloves, a stethoscope) but it was obvious she was in hard, fast labor and already in transition. So we had a choice to try and get her to a nearby birth center type hospital but they have a pretty bad reputation and chances are she would deliver in the car. In the end we decided to stay home and do our best there. In the end I got to catch a beautiful little boy name Lias. He was a stargazer (OP) though so that complicated things a bit. Thankfully he cried right away and did great skin-to-skin, mastering breastfeeding quickly. The placenta came without problem shortly after. Then we had to figure out how to get out of the fact that we had done a home birth and they would need a letter from a doctor to get a birth certificate. Plus we needed to separate baby from the placenta and I didn't have the equipment for that and it was debatable if mom needed a few stitches. So then we did get the midwives from the local birth center to help us out. They had a great time with the fact we had a home birth and fun with taking care of an expat mom and baby. We didn't have a baby scale so we used a piece of cloth and a luggage scale to figure out how much little Lias weighed. In the end mom and baby did great and I still got to catch my evening flight but I did miss the Thanksgiving potluck. There is nothing like catching a baby at home, although a few more supplies would have been helpful!  

Welcoming a New Baby to the Team

Time for another birth story of a new teammate. Apparently, I should add accompanying teammates during their births to my job description :) It is one of my biggest blessings and privileges to help teammates during their births. Once again it wasn't what we had expected but in the end we had a healthy mom and baby.

(I should mention that I won't be calling these teammates by their names or telling you where they live in Indonesia so some of the sentences might seem a bit awkward)

One of our new families is in language study is in one of the bigger cities in Indonesia in preparation for serving. They have three kids (including twin boys) already and shortly after they arrived they became pregnant with baby number #4. This momma has always delivered before her due date and this time around she had a couple of dates. The one given by the doctor and the one she knew was right a week later. Just to be on the safe side though I headed out a few days before the due date given by the doctor. Once again though we got to wait. Wait right past the doctor's due and then her due date till she was a week overdue. Since she had never been overdue before it was a surprise to us all and we were strongly debating the pros and cons of inducing labor. Being a midwife and they a family who prefers the more natural route we weren't fans of the idea but also realized it might be time. An ultrasound though showed the fluid level was good and he wasn't too big or too small. Still there was a lot of pressure from the doctor to induce so we agreed for the following morning hoping things would happen in the meantime on their own. 

And things did start slowly and surely overnight. We made the decision to go the hospital on the earlier side of things this time, especially since traffic in their city can be quite a nightmare and their hospital was across the city. Once we got to the hospital she was only a bit more dilated than the night before at the doctor's office and the doctor recommended induction but it was obvious to us that things were getting started slowly but surely on their own, so we declined. A few hours later she was in active labor hanging out on a labor ball we had brought much to the Indonesian staff surprise as they had only seen those in Facebook and YouTube videos. It was way more comfortable than their bed though! 

At her next check she was 8 cm and headed into transition with some spontaneous pushes at the peak of the contractions. The Indonesian midwife who so far had been really supportive of our plans and working well with us (minus her contraction monitoring method which involved poking her fingers into my teammates stomach during a contraction) though wasn't ready to call the doctor. After another 30 minutes in a bed and an increasing urge to push we more strongly suggested it was time to call the doctor but the midwife checked her and she was still 8 cm so wasn't willing to make the call yet. 

That was kind of the end of my patience so I encouraged my teammate to switch to a hands and knees position in the bed. I let her know it was ok to push with contractions and she could have the baby in that position if she wanted too. Apparently that position though really worried the Indonesian midwife and nurse in the room and they were making all sorts of worried looks and talking amongst themselves. My focus was on my teammate though and within a contraction or two she started pushing in earnest which really worried the Indonesian staff and they were quick to order her to turn around in the bed and stop pushing. At this point though baby was coming and despite the Indonesian midwifes attempt to push the baby back in my teammate pushed hard and fast and he came flying out. While he cried right away he did take some help getting going and was quite blue for awhile as I think those final contractions and ejection into the word were quite a shock to him too. The doctor did make it in time for the placenta though which was good as there was some increased bleeding which required several medications to help get it stopped. 

All in all at the end we had a healthy mom and baby even though in retrospect there are some things I would have done differently. For example, I should have thrown out my doula hat earlier and put on my midwife hat and been a bit more willing to offend as I think we would have had a better birth. She would have done fabulous delivering in the upright position I think instead of having to change positions etc which made things feel panicked at the end and not well handled. Overall I was impressed at the amount of equipment and how prepared the hospital was but found it odd that they thought measuring fetal heart tones every couple of hours (or more!) was acceptable. And despite my teammate having a postpartum hemorrhage her blood pressure wasn't measure once either during labor or in the early postpartum period until we had been transferred to the postpartum floor. I was also quite concerned to see the Indonesian midwife so hesitant to call the doctor even though birth was obviously not far away. There are not many women I know who have had babies before and when laboring without pain medication can manage to not push when ordered. 

Here are a few pictures of some time with them. 

The happy moments after birth - well ok the baby was less happy

Our birthing team minus Grandma who was taking the picture

Home from the hospital with big sister and brothers

Empty arms, Broken hearts

She was suppose to go home with a beautiful baby girl. This was their first baby and they had waited anxiously for many months to meet her. Because of one those true blue obstetric emergencies though, she went home with empty arms.

It was a Monday morning and the labor ward was busy with 3 moms in labor. Two of the moms were at increased risk and she should have been low-risk. We don't routinely do continuous fetal monitoring on our low risk moms - we only have one monitor. It was noisy in the labor ward as the three moms all labored together in an 8-bed ward with their families plus several postpartum patients and their babies.

Somewhere around morning shift change though her water broke, the umbilical cord prolapsed and came down into the birth canal before the baby. For those that don't know obstetrics this means that with every contraction the baby's head compresses the umbilical cord cutting off the blood supply to the baby. As the labor progresses and the baby comes down the birth canal eventually the blood supply will be cut-off completely and the baby will die. Sometimes this happens in minutes and other times it can take longer depending on how much of the cord has dropped down. Once the problem happens though you have several emergency interventions that need to be done quickly, including doing a c-section usually, to save the life of the baby.

We did well for the most part, although there were complications including the fact that operating room team had to be called in and the fact that with two other high-risk moms in labor we were short-staffed. In the end we just couldn't move fast enough and we lost the baby. The other two moms and their babies both did well though and so did the other mom who came in completely dilated and pushing in the midst of all of this.

In recent weeks we have lost several moms and babies. Moms have gone home with empty arms and families have gone home with broken hearts. It has been hard. They died from the complications that are common killers of moms and babies around the world.

I have to admit I have struggled to figure out the best way I can be involved in our obstetric care here at the hospital. It is even harder knowing the level of care that exists in the U.S. with such well-trained teams, ready at a moments notice to use all sorts of equipment and medication to save the life of a mom or baby. Deaths happen in the U.S. though too, even with all of that. I want to improve our care here and I have so many dreams for what could be!

That New Mother's Glow

I recently had the privilege of providing labor support and catching the baby of one our employees in the finance department at the nursing school. It came in the midst of a busy week and really a very busy day. Things were busy at the Nursing School with the seniors doing their final presentations (like a thesis but at the associate degree level). I had a teammate who had motorbike accident and hurt his knee, so we were in the process of trying to get him to Malaysia for MRI (no machine available here in this part of Indonesia). I was helping support an expat mom here in Indonesia who was having a miscarriage. And it was Ladies Bible Study night. As I wrapped up the work day Ibu (Mrs) Milka came to me with a few questions and asked if I thought she was going to be having the baby soon. After a quick exam on a set of chairs in our conference room I let her know the baby had dropped very low into the pelvis and had palpated a couple of decently strong contractions. I said based on that it could be tonight or several days still but I suspected it would be soon.

Just a few hours later I got a call from the maternity ward saying she had been admitted in labor and was asking for me. So I headed down to the hospital to do labor support and just be around in case she needed anything. It is always a bit awkward when your patients are friends and co-workers, because you don't really know how much care they want you to provide and how much they want you to see. When I walked into the labor ward though that all went out the window as she was obviously in transition. That is an overwhelming time for anyone and it didn't take me long to switch into midwife mode. With the first sign she was getting ready to push, I was the one checking her and then helping her get moved to the delivery room. I grabbed an apron and sterile gloves and as she moved her water broke and baby was crowing with the wave of water. A few minutes later Baby Gabriel joined us with a big cry. It wasn't long till we had her settled back in the ward with her baby where he nursed like a champ.

I took this picture shortly before I went home. Her look of joy and peace just stopped me. In the midst of the busyness it was good to stop and remember how beautiful a new mom looks. Gotta love that oxytocin!

Happy Mother's Day - The Importance of Mom

It is Mother's Day again in the United States. A day of celebration, of remembering all the amazing things moms do, of attempts at breakfast in bed by husbands and kids, flowers and cards. It is also a tough day though for those women who are struggling with infertility, miscarriages, or the loss of a child. Remember them today and reach out to them and let them know you know they are hurting. 

Moms are important and that message was reinforced for me these past two weeks as a mom in our community passed away. She was the younger sister of the women who helps me in my house with laundry, cooking, and cleaning. That death has rippled through the community as her three kids (ages, 1, 5, and 7) have been sent to live with other family members. Now, they all have another child to feed, clothe, and pay the school fees for. The chances just increased dramatically that these children, especially the 1-year-old, will struggle and may not survive. These happens frequently across Indonesia after a mom dies. Moms are really important! 

To end on a happy note though I want to celebrate my mom! She and my dad recently visited and it was so good to see here and have some precious long conversations. I miss her a lot and I know the feeling is mutual! 

Happy Mother's Day Mom! 

The Birth of a New Teammate

I had the privilege recently of serving one of our new teammates as she gave birth to daughter #3. It didn't go exactly as either of us had hoped or planned but in the end it went well. So here is the story...

Katrina arrived in Indonesia pregnant with baby #3. The transition to a new country with a new language is tough enough and then she added to it two daughters not yet four years old plus being in her 3rd trimester with baby #3 and you have one brave and tough momma. So when labor started before her due date (which is very unusual for her!) she didn't feel ready and was really tired. We as a team knew this was going to be tough but we had set her up with an American woman to serve as her translator and doula during her time in the hospital but in recent conversation with team members it was decided it would be wise if I came down to be with them also. I could help around the house and with the kids etc plus be there for the birth. I was expecting to head down a few days before her due date and stay for at least a week but then the phone call came that she was in labor already I threw a few days worth of things in a bag and headed down. Although as the crow flies it isn't that far but because we are on different island it takes a 5-hour car trip followed by two flights each about 90 minutes long followed by another 1-hour car trip. In the end her contractions slowed back down though and we spent a couple of weeks hanging out. Contractions would come and go and there were several times we thought we were headed for the hospital but in the end they would fade away again.

We kept picking a day that would be good to have a baby, for example at the beginning of the break they had from language school and there were days we tried to avoid like the days Ash (dad and our driver to the hospital) needed to see the dentist. Finally, though miss Charlotte picked her own time. Katrina was 10 days past her due date and we were headed to the doctor's office the next day and most likely going to need to consider a pitocin induction, which neither of us wanted. So Katrina told her husband that she was going to be in labor by the time he got from language school at 4 pm. She had said this at least a dozen times over the last few weeks, so it didn't get much attention from Ash. But we had a plan as soon as he headed out the door, that involved her breast pump and more exercises to get baby in a good position for birth. She wasn't at that long before her water broke. No big gush just leaking with contractions, which were becoming more frequent and stronger. Ash came home to see her sitting on her ball with a towel and all of us watching a movie, so imagine his surprise when we told him we were almost ready to head to the hospital. So then there was lots of rushing around as we finished packing and getting the girls fed before taking them to a friend's house.

It is an hour plus trip to the hospital and poor Ash had his wife telling him to slow down because every bump hurt and the midwife telling him to get there fast. When were still 20 minutes from the hospital she was complete and pushing, which had this midwife making sure the gloves and some equipment were close. It was probably one of the longest car rides of my life and oh did I mention it was a brand new car!

We made it to the hospital though and there is nothing like the sound of a woman pushing to get people moving at a hospital, no matter what country that hospital is in! Somehow she got into a wheelchair and from there to the ER where they transferred to a gurney and then from there to the 5th floor delivery room, with a gloved and masked ER doctor at the ready in case baby decided to join us in the elevator. In the end though there was time and Katrina's doctor made it and with just a few pushes Miss Charlotte joined us sunnyside up (OP). Soon she was breastfeeding like a champ and thankfully proved to be a pretty calm baby, because now there are 3 kids under 4 years old in their house :)

So while I don't think either Katrina or I were fan of her doing most of the hard work of labor in the car, it all worked out in the end and we had a healthy mom and baby.

Headed home from the hospital

Training to Take Care of our Tiniest Patients

You have heard the stats on this blog before - babies, and a lot of them, are dying here in Indonesia and around the world just shortly after they were born. The stats I heard recently, said it was one every 3 minutes or almost 500 every day in Indonesia. It is hard though living those stats every day.

There are many things we lack here in Indonesia including equipment, supplies, and in many cases well-trained people. In many cases however that is just because they have not had much training. Education in Indonesia is heavy on the theory and short on the practicing. Our staff have hearts that are eager to serve and a desire to learn.

A couple of weeks ago, our hospital hosted an updated neonatal seminar and workshop for not only our hospital employees but also for staff of government and private clinics and hospitals throughout our province. The main speaker was an Indonesian neonatalogy doctor from Jakarta. It was a great review for me and a great chance for my Indonesian co-workers to learn some of the newer methods and skills for caring for our tiniest patients.

One of the big draws was the opportunity to practice some of the skills like neonatal resuscitation. This has been one of my biggest concerns in observing the care we provide here - I would walk into a delivery room that had no equipment set-up and ready for baby, even though baby was close to crowning and was known to have meconium stained amniotic fluid. Today I walked into the delivery room to find a similar patient story but this time the ambu bag was ready to go and the suction was all set-up! We still have lots of work and practicing to do but it is a big step in the right direction!!

For fun here is a video of the first group to practice neonatal resuscitation during our workshop. They completely failed but in their defense it was an ICU nurse and ER nurse and they don't do many neonatal resuscitations on a regular basis. In the video, they are simulating receiving a premature infant who had just been born by c-section. The baby started off crying but then quickly started grunting with nasal flaring and the oxygen saturation did not increase as it was suppose to, so they should have started giving the baby oxygen but didn't.

One of my goals is to do regular simulations like this with all of the staff, so we know that all the equipment works and it is as routine as possible.

Sorry it is an Bahasa Indonesian and a video of the simulation being shown on the big screen, so everyone can learn from the process :)

Baby Bulan and other little ones

Baby Bulan

They say things come in threes and that is true for us this week. We had three 1500 grams (a little over 3 pounds) babies admitted to the hospital this week. Baby Atna was born at a local government clinic and then transferred to us for higher level care. Baby Gabriel was born at our hospital and has a heart defect. Baby Bulan is one month old and was admitted with several malnutrition.

Baby Bulan (moon) was admitted earlier week. He and his twin were born in a village about a month ago and he weighed 2.3 kg at birth. Unfortunately, his parents seem to be lacking in knowledge or skill to care for their new children. Bulan's brother died last weekend and that caused their community to intervene and they brought Bulan and his mom to the hospital. Those first few days were touch and go as he battled infection in a very weakened state. But with IV fluids, antibiotics, and milk he has turned the corner. Those first few days he alternated between being lethargic and very fussy. Now he is sleeping a lot although if you waken him he will lie there contently. I imagine it is the first time in a long time he has had a full tummy. This morning his weight was up to 1650 grams. 

He still has a long way to go as currently all of his milk is given through a tube that goes through his nose and into his stomach. We will start with a dropper and work our way up to a spoon. He is now transitioning out of the ICU and hopefully soon out of the incubator. It will take awhile though before we feel comfortable sending him home and hopefully can also arrange good follow-up for him. 

Baby Gabriel (the baby with the heart defect) was transferred to our provincial capital city in hopes of getting at least an echocardiogram and seeing if his heart is something that could be fixed. Unfortunately, he passed away on the way there.

Last but not definitely not least is little Baby Atna. She is a tiny one and like most babies has lost weight after being born but so far there are no signs of infection or major problems with her heart or lungs, so we are hopeful that with good care she will soon start gaining weight.

Baby Atna - weighing 1.3 kg (just under 3 pounds) this morning. 

Back in the Trenches

Who would think checking cervical dilation would be exciting but after more than a year sitting on the bench, as I completed language study and waited for work permit, that simple skill felt good to be doing again. Funny, to think just 7 years ago I barely could find a cervix let alone tell you how far it was dilated. I had some awesome teachers and preceptors guide me to this point and hopefully now I can do the same for others. For several months now at the hospital, I have reviewed charts, shared advice as I was able, and talked through situations and problems with our medical and nursing staff. Occasionally, I would help out with a precipitous delivery or CPR in an emergency.

This week though I finally have my work visa and so can start working with and training our staff here. Today, it was a first-time mom with spontaneous rupture of membranes with no signs of labor and an OP baby. After checking her cervix and placing misoprostol, I spent time talking the staff through different positions the mom could be in that might help the baby turn. Typically laboring moms here spend most of their time on their back and occasionally on their side.

Then I went to see the mom who had an emergency c-section on because she came in seizing from eclampsia. She had a little 35 weeker who weighs just over 2 kg (4 1/2 pounds). He was busy being very upset at the lack of mommy time and breastmilk and since mom was now conscious I took him to the ICU for a visit where he promptly latched on and breastfed for close to 30 minutes. I wish I had been able to take a picture because he was so cute as he ate but my hands were busy holding him close and plus it felt like an invasion of their privacy.

There are two other little ones in the ICU and I don't know whether they will make it. One is a 32-weeker who weighs 1500 grams (just a little over 3 pounds) and the other is a 1-month old who only weighs 1600 grams (almost 3 1/2 pounds). He is obviously failing to thrive and his older twin has already died. Finally, there is also a toddler from an interior village with a very bad pneumonia who has been on the ventilator for almost 20 days now.

So just because I can finally get back in the trenches doesn't mean all the days are going to be happy ones. But I do have to admit I am glad to be getting my hands dirty again and soon the new school year will start and I will have a chance to shape some young minds and skills from the beginning.

Oh and by evening the laboring mom had delivered after a trip to the toilet (squatty potty) resulted in baby turning and a rapid delivery for a first time mom. :)

And so it begins...

Ibu Deen

This handsome fellow was born yesterday at our hospital via c-section. His mom, Ibu (Mrs.) Deen, has been a patient at the hospital for almost a month now. She is from an interior village about 4-5 hours from the hospital, 2 of those hours on dirt and very bumpy roads.

About 30 weeks into her pregnancy she started having vaginal bleeding and her local midwife sent her out to the government hospital nearest their village. She was then referred by the government hospital to us because they do not have an obstetrician/gynecologist on staff right now. An ultrasound showed that she had a complete placenta previa, which is where the placenta is implanted right above the cervix, which blocks the exit of the baby when it is suppose to be born. This complication can cause both mom and baby to die very quickly if she goes into labor or starts to bleed. 

After she was admitted to our hospital we found out she was contracting, so she was given medication to try and stop those contractions. She was also given a steroid injection to speed up the development of the baby, specifically his lungs, because if he was born then he would have been too early and most likely would have died. The bleeding slowed down, so for the next several weeks she laid in her bed in the ward on complete bedrest. Finally she reached 36 weeks (8 months) and we let her go a relative's house in a nearby town (her village would have been too far away and with the bad roads would have been a huge risk). But less than 24 hours later she started bleeding again and she was readmitted to the hospital. The decision was made to do a c-section.

So at 36 weeks and 2 days this little one was born. He weighs 2.5 kg (5 pounds 5 ounces) and after needing a little help with oxygen during transition, he is hanging out with mom in the ward. Because he is early he is having some problems with his temperature and with breastfeeding but overall he is doing great and will hopefully work through those issues quickly. Mom is doing well also, did not bleed too much during the surgery, and is now recovering.

This one will go down in the books as a life saved from a complication that could have taken both the mom (leaving two other kids without a mom) and baby. The system worked like planned. Just a few weeks after I arrived, we lost a baby just like this one. She had started bleeding a lot and the baby had passed away before she even got to us. The baby was perfect and almost at its due date. We did a c-section and she lived but it was a close call.

Listening to the Stories

So this is one of those blog posts that should have been written a couple of months ago but I just haven't gotten around to it. It is about my visit to Bethesda Hospital in October. I knew I was only going to be there for a couple of days, so my biggest priority was seeing old friends and making new ones. It was also a chance to listen - to hear the stories of current joys and challenges of the ministry there. Honestly, it could have been more encouraging because there are a lot of challenges right now but it was also a blessing to see so many serving every day.

I had the brief chance to talk with our current Indonesian obstetrician/gynecologist, who at the moment is also the director of our nursing school. He gave every indication that he is looking forward to partnering in the work together. I am not sure exactly what that will look like but am hopeful. He and others shared a few stories with me from Zaal Bidan (OB Unit). 

One was a patient who had come in that week. Many of our patients are referred from clinics and even other hospitals for a variety of reasons. This patient had been referred to us because of a post-partum hemorrhage (heavy bleeding after the birth of the baby, which can be fatal if not treated quickly and correctly). It turned out her uterus had prolapsed into her vagina. Thankfully it was able to be returned to its normal location and with a blood transfusion and antibiotics she was expected to fully recover. 

Another patient though did not have as good of an outcome and she was also a transfer. Apparently during the birth there had been a shoulder dystocia. The head of the baby had delivered but the shoulders got stuck. This is one of the emergencies of OB medicine. So she was transferred like that and the baby died during the transfer. There are number of maneuvers that can be tried to correct the problem and help the baby be born. We are not sure if any of those were tried or what exactly happen. Once she arrived at our hospital, we were able to start her on Pitocin, to make her contractions stronger again, and with one of those maneuvers the baby was born. 

These are just a couple of the stories I heard during my few days at Bethesda Hospital. One of the doctors after telling me some of the stories, asked me if I was going to run away and never come back. I have to admit the thought did cross my mind but it was also a good reminder of the great needs that still exist here in Indonesia and around the world. Moms and babies are dying and many of these deaths could be prevented!  

I will be moving to the hospital in March, after I complete my language study. I anticipate the first few months will be spent learning more about the situation and how I can best use my skills to fit the needs. I do know that this is going to be a very stretching and challenging ministry! 

Celebrating National Midwifery Week

Birth has been in the news a lot lately. Stories on the rising c-section rate and Duchess Kate giving birth to a future heir to the throne of England are just two examples. This week we once again recognize and celebrate the work midwives are doing around the US. Over 300,000 babies (7% of all births in the US) were "caught" by midwives in the US in 2011 (the last year for which we have statistics). Did you know that midwives provide more than just care for pregnant women?

Last year, the American College of Nurse Midwives launched Our Moment of Truth, to help women know their options and to know more about the care midwives provide. You can head over to the web page here. There you can read about the care midwives provide through the lifespan, from caring for teenagers to caring for women all the way through menopause. They also bust a few myths about midwives. Last but not least, there is a place to read stories of midwives in action from others just like you. You can also share your own story.

Sexual Violence Towards Women in Asia.

More than one in ten men surveyed in six Asian countries said they had raped a woman who was not their partner and that figure rose to nearly one in four when wives and girlfriends were included among victims.

That was the lead to a recent story in The Economist about violence against women in Asia, including Indonesia. The Lancet recently completed a study into the subject and the statistics paint a distressing picture for women living in Asia.

The culture has to change around the world and especially in these countries when only 55% of the men stated they felt guilty and less than 25% were sent to prison for their crimes. I wish I had the answer on how to prevent these horrible crimes or at least punish the perpetrators. The sad reality is though, that as a health care provider for women, more often than not I will be dealing with the aftermath. So instead I will be focusing on how to help them heal.  

Pictures of Bottles in Coffins

For several days now I have seen this graphic popping up on my Facebook feed and in several of the blogs that I follow. It is creating quite the storm and getting lots of negative feedback. I completely understand how many in the developed world would find this offensive. I would be the first to tell women I am working with in the US, that while I recommend breastfeeding, I know that is not possible for some women. I think it is important to support them in whatever they decide and for them to not feel any guilt over choosing not to or not being able to.

What I think is being overlooked though in all the negative feedback is that the statistic is from the WORLD Health Organization (i.e. an organization that predominately works with people in the developing world). Now I have not had the time to find and research that specific statistic but other statistics show a similar story. For example, they show us that 4 million children die each year around the world, the majority of them in the developing world. It is estimated that 1.3 of those children could be saved each year with exclusive breastfeeding for the first 6 months and partial breastfeeding (solid food added) through the first year. In fact, they are also discovering in the developing world, in places like Ghana and Nepal that initiating breastfeeding in that first day and especially in the first hour is critical to a baby's survival. In fact, 20% more babies survive if they breastfeed in that first hour of life.

Here in Indonesia there are entire store aisles that are devoted to baby milk formula. There are billboards, advertisements on Facebook (in fact there is one on my feed right now from Enfagrow), and brochures with free samples at lots of health care facilities. They show happy, Einstein-like, musical virtuoso kids that sleep during long road trips and through the night. Not a bad thing if you have enough money to afford the very expensive formula and have clean water to mix it with, but that is rare in many homes across Indonesia and other places in the developing world. Instead they make the formula stretch by only putting a small percentage of the recommended amount in the bottle and make it with unclean water. So the baby slowly loses weight because they are not getting enough calories and then they get sick from the water. In little ones they can quickly get dehydrated and then they die. In places like Indonesia, too counter those magic pictures of formula fed babies they need graphics like the one above.

This week is World Breastfeeding Week and I think this week and every week of the year we need help each mother make the decision that is right for her and her baby. It is important she know the facts and the risks for where she is living. Then we need to support her in that decision and make sure she has the resources she needs!

The logo for this year's World Breastfeeding Week (August 1st-7th)

Back to Work

Well it didn’t even take a week before the questions while I was out and about began and the phone started ringing with questions. The news has spread quickly (not that I was trying to keep it a secret) that I am nurse and midwife. It started with simple things like a rash -- of course it had to be a dermatology question, definitely not my specialty :) I have to admit though after a year "off" from nursing, it is good to be using those skills again! 

This afternoon it was a missionary’s kid who had gotten hit in the head with a swing and had a head laceration. I told them I would be happy to go to the clinic/hospital with them but didn’t have the supplies here to do any suturing. Their response – oh don’t worry we have all of that. So in they walk to the house with this huge bag packed with all sorts of medical equipment including suturing kits and IV fluids. I guess it pays to be prepared when you are serving overseas! Thankfully the laceration wasn’t long or too deep and had mostly stopped bleeding on its own. So we found some superglue and sealed it up.

It pays to be prepared! 

Serving in Indonesia, you would expect that most of my patients would be Indonesians and they are but providing care to expats and missionaries also takes up some of my time. Being sick is never fun and can be a bit scary, especially in a foreign country where you don’t know the system or the doctors. There are some great doctors in Indonesia and there are also some not so great ones. The problem is in knowing whom you can trust.

Thankfully one of my friends, a nurse I worked with at Bethesda Hospital several years ago, anticipated this need. She is currently in the US for a couple of months on home assignment but she is normally one of those who gets these problems and questions. When I arrived there was a present in my room from her. I opened it up to discover these…

They are Indonesian drug books. In the back they list all the medications by their brand name (the name they are in the US) along with a list of the generic names (not the same as the US) they are called in Indonesia, with page numbers. It allows you to look medications up and get dosage information and warnings specific to Indonesia. There is also an online version and I have already bookmarked it on my phone.

Hopefully, most of the needs I will encounter here away from the hospital will be few and not too serious. Thankfully, I am also living with my teammate who is a doctor, although he is frequently at the hospital or doing other traveling, like he was today.

Celebrating Moms and Midwives

I find it fitting that we celebrate International Day of the Midwife and Mother's Day just a week apart. I could quote statistics until I am blue in the face but the tagline for this year's International Day of the Midwife sums it up perfectly.

As my departure nears (just waiting on my visa now) it is exciting to think and plan about how I will be serving the women of Indonesia. I have missed catching babies!

This weekend we are celebrating Mother's Day. I can think of no better way to celebrate than to share just a few of the pictures I have of Indonesian moms and their kids...

More Than Just a Number

I spend a lot of time on this blog talking about the numbers, including this blog post and this one too. The number of women that die due to complications of pregnancy and birth. The number of children that die too young. The people of Indonesia though are much more than a number to me.

For awhile now I have followed the work of Micah Bournes, a powerful spoken word artist. I came across this video recently and it touched my heart.

Is Justice Worth It? feat. Micah Bournes from World Relief on Vimeo.

The statement that caught my attention was this, "It is one thing to wonder if someone else is worth fighting for." So many ask me why I am going to serve long-term in Indonesia. In many ways it is hard question to answer but maybe it is because they are more than a number to me and worth fighting for. While my role in Indonesia is not one that seeks to bring justice, it is one that seeks to bring relief from suffering. In many ways they are a similar task. In both you tend to lose as many if not more than are saved (or at least some days it feels that way). In both it is a never-ending battle. In both the answer to the question, "is it worth your time?" is a resounding yes. The key is in identifying with that someone else. When you see their face, hear their voice, and hold their hand during their suffering they become much more than a number.

I remember the first time this really sunk in. It was December 26th, 2004. I had been in Indonesia almost 2 years. Our first cell phone tower had been finished earlier that month and we were all excited about having cell phones that connected us with the outside world. That morning all the phones started ringing with phone calls and text messages. They told us there had been an earthquake and tsunami in Aceh, Indonesia. We turned on the one TV we had hooked up to a satellite and watched the images streaming in. I could understand what the people were saying and watching them suffer brought me to knees. It reminded me of the morning of Sept 11th, 2001, when I was also brought to my knees with grief for the American people.

That morning in 2004 I realized that in those two years of serving I had come to know and love Indonesia and her people. It brought new purpose into my work and life there. Whether I was in clinic or the hospital I learned to not just focus on the physical needs but see the patients as people and listen to their struggles and their joys. I could fill a blog post with pictures. Pictures of people who are more than a number to me. Some lived and some died. Some are of us laughing and some bring me to tears. All of them, their family, and their friends are worth being there for. 

Here are some videos and stories from Indonesia during the earthquake and tsunami. You can hear them speaking Indonesian but it is also subtitled in English.

Birth Photos from Around the World

I came across this photo slide show of birth in several places around the world recently on the New York Times web page. It has some beautiful and amazing photos! There is also an article from the photographer with more information about the photos that you can read here. 

International Women's Day

It is that time of year once again, where where we celebrate and recognize women around the world! This year the theme from the United Nations is,  “A promise is a promise: Time for action to end violence against women.” One of the ways the day is being celebrated is through the release of a new song. In the song, 25 singers and musicians from over 20 countries come together in a unified voice. You can listen to it here:

One of my favorite books about women is Half the Sky: Turning Oppression into Opportunity for Women Worldwide by Nicholas D. Kristof and Sheryl WuDunn. This fabulous book tells the story of several women around the world facing struggles and how they are turned into opportunities. For example there is a Cambodian teenager who is trapped in sex slavery who escapes and becomes a business owner, which supported family. Or there is the Ethiopian woman who struggles with devastating injuries during childbirth who goes on to become a surgeon. It is a great read -- informative and challenging!

Violence against Women in Indonesia

This post is a follow-up to the V-Day: One Million Rising post from a couple of weeks ago. In that post, I talked a bit about violence against women and how I have become more familiar with the topic. I mentioned that there are a number of ways women experience violence, one of which is rape.

There was a recent editorial written in the Jakarta Post Newspaper by an American woman living in Indonesia. She was highlighting several recent incidents in Indonesia that had happened to young women (really just girls) living there.

• First, was an 11-year-old from a family of Jakarta whose father confessed to raping her. She was found to have the same sexually transmitted disease as her father. The girl passed away from an inflammation of the brain.

• Second came the report of a 13-year-old who had been married to a 39-year-old in a Balinese Hindu ceremony. She became pregnant but the baby was born premature and died. 

• Then there was an incident in the fall of last year where Facebook was used to lure a 14-year-old. She was gang-raped and they planned to traffic her but due to media attention she was released. You can read more of the story here. 

Incidents like this occur across Indonesia on a regular basis. They happen across islands and people groups. One of the biggest risk factor is poverty. For some poverty drives families to marry off their young daughters. Sometimes they are sent away to work where they are risk for human trafficking and abuse. Others are lured by promises of cell phones, new clothes, or fees for school into a trap.

I recently came across this video on YouTube which highlights the risk young women are at and simple interventions that can help save them. I thought it was worth sharing...