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.

A Matter of Life and Death - Article from The Jakarta Post

This article was published about a year ago and it highlights the tragedy of maternal mortality in Indonesia. 

Published on The Jakarta Post (http://www.thejakartapost.com)

A matter of life and death

The Jakarta Post   |  Wed, 01/13/2010 6:25 PM  |  Life

Rita A. Widiadana

Choirunissa, 38, was nine months pregnant. She was also poor, malnourished and anemic. The expectant mother — also known as Nissa — already had five children and did not want another baby. When her due date arrived, her husband Lukman called a traditional birth attendant to help his wife deliver the baby at their modest home in a remote village in Jember, East Java. During the delivery, Nissa started bleeding but the birth attendant did not recognize the seriousness of the problem until she collapsed. Lukman decided to take her to a nearby hospital but he had no money and no transportation. He finally he got a loan from a neighbor and took her to the hospital only to find that the medical staff could not save either mother or baby.

Thousands of women in Indonesia stretching from the western-most Nanggroe Aceh Darussalam to eastern Papua provinces share Nissa’s sad story — they died due to complications related to pregnancy and childbirth. The majority of Indonesian women living in rural areas delivered their babies at home, about six in 
every 10 births. Many families prefer to use a dukun (traditional healer or shaman) because of traditional beliefs and because it is cheaper than using a trained midwife or going to the hospital. These traditional birth attendants usually perform household chores while the mother recovers. In many rural areas in Indonesia, traditional ways of delivering babies still exist.
Village women in Papua are aided by traditional midwives in the middle of lush tropical forests. The local midwife usually uses bamboo fibers to cut the umbilical cord and wipe the newborn babies with guava leaves.The delivery instruments used are certainly not sterile and can lead to serious infection.

The traditional midwife may not be able to deal with complications during child labor and by the time the mother gets to a local clinic, it may be too late. As a result, according to Health Ministry data, the country’s maternal mortality rate (MMR) remains high at 307 maternal deaths per 100,000 live births, with about two women dying every hour during pregnancy and delivery. In comparison, the maternal mortality rate reached only 39 per 100,000 in Malaysia and 6 per 100,000 in Singapore. (The rate in the US is estimated to be around 11-15%). Indonesia is among the 11 countries that contribute 65 percent of world maternal deaths.

The main cause of maternal death in Indonesia is bleeding (28% of maternal death), followed by pre- and post-eclampsia (24%), infection (11%), and the complications of abortion (8%) and prolonged labor (5%). Most of these deaths occur with births handled by traditional birth attendants rather than by medically trained healthcare professionals. Dr. Saramma Thomas Mathai, United Nation for Population Affairs (UNFPA) Asia-Pacific Regional Office, said that maternal mortality is an indicator of gross inequality, human rights abuse and development failure. “It is clear that when a woman in most of Asia becomes pregnant, her survival cannot be assured. All maternal health problems are preventable as long as the government pays attention and prioritizes maternal health.”Of the 11 countries that contribute to 65 percent to global maternal death, five are Asian countries including Indonesia, Bangladesh, Pakistan, India and Afghanistan. A high mortality rate is an indicator of the status of poor functioning of a country’s health system including lack of supportive and protective legal and policy environment, Mathai said. Dr. Sri Hermiyati, director of maternal health at the Health Ministry, admitted Indonesia still faces tough challenges in dealing with maternal health. “Reducing the MMR has become the first priority in the Indonesian health care system. But we have to admit the roads are still very long and rough,” Hermiyati said.

A little history

These are two pictures of me when I was growing up. In the one on the left I am dressed up for a harvest party. I am wearing a nurse outfit my mom had sewn and in my hand is a little medical kit. In the picture to the right I am posing with my three younger sisters. A normal picture except that all of us have balls of some size under our shirts/dresses in an attempt to make us look pregnant. From the looks in my direction in the picture it is obvious that I was the instigator.

My fascination with pregnant women and being a nurse started early and continues to this day. Little did I know during those early years what a nurse-midwife even was but thanks to the Lord’s leading and some wise teachers and mentors along the way today I find myself combining those two loves of being a nurse and taking care of pregnant women.

After graduating from Baptist Christian School (now Horizon Christian School) in Hood River in 1997 I went to nursing school at Seattle Pacific University. It was quite the adjustment as there were more people living on campus than lived in my hometown! Through this program and the professors my world was opened up. It was during nursing school I went on my first international trip to serve in Indonesia. I graduated with Bachelor of Science Degree in Nursing in 2001. As a new grad I spent a year working at Seattle Children's Hospital in their oncology unit. Tough work but very rewarding to get know such amazing kids and their families.

Indonesia 2004

Then for a little over 2 years I returned to serve at Bethesda Hospital in Indonesia as a nurse. There I met many friends, explored an amazing place, and discovered I did love taking care of pregnant women and being a part of their birth story. But there in the developing world I came to face-to-face with the tragedy of maternal and neonatal mortality. So many mothers and babies that could have been saved with simple prenatal care and skilled care during birth.

I returned to the US and headed back to school determined learn more about how to save their lives. For the past two years I have been studying at Frontier School of Midwifery and Family Nursing and recently completed clinicals with the midwives at Group Health in Bellevue. After I take my board exams I will officially have my Masters Degree in Nursing and be a Certified Nurse-Midwife. After that I am in the process of preparing to return to serve again at Bethesda Hospital in Indonesia, as a nurse-midwife and mentor.

Birth and Death

This short film illustrates some of the struggles facing women around the world in having healthy pregnancies and births.