Brazilian women rebel against cesarean births

This article made me want to stand up, raise my fist in the air, and sing something about solidarity and the power of women. If you think that you can't change things, that your voice is too small and too insignificant, remember that huge changes in maternity care have come about from regular people like you. Power to the people!

Here's an excerpt from the article by the AP: Brazilian women rebel against cesarean births.

More women are pushing for more of a say in childbirth — whether by C-section or naturally, at home or in a hospital, with a midwife or a medical doctor. As patients in doctors' offices and street protesters reject the pressure to have surgical births, the federal government is investing billions of dollars into a natural childbirth campaign, including the building of hospitals devoted to maternal care.

"We need to have a serious discussion in this country to see what can be done to change this culture," said Olimpio Moraes Filho, one of the head doctors with the Brazilian Association of Obstetricians and Gynecologists. "Women are starting to rebel, and they should."

A tipping point came in July, when a medical regulating agency in Rio de Janeiro forbade doctors from doing home births and labor coaches known as doulas from helping out in hospitals, saying "there are many complications possible during labor that require immediate medical attention."

In response, women organized marches in 13 cities. In Sao Paulo, they bared their breasts and carried posters reading "Our Children, Our Decision" while chanting "Brazil, don't follow Rio's example." They enacted natural births using dolls covered with Portuguese words reading "Born Free."

 

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Homebirth in Australia: more marginalized and less safe

Homebirth Australia just issued a statement responding to the SA Deputy Coroner's recommendations to require health care workers to reported planned "high-risk" home births (more details available at the end of this post). The statement is included in full below.

Also worth reading is Hannah Dahlen's article Pushing home birth underground raises safety concerns. Dahlen is an associate professor of midwifery at University of Western Sydney.

~~~~~

Coroner’s Recommendations:  

Short sighted and misses the point on homebirth
7 June 2012

Following an inquest in to the death of three babies, recommendations about the provision of homebirth services have been made by South Australian Deputy Coroner Anthony Schapel.

Homebirth Australia has concerns about the recommendations made by the Coroner. It is our view that, if implemented, the recommendations will lead to homebirth becoming more marginalised and less safe.

What was missing from the Coroner’s findings was any real consideration of the reasons why women choose homebirth. Lack of access to quality maternity care options and sensitive providers forces many women to turn their back on hospital care.

Listening to women, respecting their autonomy and developing services that genuinely meet their needs we will do far more to ensure the safety of mothers and babies than punitive short-sighted responses that remove options and marginalise certain choices.

Women make the choice to give birth outside a hospital with identified risk factors due to their profound dissatisfaction with the current maternity care system and in some cases because of previous hospital experiences that have left them deeply traumatised.

When our hospitals leave women so damaged after a birth that they refuse to return no matter what the risk, then we need to look at why.

Any law reform around homebirth must recognise that all women (including pregnant women) have a fundamental right to bodily autonomy and a legal right to refuse medical care.

The right of women to make decisions around the circumstances of their births and to choose homebirth has been recognised by the European Court of Human Rights.

The ability of women to make decisions about their maternity care is recognised at common law and by the Australian College of Midwives, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian Medical Association.

Women will continue to choose homebirth regardless of the legal or regulatory framework surrounding midwifery practice and other women will heed their call for support if the maternity care system fails to support them to give birth at home.

Contact: Michelle Meares – 0439 645 372

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Birth Around The World: 1950s London

The Telegraph's Anna Tyzach interviewed Monica Fitten about her midwifery training in 1950s London. Below are excerpts from her interview. You can read the complete version here.

In 1955, when I was a young nurse working in London, . . . nurses were expected to be able to deliver a child. And if you didn’t know your midwifery, you were considered no better than a lay person when it came to attending a woman in labour. It was a steep learning curve with little time off but within six months, I’d delivered more babies than I can count, and had become an authority on the subject of child-bearing women – and their husbands.

Birth wasn’t a medical event back then; it was a family occasion conducted on the marital bed. Only women expecting twins or triplets or experiencing complications such as toxaemia ended up in hospital; everyone else just got on with it at home.

I’d spend my days cycling between mothers-to-be in Hammersmith, my allocated district, making sure their homes were suitable for a birth. Most women – or should I say their mothers – would have cleaned the bedroom, but running water and indoor sanitation were still a luxury in those days; many people had outside loos or shared a bathroom with several other flats, which would make my job tricky. In extreme cases – when the surroundings were truly filthy, for example, or if we knew the father was physically abusing the mother – we would send the woman off to the maternity unit to have her baby in clean sheets and peace and quiet.

I never made any attempts to glamorise birth or play down the upheaval a new baby would bring. It was no use euphemistically saying “it’s all in the mind”; I’d warn the expectant mother that it was going to be damned painful. It didn’t always sink in, though. I got used to women kicking up a fuss as they went into the second stage of labour. It’s just human nature. Some of us – myself included – are born with low pain thresholds while others give birth almost effortlessly. Generally, though, pain was an accepted part of childbirth and we’d only administer painkillers – intramuscular pethidine – to women who had ceased to cope entirely or who were giving birth to particularly large babies. If there was tearing down below, I’d stitch it up myself, unless it was extensive, in which case I’d call the GP. Back then doctors were very good at midwifery.

Despite all this, it always surprised me how well most women managed in labour. Often it was what they did afterwards that was more of a worry. It’s a myth that everyone is a natural mother. Just because you want a baby doesn’t mean you’ll be any good at dealing with it when it’s born. I met several mothers who were hopeless to the point of neglect. The responsibility of motherhood just wasn’t for them; they got frightened. Later on, when I was a health visitor, I gave evidence in the juvenile court on three occasions about mothers accused of abusing or neglecting their children.

But you couldn’t really blame these women for getting pregnant. Birth control wasn’t as widely available – or morally accepted – back then. I often helped mothers to have their eighth, ninth or 10th child. These women were dab hands at giving birth. Their mothers would be in the kitchen making tea and minding the other children while their husbands assisted them in labour. Yes, you read that right. Many of the fathers I came across would have made excellent nurses.

This wasn’t always the case, though. I’ll never forget the first time a father stepped in to help me. Just as his child’s head started to appear, he fainted across his wife’s body. I didn’t know what to do – he was too heavy to move – but the mother found it so funny that she ended up laughing the baby out. “I knew he’d do that,” she kept saying. It was instances like this that made home births so much more fun than having a child in a hospital. . . .

And thankfully I didn’t witness too many tragedies. Women experiencing complications would go straight to hospital. But I did deliver a couple of premature babies who didn’t make it – in those days you could wave goodbye to any child weighing under 5lb.

During births I was supposed to be supervised by a senior midwife but she was always late. I got used to her turning up in time for a cup of tea after the baby was born and I’d finished cleaning up the bedroom but it didn’t bother me; she’d seen it all before, whereas I was just learning. When I told her about the fainting incident she gave me a look of unadulterated scorn. “Typical man,” she said. “A bloody good period would see them off. Men simply don’t do pain.”


Read the rest here. 
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Robin Lim named CNN Hero of the Year

Robin Lim, a midwife in Indonesia, was just named the CNN Hero of the Year! She was well-known among many midwives in Iowa (where I did my PhD work), where she practiced before moving to Bali. Here are some excerpts:

Robin Lim, an American woman who has helped thousands of poor Indonesian women have a healthy pregnancy and birth, was named the 2011 CNN Hero of the Year on Sunday night.

Through her Yayasan Bumi Sehat health clinics, "Mother Robin," or "Ibu Robin" as she is called by the locals, offers free prenatal care, birthing services and medical aid in Indonesia, where many families cannot afford care.

"Every baby's first breath on Earth could be one of peace and love. Every mother should be healthy and strong. Every birth could be safe and loving. But our world is not there yet," Lim said during "CNN Heroes: An All-Star Tribute," which took place at the Shrine Auditorium in Los Angeles and recognized Lim and the other top 10 CNN Heroes of 2011....

[Christy] Turlington Burns introduced Lim's video tribute during Sunday's show, before the Hero of the Year announcement. As founder of Every Mother Counts, she is also a passionate advocate for maternal health around the world.

"Eight years ago, after giving birth to my first child Grace, I felt what could have been a life-threatening complication," she told the audience of nearly 5,000. "It suddenly got very scary, very fast. If I hadn't received the expert care in the hospital birthing center I was in, then I may have not been so fortunate.

"My wish is that every mother all over the world has the same chance surviving childbirth I had. My friend Robin Lim shares that wish and she spends her days and nights making it so."

Read the rest here.

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Birth Around the World: Midwifery in Tanzania

Today's "Birth Around the World" feature is a guest post by Pauline of Infomidwife. Pauline is an independent midwife in Australia.

~~~~

Midwifery in Tanzania

This is a snapshot of midwifery in Tanzania from my perspective. It does not refer to anyone specific; the judgments are made from my personal observations.

Tanzania is a country in which health resources are minimal and much help is required--the lack of staff, general caring, and privacy being high on the agenda.

Clean room

In the public hospital the labor ward has approx 12-14 beds. The beds are hard and there is no visible linen. The windows and doors remain open and there is a problem with flies. I did notice curtains around some of the beds, but they are rarely used. The ward is split into three sections with a resuscitation area for the babies; however, I did not see any resuscitation equipment.

Labor bed

There is a long wooden bench for the women to sit on after birth, and there is a clean and dirty room. However, it is a stretch of the imagination. There is a small room attached that has four beds and this is called the eclampsia ward. The incidence of eclampsia appears to be high, and the antenatal care is insufficient in the prevention of the condition. This could be due to the low resources, therefore not enough education. There are some rudimentary posters on the walls for treatment of PPH and eclampsia. Generally the ward is constantly busy, noisy, and often used as a thoroughfare.



A normal 24hrs could see anywhere from 74 – 120 births. On the days I spent there, the average birth rate over 24hrs was 75-85 births--a quiet time. The lack of staff is a massive problem and the ward is laden with students. As I commented in my nursing in Tanzania blog, the structure of nursing is very different to Australia. Nursing and midwifery are together in every course and I suppose this also will assist with the shortage of staff.

Just to remind you of the career structure: enrolled nursing & midwifery is now a 2 yr course (previously 4yrs). Entry level is equivalent to yr 10 (form IV). As student midwives, these students conduct 20 normal births and 10 high risk (breach, face, brow presentations etc) supervised by a qualified midwife. Diploma nurses and midwives, if they have moved up from enrolled nurses, will do a further 10 normal births and 5 high risk, and this takes a further 1 yr, also supervised by a qualified midwife. Diploma nurses/midwives straight from school good scores for form IV, three yr course. These nurse/midwives, if they want to convert to a degree course, will have to do another 3 yrs (6yrs in total). Lastly there are degree nurses and midwives (3yrs course) entry level form VI (TEE / TER level) these students require 30 normal and 15 high risk births. Confused? It took me a while to work it out.


Part of the problem is that students outnumber the registered staff. You don’t know who is an enrolled /diploma or degree nurse/midwife student until you ask, and then I was still not clear who is accountable for what. On my shift there were 6 students and 2 registered nurse/midwives and a doctor. At one stage I had four labouring women at fully [dilated] with just me myself and I. Oh, and my nursing students (as if in a maternity setting). It was frantic.

The African women need to bring with them 4 Kangas; these are traditional cloth /dress, pieces of material 2 meters long. One piece is cut in half, so there are two for the baby. The women use one as a sheet on the bed. They often have one they are wearing, and the others are for after the birth and the baby. Often the women are naked; privacy does not seem to be an issue. People walking in and out of the labor ward as if it was a thoroughfare.

Flies were annoying. It was hot/humid; everyone was sweating, no way of cooling down. There was no visible water anywhere. At times I felt useless and helpless. I allocated my nursing students to stay with each woman, attempting to provide some comfort and encouraging them to drink some water, which the women bring in themselves. I found a Pinard [wooden stethoscope] on the desk and was showing the students how to use one. There was no electrical fetal monitoring (not such a bad thing).

Delivery pack

Two women had syntocinon [Pitocin] running, so I listened to their fetal hearts first. All seemed well. Then I moved to the second two women. These two seemed to be going head to head as to who was going to deliver first. I called out for some help, and a doctor came forward. He was less than helpful; however, he did yell for someone else to assist. Whilst he was with me, I asked if he could translate to my women as I wanted her to stand up or turn over to aid her birth. His response was “no, we like them on their backs so we can see what is happening.” He promptly called for a student midwife to assist me and yelled at the women to push harder. I regretted asking him to translate.

As we were preparing for birth, I found the delivery pack but could not find a cord clamp. By now the woman was pushing well. The student midwife had disappeared momentarily, so I asked my favourite doctor who had taken his spot at the desk--watching the events, no curtains, three naked women in the room all pushing--"excuse me, I can’t find a cord clamp." "Ah, you want a cordie clampie. Ask the woman or look in her bag, she has them.” Now the student has returned and I am informed that the women bring in a cord clamp, a roll of cotton wool for the birth, her Kangas, and food and water for herself. If the woman does not have a cord clamp, you find some cotton or tear a piece of material to tie the cord. Thankfully the woman had purchased a cordie clampie. I could not find the scissors to cut the cord. Emm that’s because we use a blade. At one stage I needed to clean around the perineum and asked my student nurse for a paper towel, forgetting where I was. (The poor student went looking for one until I called sorry forgot where we are. We both nervously laughed.) It was tough to use cotton wool for everything. It is hard doing a vaginal examination using cotton wool.

It was a beautiful birth, a truly special moment. Third stage went well, syntocinon given as usual. The woman was exhausted. Now it was time for her to get up and go and sit on the bench. I had taken too long, and the student midwife was hurrying me along. It was only 40mins after the birth. The student midwife cleaned the bed with the two dirty Kangas. I asked, "what happens to them now?”  She continued to clean the bed, rolled them up, put them in a plastic bag and gave them back to the woman. No laundry required. The woman sat on the bench, drank her water, and had a bite to eat (a piece of bread I think) and started breastfeeding.


We then weighed the baby. The woman was then transferred to the postnatal ward (we walked her across) within 90mins. She then stays on the ward for 6hrs and walks home or catches the bus with her baby. The postnatal ward may have two or three women to a bed. I counted 12 beds, saw no baby cots. The women lay exhausted on the bed with their babies, some crying, soulful eyes watching you. They have a resigned look on their faces as if this is my life. The nurse is sitting at the desk. The ward is packed a sea of faces. There were be a couple of nursing assistants walking around assisting with breastfeeding. It was heartbreaking, poignant, and I was saddened by the obvious pain of life.

Resuscitation bed

It wasn’t long before there were two more babies, all healthy and well. The last woman was having difficulty and was going for a Cesarean section. They don’t have forceps or ventouse [vacuum] births in this hospital; however, I could see the benefit of using a kiwi cup...but that’s a different story. The Cesarean section rate is about 20% and on the increase. Only about 40% of women birth in the hospitals; the rest are out in the rural areas.

Traditional Birth Attendants

We did visit a dispensary that was well-equipped for births. I met some traditional birth attendants, who also stated that they birth women on their backs on the floor. I did find this interesting. I tried to share my experience of changing positions and it was met with great laughter.

Transport poster rural area

In the rural clinic the women come whenever they have time or feel they need to attend. With their first babies they seem to be more vigilant. Clearly, the more babies they have the less inclined they are to come to the clinic early. They normally show up at about 32 weeks. The clinic we visited was 2.5 hours away from the hospital, and transport if things go wrong is difficult. They often have to cope or find alternative ways of getting to the hospital.

My students really enjoyed this placement and I am sure that 4/5 students will go on to do their midwifery. For me I was dismayed and the visions stayed with me for days. I am still troubled by the conditions that women are in, and I would be keen to be able to help in a more substantial way. The issues that struck me most:

• Technology v no technology
• Caring / compassion v no caring / compassion
• Women being totally alone with no support
• The total lack of staff
• Birth flat on their back in bed

There was a complete contrast in the private hospital. The birth rate for November was approximately 50 for the month. There were no patients on the day we spent several hours there. Privacy is still an issue with three labour beds in the one room. The labor ward has just been renovated so was very modern.

beds in the private hospital

There were brand new beds. However, I was disheartened when I saw the strips remain in place on the bed. For me, this would mean because they are there they will be used. There was a CTG [EFM] machine. In another room there were two labor beds, and there was one private room (the executive room, of course at a price). What was surprising was they had a spa bath. It was great to see. However, they would need education regarding its use. (I was asked to give a lecture on waterbirth, but that’s another blog). There seemed to be more staff here, and they did seem more caring and provided one-to-one care. But this was only a snapshot, so I really could not give an accurate account. It was reassuring but sad at the same time, because most women could not afford this care.

My maternity time was an experience, as was my whole Tanzanian clinical practice. I met some phenomenal people and some I hope to continue to keep in contact with... more in my next blog.

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Birth Around the World: Vertical Birth

I recently added a vertical/upright birth button to the left sidebar. Clicking on it will bring you to a list of posts mentioning upright birth.

I also wanted to bring your attention to several articles and links about vertical birth.

First, read The Unnecesarean's fabulous article about the Vertical Birth Movement in Latin America. From Venezuela to Peru, from Ecuador to Mexico, hospitals and childbirth advocates are starting to adopt vertical birth as a way to increase safety and as a fundamental human rights issue.

Next, Susana of Spirit-Led Birth that birthing in an upright position liberated her from pain:

Once I learned that women can birth while sitting, standing, or on all fours I was liberated! From the bed and from pain! My first two births, (which were hospital births) were conducted in a bed. For the rest of my 5 births I never once laid in a bed. During my first homebirth I went to lie in bed, out of habit I guess, and as soon as I laid down I felt pain so I got out the bed and never got back in!

She includes a link to a Spanish-language video called "Humanized Birth: Retrieving the Vertical Position." Lots of lovely upright births!



Finally, Sage Beginnings has photo illustrations of various birthing positions. These pictures, taken in a variety of birth locations, are so much more helpful than the line drawings found in many birth books!

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Birth Around the World: A VBAC in Tajikistan

Rhiannon Laurie, a doula and student at Western Washington University, sent me the story of a birth she attended last year in Tajikistan. Rhiannon recently returned from a 10-month stay in Tajikistan studying childbirth and culture, funded by Fairhaven College's Adventure Learning Grant. She writes: "In Tajikistan I worked with an Intergovernmental Organization on AIDS prevention in Birth Hospitals, studied traditional medicine at a University, attended/observed one and a half births (read about them here), and (perhaps more importantly) sought to form deep and genuine friendships with the people I met."

Rhiannon runs the website Childbirth for Transformation.

*****

A VBAC in Tajikistan

by Rhiannon Laurie

An examination room at the birth hospital

The room is dirty and cold. There is a bare electric light hanging from the ceiling, but the power is only one from 6a.m. to 8a.m. and 6p.m. to 9p.m. and right now it is midmorning. So our light comes in through the dirty glass of the window, and the little heat we have is from wood stove boiling some water in the middle of a room.

“We” are a young woman, her kurta dress up over her knees, her long smooth legs bent into stirrups, and me. I’m the American standing uncomfortably on the side of the room in a borrowed white lab coat. The one who keeps putting her notebook down on the table and then picking it up again.

For ten months in 2009-2010 I lived in Tajikistan on a grant to “study childbirth.” It took me the better part of the year to manage to sneak through the red tape to see one, but it was certainly worth it. Even when the KGB chased me out of town later that week.

We are in a mountain village named Jirgatol in the valley of Gharm. It is one of the poorest parts of Tajikistan. Villages here cling to tiny bits of flat land between looming mountains and the river far below.

It was poor even to start with. Then the Gharmis lost the recent civil war and things got worse.

I am visiting from the capital, and the people I’m staying with won’t let me out of compound without an escort. Actually, they won’t let me go or be anywhere without an escort. This is the type of life I came here for, but already the KGB are pestering me for more documents every day, and the squat toilet visible to all the nearby houses is giving me a run for my money.

All this for a chance to see a birth.

Let’s call her Nodira, though no one told me her name. She has one of those gorgeous Tajik faces – light brown eyes, freckled skin, and softly curling brown hair. She’s so thin that her belly looks like it should belong in early pregnancy – and yet here she is pushing her baby out.

She is accompanied at various times by me, the doctor, the nurse-midwife, a “sanitation worker,” and her friend. And yet she seems thoroughly alone to me.

I’ve preached endlessly about cultural relativism – that reminder that something abhorrent in our culture may be quite right and good in another. But I can’t help but flinch at the way these normally kind people treat her.

The doctor, a small and equally pretty woman with four daughters (she plans to try again for a boy when her youngest turns two), turns into a force of rage and brutality in the birth room. She and the midwife stand between Nodira’s bent legs, chatting about unrelated subjects between contractions, and repeatedly flipping her dress farther up her body whenever she tries to pull it down to cover herself.

A contraction comes up and the midwife leaves the room to get something, opening the door briefly onto a busy hallway with medical students rushing by – no money for curtains for privacy here. The doctor wedges herself between Nodira’s knees – one shoulder digging into one and both arms pushing the other. Her legs are braced against the bottom of the bed so as to force Nodira to open even farther.

I do yoga every day and there is no way I could get myself into that position at all, much less on a high steel bed as I tried to birth my baby. Nodira cries in pain. Her friend, standing at her left side, worriedly shushes her. I remember my host mother’s proud words: “The Russians and Americans might scream in birth, but we Tajik women keep quiet.”

When the contraction is over, the doctor flashes a frown. She picks and plucks at Nodira’s belly with her fingernails to start another contraction, and begins to lecture.

“You think we’re just going to cut this baby out too because you’re too lazy to push? That’s not an option. You either kill your baby by not trying or you push it out.”

Nodira is crying, “Oh Ochajon, please don’t do this to me.” The doctor just glares. “Try harder.”

I move over to her side, uncomfortable with the voyeurism of my situation. I pick up Nodira’s smooth hand and smile. I know that Tajiks feel affection differently than I do – that a stern word can be a sign of care and love. But I can’t leave this room without having given her some warmth and light, even if it’s culturally inappropriate to do so.

She rolls her tired eyes over towards me and smiles back through her surprise. I’d be surprised too – a stranger showing up in the birth room. It breaks all my rules of conduct for attending births in the U.S. but here I am.

Before the next contraction, Nodira slips into that late labor sleep I’ve seen in births I’ve attended at home. There we would see it as a good sign, provided labor was progressing normally. It means that the mother is staying relaxed, getting the rest she needs, and that she’s basking in all those late birth hormones.

The sanitation worker, a kindly old woman boiling water with which to scrub gloves and aprons, lets out a “oy!” and the rest of the team is called into action. The doctor flicks cold water in Nodira’s face.

“Didn’t you sleep last night? If you pushed better you’d be in the recovery room napping by now.”

When the next contraction comes the doctor is once more pushing legs every which way. I lean down close to the mother and whisper “good job, wonderful job, you’re doing so well,” though I can’t tell from her response if she even understands me. I learned Tajik in the south from southerners and the Gharmi accent is different.

A few more contractions pass and more lectures are given. I quietly demonstrate what effective pushing looks like and Nodira watches intently. This backfires when the doctor sees and exclaims “see, even this unmarried American knows how to push!” but with subsequent contractions she seems to be doing it better. Finally the baby begins to crown.

Now it looks like all the U.S. birth rooms I’ve seen, with everyone screaming “push, push, push,” though in the U.S. we ought to know better.

As the baby comes out, Nodira reaches down to feel its head, to guide it out with her hand. The doctor slaps her, “Don’t touch! What’s wrong with you!” and begins to wrestle Nodira’s right hand back up the bed towards me.

Her friend and the midwife are both working together to hold down her left arm but I am aghast at the brutality of it even as I’m once more in awe of birthing women’s power. The sanitation worker has to lay on her right arm by herself, without help from me.

Then suddenly, like it is always sudden, there is a big wet baby in the room. She’s a big healthy girl. I can’t believe she fit in such a small body. The set her on a blanket on her mother’s stomach to cut the cord, suddenly upset that she won’t touch her baby. “Are you going to let her fall off you?!”

That is only momentary. She’s whisked off to the other side of the room to be cleaned, dried, measured and wrapped – all with supplies Nodira had to bring herself. Then they turn her to one side (presumably so she won’t choke on anything) and leave her all alone on the high table.

As soon as they take her baby away, Nodira begins to shake. Through her tremors she asks if it’s a boy or girl, and lets out a small wail when she hears “girl.” In most of Tajikistan, people are excited by all children and most families want girls as much as they want boys.

But in Gharm boys are a much more important commodity and a young daughter-in-law’s status is precarious until she’s had a boy. With a second girl Nodira has deeply displeased her husband’s family. The doctor looks at her kindly and says “girls are gifts from God too, you know.” I want to hug her and strangle her at the same time, but I’m still holding Nodira’s hand.

The placenta is easily delivered but then there is a tear to be sewn up. A struggle ensues between the wildly panicking Nodira, who bucks and shakes as though she wants to crawl right out of the bed and into the sky, and the determined doctor, who is going to give her stitches. I can’t watch. I can’t listen. I walk back over to my notebook and pick it up. Put it down again. It’s all over soon.

Nodira’s friend asks if they can put a jacket on her. It’s almost as lovely as her kurta dress – I guess they are the finest things she owns, gifts from the birth of her first child. She is covered up and turns her head on the pillow, closing her eyes as if to sleep.

I realize that everyone is leaving the room. The midwife is already gone, monitoring some of the other women in labor. The sanitation worker has finished mopping the floor and left as well. The doctor looks at me, that familiar look telling me I’m doing something strange again, and says “let’s go have some tea.”
I glance at the baby, lying on the table a good ten feet from her mother, and back to the doctor. “Come on. It’s tea time.”

You don’t disagree with your elders. I go.

That was my Tajik birth. I was invited to another later that day, but the woman was Kyrgyz so I couldn’t communicate with her and she seemed uncomfortable with my presence. Still feeling conflicted about my role in the earlier birth, I bowed out. And then the KGB kicked me out of town and there was no way for me to see more.

I don’t want to give an unfair representation of this clinic. Most births in that region take place at home, though home birth is technically illegal. Births in the clinic are the worst cases – often women who’ve been brought in from hours away on donkey back and near to death.

Hemorrhaging and pregnancy induced hypertension were high. And yet the doctor and her team did the best they could for women every day with the skills and training they had. And they were kind enough to let me hang around observing and asking questions.

All the births I’ve attended sneak up on me sometimes. I’ll suddenly stray into a memory of a mother’s breathing, or relive the moment she truly accessed her inner force. But this birth is with me even more. It stalks me, calling me back. Calling me to midwifery training and then to organizations which improve birth practices in Central Asia.

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Birth Around the World: My Alien Baby

Inspired by Brieanne's story of giving birth at night to the sound of coyotes, Anna wrote a generational saga of two births – her own arrival in Azerbaijan, and her daughter's birth in the USA. Anna has been a blog reader for several years. She wrote to me:

Your blog was my gateway to the birthing blog world. Ten months ago, I gave birth to a baby girl in a homebirth-turned-unplanned c-section. I was so excited about birthing my baby at home. The c-section was incredibly traumatic. I have been working on recovery since the birth. As my daughter's first birthday approached, I felt a more urgent need to heal spiritually from her birth.

Writing the story has helped enormously – writing down my anger at God for letting this happen to me has allowing me to slowly let go and grow in my compassion.

Besides writing the story, I have been working on several writing projects, including my blog. In one way or another the majority of my writing is prayer for my daughter. Her soul was unable to enter this world peacefully, writing for her, addressing my writing to her in the final sentence is my way of sending her divine peace.

Writing is my prayer.

Anna blogs about faith, feminism, and spirituality at Sotah.

*****

My Alien Baby

I believe that is possible to birth yourself.

That I can get down on all fours, open my womb, and emerge from within – whole.

My mother birthed me in a small hospital in Baku, Azerbaijan, a hospital that by all accounts (and by all accounts I mean my mother’s account) was a third world shithole. She was there for three weeks before my birth in a high risk ward, because I was Rh+ and she was Rh-, a potentially fatal mix without a RhoGAM injection. Though it had been available in the west as a routine matter for women at risk since 1968, it was not available in the Soviet Union, even in 1984. Ten thousand babies a year are saved by a RhoGAM injection to the mother. This terrible combination of lacking the real cure, RhoGAM, and still attempting to be helpful overtook the medical establishment. And so, listening to the advice of her doctors, my mom checked herself into a hospital a week before she was due and spent the next three weeks living in a room with a dozen high risk women, whose babies, generally, did not make it. Three weeks of the dead baby parade – followed by labor, alone. Visitors wore not allowed in soviet maternity wards. My mother is laboring alone with her first (and only) baby, knowing little about birth. She has never been to a birth or seen a video of a birthing woman. There were no birthing classes for her to attend.

On the shores of the Black Sea, in the small town of Sudak, Ukraine, a radical apprentice trained midwife, Elena Tonetti-Vladimirova, is running birthing camps where hundreds of women are coming to birth in the sea’s shallow lagoons with the dolphins. There is available footage of eleven of these births in a documentary called Birth as We Know It. These images are alive. I am wet with the ocean water. Elena talks about the spiraling motion of galaxies and of our hips: they are the same.

I am born in the hospital, finally. We are drugged and I am sluggish in the birth canal. The doctors cut an episiotomy. It will be stitched up without drugs – female genital mutilation. I was born after six hours of labor, a short labor for a first birth. No one ever asked my mother to draw her birth energy with washable crayons on white poster-paper, such things did not exist for her in Azerbaijan, and yet there was Sudak and the dolphins.

Three days after my birth and after bribing a nurse, she was finally able to see me. Another woman was breastfeeding me for those three days. Was I lying there, mostly alone, for my first three days? I feel petty wondering how this birth affected me – how I might have been different if I was born into the sea. If my mother welcomed me on to this good earth and laid me on her chest and snuggled my gooey, vernix covered, unfurled newborn body? Would I then have peace?

My mother told me the story of my birth many times – I have always known this story. It is a sad story of the pathologizing of birth. It is a typical story of modernity gone wrong – characterized by an authoritarian imposition of power acting upon the most vulnerable, a laboring woman and her infant.

I need a radically different story to tell the un-born creature; to tell myself. In the Torah, the Hebrew Bible, characters are constantly rebirthing themselves in new stories. Each new story is a tikkun, a metaphysical and proverbial fixing of the story that came before, a rebirthing of itself. I want a tikkun for myself and for Eve, who was cursed to bear children in pain. In an inflatable kiddy pool, decorated with fish drawings, on the second floor of my DC apartment, I would undo Eve's curse with my very own birth. There would be no dolphins and no black sea, only my inflatable pool where I would know God in the moment of her birth – a creature emerging from between my legs. Z, welcome to the good earth.

*****

At five am, when I get out of bed to pee, my water breaks like it does in the movies. Many women labor the entire time with their amniotic sac intact, only to have it break at the very end. Some women's water never breaks - the baby is born in caul; this is auspicious. Babies born this way are believed to have shamanic powers in some cultures, including in medieval Europe. My water just burst open, gushing down my legs. It bursts clear and beautiful. I cannot feel any contractions. And as the amniotic fluid continued to leak out, the color changes from clear to yellow to green. Meconium

It is a sign of fetal distress – routine in late stages of labor, but abnormal at the start. My midwife arrives and I know what she is going to say – hospital. I did not pack a hospital bag. I bought home birth supplies instead; gloves, gauze, wash clothes, dozens of receiving blankets in a warmer, mesh underwear, chuck pads, plastic sheets and umbilical tape. I spent the previous week trying to make sure I had the right connector from the water hose to the sink, so the inflatable pool could be filled. I did not pack a hospital bag.

I mourn the birth I will not have – the peaceful, undisturbed birth in the dark, on my knees. The earth, the Universe, God, all of you, how can you let this happen to me? I am so sad. I cry for the next four days – I cry till I am finally home, and then I cry some more. I can barely walk around the block. I am scared to shower alone. I cannot lift my baby from her bassinet – it’s too deep. I go to a shrink and she tells me that I am turning birth into a contest, that it is not my fault. I never go to her again. I don’t blame myself – I blame God. Hospital-pitocin-epidural-csection-hospital-potocin-epidural-csection-hospital-pitocin-epidural-csection. I was going to be a mystic, a seer, a conduit for the energy of the earth, spiraling my hips like the galaxies: I wanted to be a birthing woman.

I read a story of a woman giving birth, squatting on the cold hard earth, howling with the coyotes. I wanted to howl with the coyotes and dance with the moon. I wanted Z's birth to be the exact opposite of my own – no fear, no pathology, no suffering. I dreamt of my birth, imagining the opening of my womb – until she and I emerged on the other end. I was thrilled that Z was female, perhaps, one day she might find herself dreaming like this – dreaming of her own birth.

This was not my way – not this time.

Z was born in the hospital operating room. The operating rooms are insanely cold (for the prevention of infection they told me). I was shivering on the operating table, warming blankets all over the body parts I could feel, mostly my arms and neck. There was no way Z could stay in that room for more than a moment, wet and new, simply because it was far too cold for her. She screamed when she was born – the TV scream, loud and distraught. I held her three hours later – after she was cleaned and the IV port was inserted. She was wrapped in the blue and pink stripped blankets – appropriate for both females and males. I saw the babies in the nursery wrapped in the special blankets their parents brought – we did not think of bringing any special blankets. When the nurses brought her, I read the number from my hospital bracelet, and then they give her to me. My baby.

Maybe Z is an alien. C-sections are really an alien invasion, where our human babies are being taken by the aliens, and they are sending instead little aliens, disguised as babies to study us. Z is sending back messages to her home planet, I hope she likes us and we will be spared when the invasion comes.

I am sad because I did not see her emerge from between my legs. It disconnects me from my body, leaving me wanting for prophecy and vernix; for words, for my placenta, which I did not make prints from. The prints I have seen look like trees. I never saw my placenta. Was it more like a maple or a spruce?

My first nurse after surgery was wearing a gorgeous cap – brightly colored, absolutely fantastic. I love nurses who accessorize their uniforms. She had three c-sections. She tried to birth her first two babies; with the third she scheduled the c-section from the start. Michelle Dugger, a mother of 19 children with a show on TLC, had twelve children vaginally after a c-section. Did she howl with the coyotes when she opened again during the birth of her eighteenth baby? Do her hips spiral with the energy of galaxies? Her nineteenth baby was a preemie and a c-section. She was due the same week as Z, but born over two month earlier. Z and Josie Brooklyn are the same real age – both aliens.

The c-section scar is surprisingly small, a thin line only three inches long. The doctors put their hands in this small wound took out my baby, feeling good about themselves. A textbook c-section and healthy baby. The doctors do not know what I am mourning for. I wanted to birth us both, on my knees on the dirt, howling at the moon with the coyotes, and swimming in the sea with the dolphins in my DC apartment. Would the doctors be sad if they knew?

Z, my c-section alien baby, happy birthday – welcome to this good earth.

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Birth Around the World: Mother Health International in Haiti

On the anniversary of the terrible earthquake in Haiti that took so many lives, I want to highlight a non-profit organization dedicated to improving maternal and child health in Haiti. Mother Health International was founded a year ago today to "respond and provide relief to pregnant women and children in areas of disaster and extreme poverty." It is run by a volunteer medical advisory board of CNMs, CPMs, OBs, and NDs.

Mother and baby at MHI

From the MHI mission statement:

We are committed to reducing the maternal and infant mortality rates by creating healthy, sustainable holistic birth clinics using the midwifery model of care with culturally appropriate, education for the health and empowerment of women. With every healthy birth there is a positive benefit for the communities that we serve and the world as a whole. Our ultimate mission is to empower and educate the local clinic staff, with gender equality, to become the health care providers for their community.

I wrote to Heather L. Maurer, Co-Founder and Executive Director, for more information about her organization. Here is a brief history of MHI:

Located in the country’s southern coast, Jacmel suffered extensive causalities as well as was left littered with crumbled buildings and destruction after the January 12, 7.0 earth quake. MHI founding members were part of a first responder team of seven medics, midwives and support staff, originally affiliated with Bumi Sehat International Foundation, who traveled to Jacmel, Haiti on January 28, 2010 via Santa Domingo, DR to offer disaster relief to women and children. With the help from private donations, NGO’s, nonprofit organizations and government organizations, the team was able to provide emergency medical aid, water and food to the women and children who survived the earthquake.

Shortly after arriving in Jacmel, the founders of MHI recognized the greater need beyond disaster and emergency aid and began the process to build a holistic birth clinic in the heart of one of the most under served areas in Jacmel, St. Helen Parish. On March 10, MHI officially opened our doors to pregnant women and started prenatal evaluations. A few weeks after the opening of the birth clinic, the first baby boy was born into the hands of a volunteer midwife, peacefully and healthy. Today over 400 babies have been born at our birth center and thousands of women have received prenatal visits. Midwives and OB/GYN’s come from around the world volunteer their time in the birth clinic. Our birth attendants are skilled at gentle birthing techniques intended to offer women a place of dignity in which to give birth, reduce pain, decrease interventions and cesarean sections. Our model of care incorporates traditional holistic midwifery care while respecting and embracing Haitian culture and customs.

Our plans are to build permanent structures to serve as our birth clinic and we are searching for a sponsor/donor. We are in immediate need for this as the demands are growing.

Mother Health International's birth clinic in Jacmel has seen over 425 births since its opening in March 2010. It is housed in a 44-foot diameter (1,500 square feet) dome from Pacific Domes. The birth center has 9 beds.

Interior of dome

Dome at night

I love reading the employees' and volunteers' stories of their time at MHI. To keep this post from running too long, I won't repost them all here. Please take the time to visit these links--I think you'll find them as inspiring as I have:

• A reflection from volunteer Melinda
• Meet Marie Antoinette Helen Jeune, Assistant Midwife at MHI
• Meet Ninotte Lubin-Assistant Midwife, Administrator
• Judith Baptist-HIV Counselor
• Sheline Agella
• Clare Loprinzi: Haitian women move with strength and grace
• Tata's Story
• Meet Nadege Medee-Another MHI team member
• Meet Shela Barthelemy-Student Midwife

For a feel of what it's like to give birth at the MHI clinic, read Imaccula's birth story or the story of MHI's first set of twins. You can learn more about MHI at their website, blog, and Facebook page.

Eloufeine traveled 2 hours to birth at the MHI clinic.

If you like what MHI is doing, please consider donating to help keep the clinic operating. All money donated to MHI goes directly to maintain and sustain the birth clinic in Haiti; board members and directors work on a volunteer basis.

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Birth Around the World: European Court of Human Rights rules home birth legal in Hungary

From The Wall Street Journal blogs: European Court Makes Home Birth Legal in Hungary

Last year, Budapest resident Anna Ternovszky was looking forward to giving birth to her second child at home. Like elsewhere in the world, Hungarian women can be discouraged by the unfriendly sterility of hospitals and like the idea of their children arriving into a warm, welcoming home environment instead.

Ms. Ternovszky soon realized, however, that in Hungary a hospital birth was her only option as any doctor who would have assisted her with home birth risked facing criminal charges. She turned to the European Court of Human Rights in Strasbourg, which last week ruled that Hungarian women must be allowed to give birth at home if they choose to....

In its ruling, the Strasbourg court said that the Hungarian state was violating the right to respect private life guaranteed by the European Convention on Human Rights. This right encompasses the right to choose the circumstances of giving birth, the court said.

A basic human right in the rest of central and eastern Europe, home birth is thus getting the green light in Hungary. Hungarian legislation seems to be catching up: the Ministry of National Resources — and the state secretary responsible for health issues within the ministry — prepared and published Monday a long-awaited set of draft regulations for births outside health institutions.

From the Hungarian Civil Liberties Union: Victory in Strasbourg for the cause of home birth!

Today, the European Court of Human Rights in Strasbourg handed down a judgment in which it holds that the Hungarian state has violated the “right to respect for private life” guaranteed by the European Convention on Human Rights.

Exactly one year ago today, a pregnant Hungarian woman applied to the European Court of Human Rights. In her claim, the complainant alleged that the Hungarian state had violated her right to the respect of her private life by threatening midwives with sanctions and thus effectively preventing her from choosing to give birth at home. The complainant was represented by the HCLU’s attorney, Dr. Tamás Fazekas.

In its decision announced on 14 December 2010, the Court, in a decision of 6 against 1, held that the failure of the Hungarian state to regulate the issue results in a violation of the right to privacy guaranteed by Article 8 of the European Convention on Human Rights. A joint concurring judgment was submitted by Judges Sajó and Tulkens, while Judge Popovic wrote a dissenting opinion.

(1) The Court held that the right to respect for private life includes the right to choose the circumstances of birth.

(2) The Judges argued that the section of the Government Decree that imposes fines on midwives assisting at home births constitutes an interference in the exercise of the rights of the complainant and of similarly situated pregnant mothers.

(3) According to the Court’s opinion, the threat of sanctions – along with the absence of a specialised, comprehensive regulation in this area – are detrimental to the complainant’s ability to choose home birth. This in turn constitutes a violation of the legal security for the exercise of privacy rights, and in particular, violates the principle of legal certainty.

“We find this judgment to be very important”, stated Dr. Tamás Fazekas, attorney for HCLU, “because this means that, so long as Hungary fails to enact legislation regulating home birth, and so long as professionals assisting at out-of-institution births are unable to obtain a license for their work, Hungary is in violation of the European Convention on Human Rights”.

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Birth Around the World: A Tale of Two Births in Canada

Joanne is a software engineer in Ontario, Canada. Her first child was born in 2007 at Kitchener Ontario's Grand River Hospital, which sees about 4,000 births per year. She chose a midwife-attended homebirth in 2010. This post is lengthy, but it’s really two birth stories in one! It shows two contrasting styles of maternity care available in present-day Canada.

When I became pregnant with my first child in 2007, I had no reasons to distrust the latest technology and knowledge of the Western medical establishment. My family doctor referred me to an obstetrician, who are in short supply in my area, so I “got who I got.” My pregnancy was highly normal and my care was fine (sparse but sufficient) up until the time my due date came and passed, and I waited... waited... waited to go into labour. My OB scheduled me for an induction at +10 days (a Friday--coincidence?) without discussion. I was worried about how I’d be able to handle an induced labour and thus mentally felt increasingly desperate as the fateful day approached.

The night before, I awoke with increasingly strong and regular contractions which I was pretty sure was finally it. When I arrived at hospital the next morning on schedule, the nurses confirmed I was 4 cm dilated and cleared me for continuing since I was in labour already. At noon my OB showed up and was quite annoyed with the nurses (and me) for not following his induction orders.

"We've got to get this baby out now."

"Why?"

"Because it's been long enough."

"I'm concerned about the pain with Pitocin contractions."

"It's called LABOUR for a reason; it's going to be painful. Look, you don't have to do it but I highly recommend it."

Seeing as I was contracting strongly, in pain, I wasn't expecting this, and I didn't have experience going against my primary care provider, I reluctantly agreed to let him break my water and start the Pitocin drip. Of course then I required continuous fetal monitoring, which made every little movement quite an event. The contractions quickly grew stronger, stronger, and more painful. I lasted another 4 hours and with such pain, the tension in my body hadn't actually let me progress past 4 cm. Discouraged, I agreed to an epidural. Admittedly it was a tremendous relief and I wanted to hug the anesthesiologist. Now that I could relax some, I actually progressed to 10 cm in a couple of hours. I also found out something I didn't know about epidurals--i.e. they don't provide total pain relief, at least not for me. Much of the time I could feel most of one side of my body, and the nurse would regularly have to call for permission to top it up.

Naturally I was confined to the bed, so I couldn't move around to deal with the pain. So pushing HURT. I was a good pusher and the baby descended steadily. At some point, the head nurse came in to say "she's got to stop pushing." It turns out (since it was now Friday evening) there was only one OB on the floor and she was busy performing an emergency C-section. And of course, my baby couldn't be born without a doc present. So they turned the Pitocin and lights off and rolled me on my side. What utter agony--I thought my body was going to push out the baby whether we were ready or not!!

There was some meconium in the fluid by this point (likely from the stress) although we could "hear" on the fetal monitor that baby's heartbeat was still reacting well. I was whimpering and at this point my partner secretly believed I was headed for a C-section too. He whispered to me "think of the other family" and I tried to. But eventually the OB and staff appeared, and another 2 pushes, and Alice was out. What relief--I simply cried tears of joy and relief.

The pediatrics team pumped the meconium out of baby’s stomach and luckily she was fine to stay in the room with me. So, in the end, despite all the "help" from the medical establishment, my body did what it was supposed to and I pushed my baby out. Looking back now, I realize I was probably lucky: this combination of Pitocin, epidural, and baby-stress can doom many a woman to an unwanted C-section.

I learned a few more things. I bled heavily after this birth and became anemic.... I learned later this can be a side effect of all the interventions. My tear/episiotomy site became infected, and I can’t rule out the possibility that the cause was from being in a hospital. But: my birth went well, didn't it? I had a healthy 8 lb. 10 oz. baby, delivered vaginally, no NICU visit, and all the nurses were really nice and helpful with breastfeeding. So, I should be satisfied, right? Right?? I had myself convinced for a while.

When I became pregnant with my second child I knew I wanted to try something different for care, so I called a local office of registered midwives. At first, I assumed I would go to the hospital again for delivery because that was just what people did. After processing some of the materials in the lending library, to our surprise, my partner and I independently came to the conclusion that we wanted to try a homebirth. Some of the stories about actively-managed labour with OBs in a hospital setting were simply eye-opening--this is exactly what had happened to us!! I don't know if we would have believed them had we not gone through the experience, but we had. So all of a sudden we were committed to a different kind of birth.

homebirth by reading what natural childbirth subjectively feels like. All these stories, including Rixa’s own birth stories, helped me overcome the knowledge deficit and gain confidence in my body's own ability to give birth naturally. I drank these up in my quest to "reverse" society's notion that childbirth is necessarily a medical event to be managed medically.

So, my second due date came and went with no baby in sight. Even with a midwife supportive of natural birth at home, her guidelines dictate repeated non-stress tests and ultrasounds to check on an overdue baby, as well as a "plan" for what would happen should two weeks past due date come and go. I was starting to feel increasingly desperate again as I saw my dream for a simple homebirth, at risk.

But, eventually at +10 days (again) those pesky prodromal labour contractions finally (finally!) became strong and regular enough to push out my baby. I laboured quietly at night in my bed from 2:00-6:00 a.m. which was nice actually--I could relax sleepily between contractions, which I knew was important for dilation. It was just so great knowing I didn't have to deal with going anywhere. By 6:00 am contractions were too difficult to lay through so I woke up my partner and told him it was time to call our midwife. She took her time getting ready and arrived at 8:30 am to find me 6-7 cm dilated ("and your body did it all on its own," she encouraged me). I was anxiously awaiting her arrival so I could get in the bath tub, post cervix check, for a change of pace.

I laboured alone as the others got the bed ready and brought in all the midwife's equipment. I got on all fours for each contraction (couldn't have done that in the hospital!) and actually found a semi-sitting position that was comfortable for relaxing in between. (I found that was key for me in both labours--I felt a lot of pain in between contractions if I couldn't find a good resting position, and those were elusive.)

I was off in labourland when Nicole came rushing in with "do you feel like you need to push?" Apparently my vocalizations had changed to what they often sound like when the baby is descending during second stage. It was all involuntary, which was awesome--my body was doing it all and I was just along for the ride!! My water spontaneously broke with thankfully only a bit of vernix to see. After 2-3 pushes on my hands and knees (still in the tub--not my midwife's idea of a convenient position but I wasn't willing to move anywhere!), Claire was born, nuchal hand and all. Finally I understood what I had read about it being a relief to push--on my hands and knees, it did feel better to push, almost like applying counterpressure to the contraction. (This was a definite contrast from being confined on my back in the hospital.) I didn't feel a ring of fire or any tearing, although I did receive a second-degree tear again. In fact, comparing the two births, I would say the pain levels were similar, although the first one was with an epidural and the second was obviously much shorter in duration.

It was 9:30 a.m. by this point--all the birthing and emergency equipment was barely in from the car and the backup midwives hadn't even had time to arrive yet. The tub had had to be drained (since it wasn't deep enough for a water birth, unplanned anyway) so I knelt on the floor of the empty wet tub, clutching my slippery newborn. I couldn't believe it had really happened!! A birth at home, just the way we had planned. I cut the cord myself.

Out of the tub and back to the bed for the delivery of the placenta, stitches, and initiating breastfeeding. Another healthy girl, 8 lbs 11 oz. So THAT is what birth is supposed to be like! What a privilege to have been able to experience a safe, natural childbirth at home. This is an experience I would wish for more women. It was so perfect and meaningful and to this day it’s still hard to believe it actually happened all the way we planned!! It was an empowering achievement in the way that my first birth, amazing in its own way since it was my first, just wasn't.

So yes, I join the ranks of moms who had one undesirable hospital birth experience and, as a result, experienced a beautiful homebirth subsequently. 2-5+ years ago, I would have never believed I’d be one of these women!! I try to not be judgmental of other people's birth choices, but now I encourage others to at least call a midwife early in their pregnancy to give themselves some birth choices. I remember my grad school supervisor telling me that if you knew at the beginning what you had learned by the end, it wouldn’t have been a learning and growing journey.... It’s not an end by any means, but the beginning to parenting my two girls!

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Birth Around the World: Training Medics in Burma

One of the midwife blogs I follow is Missionary Midwife Mama. She lives in Thailand and is a mother of four. She occasionally travels to other parts of the world doing midwifery training & clinicals. She recently came back from training medics in Burma. Here is her account:

I was able to teach for about 4 days. We started out by taking a survey of all the local birth practices and labeled them as "helpful" "harmless" or "harmful." I learned so much about this that I am considering writing an article about it for Midwifery Today. The next classes were about taking a prenatal history, doing a basic prenatal exam, the stages of labor, hemorrhage, breast exam, breastfeeding (importance of colostrum; not how, but dealing with mastitis, etc.), fertility awareness method (some access to condoms but not much else), and cord burning.

There were 2 main things that I emphasized through out. First, that what I was teaching was practical for attending births in the jungle. They had been taught some about birth already but so much of it was over-medicalized and appropriate only for hospital. For example, how can someone go in and teach about a "managed 3rd stage" when there is NO PITOCIN AVAILABLE. Or how can someone teach about cutting a cord when there is NOTHING CLEAN to cut it with?? I know these medics will be getting all kinds of information, a lot not evidence-based, and not practical for birthing. Hopefully what I taught will make them think and know that they have other options. Dealing with hemorrhage with only having been taught what to do using pharmaceuticals is dangerous... they needed other options, which I gave.

The second thing I emphasized was working with TBAs (Traditional Birth Attendants). I started by asking a question: "who knows more about birth? TBAs or medics?" They all answered: MEDICS. And so I said, "Oh really? If you have seen 5 births, and a TBA has seen 200 births, who knows more about birth?" Lightbulb moments for all of them, and this opened up a discussion. The medics cannot be at every birth all over their area of northern B-Land. TBAs will continue to be the main source of birth attendants. By working together, they can teach each other. The medics can learn more about normal birth and complications from TBAs while the TBAs can learn about some complications and sanitary birth from the medics.

You can read more on her original post Beautiful B...urm...a. She has several pictures up there as well. I'll just share the best one--a wooden delivery table. Doesn't that look comfy? She wrote about the picture: "The ... birth... bed.... (we had long discussions about this one and we all agreed the floor with a clean mat was a way better option!)"

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Birth Around the World: Birth at 37,000 feet

Earlier this month, a woman gave birth on a Korean Airlines flight headed for the Philippines. Talk about a birth around the world--literally! Fortunately, CPM Vicki Penwell was on the flight and lent her assistance.

I contacted Vicki to see if I could repost her story and feature her non-profit organization Mercy in Action. She graciously agreed. Here is more information about Mercy in Action:

Mercy in Action is a non-profit organization that focuses on the crisis in Maternal/Newborn/Child health care worldwide. We have been establishing and funding free birth centers for poor families in the Philippines since 1992, and to date more than 12,000 babies have been delivered free of charge for the poorest of the poor in Mercy In Action's Birth Centers, and literally tens of thousands of lives have been helped and healed in the medical outreaches.

Mercy in Action also trains midwives, nurses, medics, and support personnel, helping "provide compassionate health care throughout the developing world." As the Christmas season approaches, you might consider donating to Mercy in Action. I feel humbled at the incredible service this and other organizations (such as MamaBaby Haiti) are providing to women and babies around the world.

Here's Vicki's story of the birth at 37,000 feet:

~~~~~

Korean Airlines Flight #12 on November 15, 2010 took off from LAX on time with Scott [Vicki's husband] and I on-board, en route to Manila to start a new charity maternity clinic for the poor. We scored the exit row seats in economy, so had plenty of leg room and slept for a few hours.

When I woke up about 6 hours into the flight, I noticed a flight attendant was bringing a woman to the jump seat in front of us, and she was sitting like she was in pain. My subconscious brain immediately recognized the unique type of squirming and sideways twisting that I had seen thousands of times...but my conscious brain said "no, people don't go into labor on airplanes except in the movies!" and anyway, in the dark I could not even tell if she was pregnant. But being medically trained in emergency and primary care as well as being a midwife, and being a generally helpful person, I got up and approached the scene to see if I could lend assistance.

A short history revealed that the woman (a Korean citizen named Jannie, who lived in Los Angles) had boarded the plane feeling fine but had been having stomach pains the past 4 hours, and had just gone to the bathroom and discovered she was bleeding. This was her third baby, due Jan 1. Her squirming had now turned into low moaning as well, and the steward looked terribly uncomfortable, unsure of what to do. He helpfully approached her with an oxygen mask, which is what you do for heart attacks, but was not much help for this situation. I told the steward we needed to get her to a private place, that she was going to deliver. He looked shocked and in denial and so did the woman. I insisted he think of a plan for a private place...perhaps clear out the back row of seats?

Finally making up his mind, the steward turned and led the way, so we walked forward, me supporting the laboring woman, all the way through the plane to the very front (the part I had never seen) where the first class passengers live in a world apart. It was like a small apartment, with wide seats that made into fully reclining beds, and very wide isles. We got the woman situated on a makeshift bed. By now she was really in hard labor. The steward in charge came up and demanded some medical ID from me, which Scott produced out of my handbag. It was pretty obvious the word "midwife" did not register with them. They were scared, understandably; they called on the intercom for any other medical assistance, and a Korean cardiologist came forward. However, since delivering babies was not in his scope of practice, he deferred to me and seemed very relieved at my answers to all his questions: "Had I done this before, because he had not"..."Yes," I said, "over 2,500 deliveries"..."Did I know how to resuscitate a baby?"..."Yes, I am trained in Neonatal Resuscitation"..."Did I know how to stop bleeding if she hemorrhaged?"..."Yes," ...and on and on.

The woman's water broke with a splash at this point, and discussion ceased. They all agreed I was in charge and they seemed very happy for it. The stewardesses tripped over each other each time I would ask for something, and rounded up every bit of medical supplies they had on the plane, though most were for heart attack emergencies. Since by dates the baby would be 6 weeks premature, I asked for lots of blankets, and told everyone we would be doing kangaroo care, with the baby skin to skin on the mother covered by blankets after birth. Since the doctor was worried that we had no anti-hemorrhage drugs, I told them all we would use breastfeeding and massage to contract the uterus. Since we had no resuscitation equipment or suction, I figured out a plan how to do that if necessary with what we had on hand.

At the time of the birth, there were about 6 stewardesses up there helping, holding the woman's hands, wiping her brow, giving her sips of water through a straw. it was like a homebirth and they were all her sisters! Scott was standing at my shoulder to hand me the improvised items I had found to use for emergencies should I need it. Fortunately I did not.

Ten hours after take-off, and with 4 hours left to go before landing, a nice baby boy was born, and with a little stimulation he cried and pinked right up. The stewardesses clapped and laughed and cried. The Apgar score was 9/9, meaning he transitioned well to extra-uterine life at 37,000 feet! By exam the baby was 38 weeks, meaning her dates had been a month off and he was really full-term. The placenta came after about 45 minutes, and the baby began to nurse like a champ. Airline policy actually forbids cutting the cord after an in-flight birth, so that was great; I just wrapped it up in a first class linen napkin and tucked it in the blankets, preventing any chance of infection.

For the rest of the plane ride into Seoul, Scott and I sat up in first class and I monitored the mother and baby. It was a very joyful atmosphere. The mother was so thankful and happy, and appreciative, and so were all the airline personnel. Scott took a short video using his laptop computer after everything was cleaned up and the mom and baby were relaxing. (Click the link to watch a few seconds of post-birth video.)



An ambulance crew came on and got the mother and baby when we landed, and Korean airlines officials guided Scott and I personally to our next gate on to Manila, and changed our tickets to business class. The pilot himself on the Manila leg came back and said thank you for my help. It was pretty great, even though I landed in Manila exhausted with that unique feeling all midwives know of having been up all night at a birth, with jet-lag on top!

The really interesting thing is, a few days ago I was wondering why we had decided to leave the states a week before Thanksgiving holiday, and was pondering if we had made a mistake...now I see that God had a plan that I was to be on that particular airplane on that night...nothing happens by chance when our lives are totally given over to God to be used for His good purposes in the world. In mysterious ways He leads and directs our every step, and puts us in position to be helpful to those in need.

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