Saturday, January 4, 2014

The Midwives of Angkor Watt

The Midwife at Angkor Watt

The women in the health centers here, as well in most colonized countries, give birth flat on their backs on small, metal tables.   They are free to walk around until they are ready to give birth and can often be seen outside or on porches with family and friends.  The delivery rooms are often very small and may lack privacy.  They climb on the table.  If they are ten and not pushing they are given some Pitocin and perhaps an episiotomy.   This is not very different from my own country’s hospitals except that the bed can go up and down and let the woman sit and she  will more than likely have an epidural as well and certainly is not allowed to walk around outside in labor. 

Once a woman has Pitocin in labor, both her and her baby are at increased risk for complications that have been well researched and documented.   Women bleed more, after the birth.  Babies do not come out breathing as well. They have more jaundice and thus more problems with breast-feeding.  Midwives, from experience, know that if a woman lies flat on her back the baby’s heart rate goes down.  In my country’s hospitals women are put on fetal heart monitors and can be given a C-section, more Pitocin or have a vacuums put on the baby to get him out quicker.

In Cambodia, the heart tones are rarely taken and yet the woman is laid flat on her back with Pitocin.   I am here to help babies survive in this country; not just at birth but also for the first year of life.  I am here for such a short time so what can we tall about that might make a difference.

They say all Cambodians give birth flat on their back and always have.   A woman from Australia says, “Women is Cambodia always gave birth on their backs.”   And yet the midwives tell me they are terrified of babies getting stuck and dying; either as a breech or shoulder dystocia. 

After several days I consider all this and then I remember the carving of midwives at Angkor Watt.  The woman is squatting; being held up by two women on either side while the midwife kneels to catch the baby.  I bring a print of this ancient carving to the trainings.

Angkor Watt is an ancient kingdom in northern Cambodia that existed in the twelfth century.  It is a wonder of the world with exquisite architecture, pools and carvings.  Thousands of tourists visit it and it is the national pride of Cambodia. 

Most Cambodians have not and cannot go there.  It is free, for them but it is far away from where I am.  But they know they word and are quiet when I show them that there were midwives, like them, carved on the great wall so Angkor Watt.  They stare and consider this.  An older midwife says, “So squatting came from Cambodia and not the west.”   I tell her that all women, everywhere in the world, most likely were in some upright position for some part of pushing, all over the world. Or that at least it was a tool midwives used when they needed to get a baby out.  

I show them hands on knees, rolling on their side and bringing the legs way back when a woman I son her back.  Everyone laughs as we practice delivering babies. 

I offer them the wisdom that was not mine but was their birthright and history all along.  I offer that if the babies are ever stuck they can think perhaps of moving the mother or if she can’t push to get her up.  

There is no memory, even amongst the TBA’s of giving birth upright.  It is hard to know when it was lost or shamed out of them or became out of style.  In other countries the old midwives had women up and about for birth but here even the oldest midwife says they always delivered the babies with the woman flat on her back.  

I do not really know.  Did the French bring this to Cambodia’s royalty and then it became the custom from there?  

How did it become the custom in my country? 

A young midwife asks me if women in my country have C-sections and give bottles o they look cute?  I consider this and say no doctor is supposed to do this but I suppose some do. They look for a medical reason, I say.  She says if you have enough money a doctor will do that there. I explain that this is dangerous and no one should be doing it anywhere for that reason. 

 I show her again the picture of the carving at Angkor Watt and say, “this is the wise way.”   She smiles and we all tell more stories and laugh and wave good-bye. 

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