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.