Separated at Birth

When a woman who has just given birth cannot afford to pay medical fees, there is a risk in Indonesia that her baby will be taken hostage. 

This was a recent story on the BBC web page that told the too common story of newborns separated from their families by hospitals, clinics, and private midwives when they are unable to pay the bill for care during their birth. The story highlighted one such family in Bali (pictured above) in which a women who had given birth to twins but only had enough to pay for one birth. She was separated from her son for four months as every day the debt increased, as the clinic charged for the baby's upkeep. In the end her son was returned to her thanks to the intervention of an American midwife living and working in Bali.

According to the story 36 such cases were reported to the government in 2010 but they acknowledge that many more cases probably occurred as most people probably didn't report it. Care for poor women who are pregnant has been paid for by the government for several years now, but correctly identifying those women, budget shortfalls, and bureaucracy have prevented this funding from reaching those in need. In the coming year a new plan will hopefully be put in place providing universal health care for pregnant women throughout Indonesia but funding problems are expected. Hopefully at least these steps will help reduce this problem. In addition, hopefully it will encourage those who avoid coming to clinics and hospitals because of the cost to seek care.

The State of World's Midwifery Report

Midwives deliver babies -- and they do much more. This slide show created from photographs submitted by UNFPA Country Offices, shows midwives in action in more than 40 countries.

Increasing women's access to quality midwifery has become a focus of global efforts to realize the right of every woman to the best possible health care during pregnancy and childbirth. A first step is assessing the situation. Over 30 organization including the United Nations and the World Health Organization recently worked together to release the first global midwifery report for 35 years. The report surveyed 58 countries representing just under 60 percent of all births worldwide but 91 percent of all maternal deaths.

According to this new report every year 358,000 women and 3.6 million newborns die due to largely preventable complications in pregnancy, childbirth and the postnatal period. Up to another 3 million babies are stillborn.

Increasing access to midwives has become a focus of global health efforts since it is central to three of the Millennium Development Goals agreed upon by the international community to reduce child death, improve maternal health and step up the fight against AIDS, malaria and other diseases by 2015.

In upcoming posts I will share information from the report on Indonesia. If you are interested you can find more information on the report on the UNFPA web page.

Big Week!

The coming week is filled with special days in which we remember and recognize midwives, nurses, and mothers.

We start things off today, May 5th, with the International Day of the Midwife. Here in the Puget Sound and in many neighborhoods around the world that means midwives will be gathering together to celebrate. In the Seattle area, people are meeting for a 5k walk at Alki Beach with a special guest Ina May Gaskin. Other events include a virtual day with events starting in New Zealand at 12 pm (5 pm on May 4th for those in PST) and working their way around the world with a different topic each hour. You can find more info at Virtual International Day of the Midwife.

Then Nurses Week kicks off May 6th. The theme this year this year is "Trusted to Care." This is in recognition that for the 11th year since they were added in 1999, nurses were voted as the "most trusted profession" according to an annual Gallup poll.

Finally of course is Mother's Day on Sunday May 8th. There are so many great moms out there to celebrate. There are also of course many families who will be missing their mom for a number of reasons. One reason though that is largely preventable and therefore especially sad is those moms who are missing because they died giving life. This short film from UNICEF highlights this tragedy.

So take this week to celebrate the midwives, nurses, and mom's in your life!

Moringa Leaves, Vacuums and Boise, Idaho.

Yep, they really do all have something in common. Hard to believe I know! So what is it that they have in common? They are all related to a training I did in late February. The training was held by Mercy in Action in Boise, Idaho. They have been very successful at providing life-saving care to the women of the Philippines through several birth centers for over 25 years.

This specific training was called Midwifery Volunteerism in the Developing World. I went hoping to help bridge my knowledge between all I learned in school about working in the US and the differences I know I will encounter in returning to serve in the developing world. We talked in depth about the top five causes of maternal and neonatal death and how to address each of those problems through low cost and simple interventions.

We talked a lot about nutrition, as poor nutrition is a common cause for problems during pregnancy such as preterm birth and bleeding after the birth. One of the resources they shared was the moringa tree. You can read more about it here. They are an amazing source of nutrition that grows well in the tropics, even in poor soil. I definitely hope to plant a few around the hospital, enjoy their leaves myself, and encourage the women in the village to do the same.

We also learned a lot about obstructed labor or when the baby gets stuck in the birth canal for one of many reasons or birth needs to happen quickly due to complications. We then trained on how to properly assess and use vacuum device to assist with birth in certain situations.

There were several other topics addressed including working with HIV positive women, treating hookworms and malaria, preventing/treating neonatal infections and preventing/treating problems like postpartum hemorrhage. All in all it was a great training and one I would highly recommend to anyone serving in the developing world in any health-care role take.

One of the hardest things I know I will encounter while serving is the reality that I am going to have moms and babies who die in my care. Many will come with problems that are too severe or it is too late to help. In other cases it may be that we lack equipment or the medication needed to help. Death is a rare problem in most OB units here in the US but unfortunately much more common in Indonesia and a reality I have to prepare myself for. I hope by completing some of the training and reading I am doing before I go, I can help to save as many as possible.