Meeting with midwives and mothers on Wotje Atol in the Marshal islands.

Meeting with midwives and mothers in the Marshal Islands

I love meeting midwives, when I visit somewhere.  My sister invites a midwife to visit with me on a recent visit to Boston.  I have lunch with a midwife in Oakland.  I love to hear what their experiences have been; their training and what the challenges are.

When I visit Wotje, I learn  that the women next door had recently given birth at home with the local midwife.  I was excited to meet her and hear her story.  I had met the community nurse at his clinic and asked him about care.  He said, "Prenatal care is on Thursday mornings but when I arrived, no one was there, including him."  I wandered off through the paths of coconut trees and women working in their yards.  I ask them,"Where does the midwife live?" They point towards the lagoon and eventually someone goes and gets her and we sit in the warm sun, visiting.

She had been trained some twenty years ago with a short course in the capitol of Majuro and reports she has had no training since.  She delivers most of the island's babies, unless a mother chooses to go stay in Majuro at the end of her pregnancy.  She has no way to listen to a heartbeat, no blood pressure cuff and no medications.  She uses her heart and hands as she always has.

When asked if she ever had a complication, she seemed to be focused on presentations, other than a head including a cord, foot and breech.  They can call a plane for transport, at no cost to the mother, but that would take several hours, at best.  Although the islands report high levels of high blood pressure and diabetes, she did not say she ever experienced eclampsia.

The nurse had prenatal vitamins and could come and check a blood pressure at the start of labor.  He did not have any means of listening to a heartbeat or a bag and mask to resuscitate a baby.  The nurse said he had medications to stop bleeding but running to get him, even on a small island, could be problem.

The women of Wotje sing to me after our birth gathering.  They also covered my hair with homemade flowers!
I felt so happy to bother with them.  Understanding that the birthing wisdom of their grandmothers still served them well.

Gathering of women and midwives at Wotje Atol, Marshal islands

Like the mountains of the Philippines, when I invited the midwife to a Helping Babies Breathe Training, all the women came.  We had a fun time sharing birth stories and doing some birth scenarios.  Some the younger women were interested in becoming midwives themselves and expressed concern about the birth services on the island.   They again shared that there was no prenatal care and that they were not prepared for an emergency.  They shared that many women do not give the baby colostrum after the birth and that few exclusively breastfeed.  The women had many babies and were only recently gaining access to family planning.  I left a fetoscope, a newborn bag and mask and a birth picture book with them.  I promised to send some materials including Hespiran's Book for Midwives and Where There is No Doctor for Women.  I also downloaded the wonderful training films from Global Media.  I suggested a study group until they can send someone from their island for a midwifery training.  

My hope is that one day, each atom can have a skilled birth attendant with the necessary emergency supplies and training.  In the best models, it seems that the newly trained midwives can work with the older traditional midwives and within the health center.