Before our arrival in Sukadana, I was (and still am!) curious about all we’d learn here. So far it’s been a grab bag of new knowledge – the challenges of treating TB patients, a crash course on reforestation techniques, how to cook super-moldy tempeh, the serious threats extractive forest uses pose to orangutans, how to entertain oneself with infrequent internet access.
Despite the variety of new information, I hadn’t considered that the basics of delivering a baby – and a few tips on what to do in emergencies – would be among my new (albeit very amateur and basic) skills when we leave Sukadana in a few weeks.
In a country with relatively few OB-GYNs and large percentages of the population living in remote regions far from medical centers, home births and deliveries in basic clinics are common. Lack of access to resources often makes safe and healthy deliveries difficult, resulting in an undesirably high infant and maternal mortality rate.United Nations Millennium Goals, Indonesia is committed to reducing maternal mortality – the UN seeks an ambitious three quarters reduction in the global maternal mortality rate. To meet the goal, Indonesia is making a push (ha!) to train many more midwives – some 13,000 new ones entered the fray just last year.
Since beginning this program, however, the rate of maternal deaths in Indonesia has actually increased. There’s no shortage of would-be midwives, but midwifery education here often lacks in quality and standardization.
ASRI volunteer Karen Ruby Brown, a midwife from San Diego, is helping to reverse the trend and hopes to work with health officials to develop a set of national midwifery curriculum.
A couple weeks ago, I tagged along to a midwife training in Teluk Batang, held in a breezy, wood-paneled room on the second-floor of a rural health center. We arrive with Karen’s bag of tricks in tow: fake (yet heavy and lifelike!) babies, a low-tech educational tool called ‘Mama Natalie’ that is easy to deploy in low-resource countries, and goodie bags filled with gloves, infant-sized breathing masks, scalpels, and clean towels.
About 15 midwives, ranging from teenaged students to wizened middle-aged women with decades of experience and dozens of stories to tell, line the bench seats. The day begins with a lengthy introduction by an administrator, the Indonesian national anthem and a song that, as far as I can tell, is an ode to women, and a coffee break that features garishly green cakes and rolls of sticky rice instead of coffee.
The women descend to the floor, crowding around Karen, who has donned her Mama Natalie suit. They follow her lead, role-playing how to treat asphyxia. As she demonstrates chest compressions and pumps air into the fake baby’s lungs, Karen reminds the group “The first minute of life is the golden minute. Don’t wait and watch for too long.”
We talk about the ergonomics of giving birth in a squatting position, a culturally-ingrained sort of body mechanics that has largely been lost on Western populations. Karen recommends that the midwives encourage their patients to “squat with spirit!”
For me, much of the afternoon session functions as birth control: there are videos of breech births gone wrong, a PowerPoint presentation on preeclampsia, a hands-on tutorial on removing torn placentas from uteri, and the danger of post-partum hemorrhage. Not-so-fun fact: every four minutes, a woman dies from post-partum hemorrhaging (worldwide).
On the way home, Karen laughs at my horrified reaction to the sometimes-grim realities of birth, but reassures me that delivery is often not a worst-case scenario. I’m slightly reassured a few days later, after she gives a crash course on ‘normal’ deliveries at the clinic.
Major takeaway? The miracle of birth, indeed.