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When

Pregnancy
Goes SOUTH:
Keeping Birth Gentle
by: Robin Lim

M
others, father, grandparents, causes our cells to obtain the nutrition we year, even though they are born in a coun-
midwives, nurses, doulas, doc- need when we eat, drink and live. try where there are more neonatal inten-
tors and concerned citizens are In 2012 I spoke at the Women Deliver sive care units than the 25 countries that
calling out for human rights in childbirth. Conference in Kuala Lumpur, Malaysia. have lower infant mortality rates (Haelle
Yet, this worldwide push is relatively small I was saddened as I listened and came to 2014; CDC 2014).
when we consider how many women, new- know that in a gathering of some 5000 Suffering in childbirth need not be
born babies and families are affected by birthkeepers, most were Ob/Gyns, few the norm, for without drugs and without
human rights infractions in childbirth. The were midwives and even fewer were doulas. medical interventions imposing iatrogenic
bullying of mothers and their families, just What I found there was that the reproduc- risks, healthy, well-supported women, car-
when they should be enjoying the miracle tive health agenda being promoted world- rying healthy babies, may make the pas-
of birth, is all too often, all over this world, wide, as it relates to birth, is a global push sage of childbirth with dignity, surrounded
accepted as the norm, as though wom- of childbirth into bigger, high-tech hos- by people of their choice, with joy, grace
en should suffer in childbirth. I cannot pitals and away from personal culturally and even pleasure. The gentle birth move-
imagine that our divine Creator meant for appropriate childbirth options, such as ment advocates for the basic human right
women to suffer. There is, in my experience homebirth and midwife-to-mother care. It of women to labor and deliver their own
of birthing five times and receiving thou- seems nearly no one in obstetrics is learn- babies with respect from their health care
sands of babies into the world, a big differ- ing from the problems the United States is providers, with support for their choices
ence between the challenging strength of having, as it becomes the country ranked and privacy. Furthermore, families and
childbirth contractions/waves/rushes and 60 in maternal mortality, though it spends wise health care providers are advocating
suffering. Suffering happens when mothers more money on childbirth technology than for the rights of babies to be handled in a
are not supported, not well nourished, not any other country in the world (Kassabaum way that does not impair their future health,
respected and not loved within the con- et al. 2013). Likewise for infants, birth in well-being, intelligence and longevity, i.e.,
text of pregnancy, birth and postpartum. the US is not always a safe journey. Babies delayed umbilical cord severance and skin-
Please remember: Love is the nutrient that born in the US die at a rate of 24,000 per to-skin uninterrupted contact with mother

14 Midwifery Today | midwiferytoday.com | Spring 2015 Photograph | Randy Verlie—mozzaphotography.com


following birth. Clearly, much of the trau- One would think that all mothers are Antiphospholipid syndrome (APS, also
ma experienced by mothers in childbirth willing to give up their plans for child- known as sticky blood syndrome). Her first
and babies at birth is preventable. birth without interventions should medical child, a daughter, had survived prematurity,
As a midwife, I find myself walking procedures become necessary for the baby spending six days in neonatal intensive care
the delicate line between completely advo- and/or mother’s safety and well-being. This and several weeks in a hospital nursery. This
cating and supporting every mother’s hu- does not mean the birth cannot be gentle mother had also suffered three miscarriag-
man right of choice in planning her baby’s and respectful. I have witnessed many nec- es. It was shocking to me that this mother
birth and needing to sometimes become essary, gentle, miraculous cesarean births. would still choose to travel in a developing
the “bad gal” when risks determine that a I wish for all cesarean mothers to know country when pregnant and in a high-risk
particular motherbaby must be referred for that birth is a miracle no matter how it situation. She was not on anti-coagulant
obstetrical care. happens. Cesarean mothers have faced medication and her Ob/Gyn in Australia
As a midwife, I do not often refer moth- the furthest reaches of modern science to had strongly recommended she not travel.
ers to obstetrical care, unless it really is bring their baby Earth-side. Sometimes I gently but firmly advised this mother
important to do so. Bumi Sehat Bali* has a cesarean birth is not necessary, but is to go home to Australia immediately, where
about a 2% rate of referral for cesarean imposed upon the mother. How can we she had access to excellent free First World
among mothers who begin labor with us. dare to judge unless we were there and care—a luxury most Indonesian families
Sometimes transport is really needed; other know all the facts? We cannot know for do not have. She had noticed reduced baby
times it is caused because of the national sure from afar whether the cesarean birth movements. Her blood pressure was quite
protocols we must adhere to in order to keep was necessary or not. Clearly, too many high, and she did not glow as pregnant
our licenses. Other times, transport hap- are done. But darn it—we need to support women usually do. Her mother said they
pens because of pressure from the extended our cesarean moms so they do not feel like were leaving in five days’ time, and the flight
family, especially when labor is long. This failures. I have sung Gayatri Mantra and home to her part of Australia was only 3.5
is cultural and cannot be avoided. We try Amazing Grace with the surgeon, anes- hours. I advised them to leave that very day
to support families to make wise decisions thesiologist, nurses and the mother during and go directly to the hospital from the
by keeping them informed of the mother cesarean births. I have assisted many times airport. The mother’s mother proclaimed
and baby’s health status throughout labor. as a doula at cesarean lotus births. There is they could not afford to change their tick-
Last night, our team of Bumi Sehat normally no reason to immediately clamp ets. To facilitate the return of this mother
midwives supported four birthing moth- and cut the baby’s umbilical cord, even if to her homeland, where very good medi-
erbabies. One was a VBAC, who was told the birth is by cesarean. Sadly, the hands cal care is available on the National Health
by doctors on two islands not to attempt of many caring, well-informed doctors System, I had a travel agent friend change
a natural birth. Our back-up Ob/Gyn ad- are tied to archaic or non-evidence-based their departure, so they could fly out that
vised her to try a natural birth at Bumi protocols by the hospitals they work in. evening without charge, on medical advice.
Sehat. Her birth was lovely, and her baby Four days later, this mother arrived at
girl was a good size—3.8 kg (about 8.4 lb). A Pregnancy That Went South dawn at my home in tears. “My baby did
Next we helped a first-time mother with Three years ago, a tragedy unfolded that I not move all night,” she sobbed. I bit my lip
no apparent risk factors; she also did very will never forget. A pregnant tourist came so I would not shout, “What are you still
well and birthed her baby boy in a side- to Bumi Sehat to say, “My baby is not mov- doing here in Bali?!” Instead I hugged her.
lying position. Another was a first-time ing.” We midwives were able to comfort her The baby was indeed dead—the mother’s
mother, who was told she must have an by giving her the joy of hearing the baby’s blood pressure was now 189/120! I went
elective cesarean birth because her eyesight normal heartbeat. The amniotic fluid was with her to the hospital in our ambulance.
is -7 (which is not really that bad, by the low and this mother’s blood pressure was I stayed for hours while they stabilized her
way) and a natural spontaneous vaginal 140/90, which she said was normal for her. BP. I helped her use my phone to call her
childbirth would pose a risk of retinal de- As we had never seen her before this visit husband in Australia. I stayed and held
tachment. Fortunately, this young mother at 30 weeks’ gestation, we could not know her through the cesarean birth/death. Our
did her research and found no reason for what normal was for this mother. My heart Bumi Sehat team arranged the cremation
her to elect cesarean to preserve her eyes**. felt heavy and I sat with this second-time and made the proper traditional Balinese
This young mother’s birth was glorious as mother and her mom. They had come on offerings for baby James. Because they did
she squatted in the water tub, singing. The a mother-daughter vacation to get to know not have enough money, I paid their hos-
next mother to birth was a second-time one another, as they had been separated for pital bill and funeral expenses—a consid-
mom, who was quite malnourished, but most of their lives. I became very alarmed erable amount—which they promised to
showed good lab results. She did have a when this raven-haired beauty shared with pay back, and never did.
mild shoulder dystocia, which was resolved me that her first baby was born by emergen- The bereaved father yelled at me over
by the Gaskin (hands-and-knees) maneu- cy cesarean three years earlier due to fetal the phone saying I should have forced his
ver. She lost 450 cc of blood, which is not distress—a situation similar to what she was wife to go home earlier so they could be
unusual given the normal Indonesian diet feeling now with less and less frequent baby together through this ordeal. I was kind;
of white rice and GMO soy tempeh. movements! She had been diagnosed with I was firm. My advice was not received

Spring 2015 | midwiferytoday.com | Midwifery Today 15


or followed. This family actually believes A Pregnancy Well Saved Given the stress the mother was under, it
that I failed them. Three years later, I ad- Tomorrow at dawn I will be arriving at the was not a surprise that the mother’s blood
mit, I am still doing the mental/emotional hospital to support a gentle, necessary ce- pressure was climbing. Her platelets were
postmortem. sarean birth. The mother planned well her climbing high above normal. Hospital food
We hear stories in social media about home delivery. However, at 37 weeks ges- in Indonesia is far from healthy, but her hus-
mothers being forced to have a cesarean tation, she lost her amniotic fluid; in fact, band and friends were bringing her healthy
birth. We shudder to imagine how hard there were zero pockets of fluid to cushion food, so diet alone could not explain why
this must be for any mother and her fam- the footling breech baby with a double, tight +2 protein was found in her urine with high
ily. We are beginning to understand the nuchal cord. This motherbaby’s amniotic levels of leukocytes.
unseen risks of cesarean. Films like Micro- fluid had not released; it had just disap- Imagine how shattered this mother was
Birth are helping disperse this information. peared. When this mother came to me for as her dream of a completely gentle, hands-
However, I know I will make no friends by an external version, I put my hands on her off homebirth slid away. As a birthkeeper,
asking this question: “What if the mother’s belly and shuddered. The baby seemed to midwife and doula, I was frustrated for
choices really do endanger herself and/or shout: “Be careful!” As much as I don’t like this mom who had done everything “right.”
her baby? What happens in the context of the misuse and overuse of ultrasound, in this Having a breech baby was not the reason
human rights in childbirth then?” When case I wisely applied science to give us clear that she ended up in the hospital facing a
a mother brags to me that she is 17 weeks guidance. In this case, it was the midwife cesarean birth. Heaven knows that the di-
pregnant and has just completed her sec- calling the Ob/Gyn to say, “We have some sasters I attend as a midwife have me han-
ond ten-day water fast! How should I re- risks here; we need to pay special attention dling breech birth a lot, because when the
act? Who speaks for the baby? Do I, as a to this motherbaby.” Our first attempt to world goes topsy-turvy, so do the babies. I
midwife, have any right to protest? How solve the zero amniotic fluid issue was to don’t love breech birth, but I do it as long as
do I handle the fact that this mother has encourage hydration via drinking plus acu- I feel I am not endangering the baby. Some-
every intention of delivering her baby at puncture, herbs, homeopathy and improved times I do it because the mother arrives at
our free-standing birth center? And how nutrition. We began immediately with the our disaster relief camp in the Philippines
do I sleep at night when accused of being help of the expert practitioners of holistic with a foot protruding from her vagina, and
a “bully” because she will not adhere to a medicine that share our work at Bumi Se- I have no choice but to be calm and gentle
reasonable diet in pregnancy, and as her hat. Everything helped for a day, but the and employ the skills I have learned about
health and the baby’s health deteriorate, next day the baby was again without fluid. receiving the breech.
I want to risk her out? The nine Balinese We closely monitored and found the baby’s Wayanik’s situation, as described above,
midwives who work with me worry that movements were deteriorating and the heart became a beautiful dance of risk reduction
if something goes wrong, we will all lose rate was slowing. The next intervention was made possible because the mother listened
our ijin praktek (license to practice). hospitalization and IV fluids. Things began to my advice and followed it. It was also
My question as a birthkeeper is: “How to look brighter when fluid pockets were ac- possible due to my trusting and respectful
do I balance prenatal care with prenatal tually found in the womb with baby. How- relationship with Dr. Hariyasa and other
scare, when pregnancy goes south and be- ever, the next day there was less fluid, and Ob/Gyns in Bali. These quality professional
comes high risk?” the following day nearly no fluid was found. and egalitarian relationships between mid-
wives, the guardians of normal birth, and
Ob/Gyns, the angels of intervention, can

In His Hands
be lifesaving. I encourage all birthkeepers
to work in harmony together.
Wayanik’s baby boy was born by neces-
sary cesarean. Dr. Hariyasa did not clamp
or cut the umbilical cord. The reluctant but
openhearted pediatrician allowed me to
keep the cord intact for 20 minutes follow-
We provide birth supplies to Midwives, Birth Centers, Doulas ing the cesarean. A nurse tried to scrape the
abundant vernix off of the slightly prema-
& Expectant Parents across the United States. We strive to
ture baby’s skin while the pediatrician was
have the lowest prices and a high level of customer service. worrying about hypothermia. I stopped the
Please visit our website to shop our wide array of nurse from scraping baby Putu and he was
midwifery supplies or contact us to set up your own put skin-to-skin with his mother in recov-
ery. I used a sterile gauze pad to swab the
custom birth kit. We look forward to serving you! mother’s vagina and placed that in baby’s
mouth to insure that even though he was
Follow us! cesarean born, he would have all the mi-
crobes if his mother’s vagina.

16 Midwifery Today | midwiferytoday.com | Spring 2015


I have said this many times, but it de-
serves to be said again. We birthkeepers
must stand on three strong feet to avoid
falling down: Respect for Mother Nature
and Father Time, good science employed
only when necessary and Adat, which is the
Balinese word for “spirit/tradition/faith” so
that we may be wise.
*To donate to the Bumi Sehat Foun-
dation, please visit bumisehatfoundation
.org. The organization is always in need of
funding, and with the incredible need they
face in their country, it is vital that readers
of Midwifery Today and others around the
globe give financially to keep the organi-
zation afloat.
**We concluded that prenatal treatment
of asymptomatic retinal pathology is not in-
dicated and that spontaneous vaginal deliv-
ery may be allowed to take place in women
with high-risk retinal pathology. (ncbi.nlm
.nih.gov/pubmed/8543212)

References:
Kassebaum, NJ, et al. 2014. “Global, Regional, and Na-
tional Levels and Causes of Maternal Mortality dur-
ing 1990–2013: A Systematic Analysis for the Global
Burden of Disease Study 2013.” Lancet 9947 (384):
980–1004.
Haelle, Tara. 2014. “US Infant Mortality Rate Worse
Than Other Countries.” CBSNews.com. Accessed
January 20, 2015. http://www.cbsnews.com/news/
u-s-infant-mortality-rate-worse-than-other-countries/.
CDC. 2014. “Infant Mortality.” Centers for Disease Control
and Prevention. Accessed January 20, 2015. cdc.gov/
reproductivehealth/MaternalInfantHealth/Infant
Mortality.htm.

Robin Lim was born in 1956 when


a Filipino-Chinese woman married
a German-Irish-Native American man. They
built a bridge of love across cultures at a
time when the world was not nearly ready
to accept the changes that love would
bring. Robin now lives in Indonesia where
she is called “Ibu Robin” (Mother Robin). Lim
is a certified professional midwife with the
North American Registry of Midwives and
Ikatan Bidan Indonesia. She devotes her
life to Yayasan Bumi Sehat, a not-for-profit
organization with clinics in Bali and Aceh. New data published in The Lancet (thelancet.com/journals/lancet/article/
In 2006 Ibu Robin received the Alexander PIIS0140-6736%2814%2960696-6/abstract) shows the US now ranks at #60
Langer Peace Award in Italy. In 2011 Lim in terms of maternal mortality, falling from our previous ranking of #50. The
was named CNN Hero of the Year for her rate of maternal deaths in the US is rising and more women are dying from
work in maternal and child health in Indo- pregnancy and childbirth-related causes now than they were in 2003. That in-
nesia and disaster zones. Currently Lim and
crease contrasts sharply with most other countries, including those in East Asia
the Bumi/Wadah Foundation have adopted
full responsibility for the Medical Relief and
and Latin America.
Childbirth Camp in Dulag, the heart of the The US is one of only eight countries where maternal deaths are rising
Philippine Disaster zone, where an average (everymothercounts.org/u-s-maternal-death-rate-is-rising/).
of 40 to 60 patients are seen per day and 2
to 7 babies are born in the tent each night.

Photograph | Randy Verlie—mozzaphotography.com Spring 2015 | midwiferytoday.com | Midwifery Today 17


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