Gratis - the cost of healthy mothers and babies

Gratis

The cost of healthy mothers and babies

 

Prenatal classes for all the pregnant women who visit the clinic.  The posters are made on from materials I buy at Scrap in Portland, Oregon.  After I did it once, the midwives took over

Ever since I have suggested that the prenatal care cannot cost anything, I have head the word “ gratis” passed around in animated voices of disbelief.   The social doctor is vehemently against it.  He says free health care will ruin Haiti and no one will pay him.

I look around the clinic.  Five paying patients a day is not going to support even one of them, yet alone the whole staff.  They are not earning their keep, even with their payment system.   It is not financially viable.   There is a chart person, a lab tech, a pharmacist, two nurses, two doctors, and now two midwives.  There are all sorts of housekeeping and grounds people.   Outside the clinic there are hundreds of women with no prenatal care.   He shrugs.

“How much is a visit,” I ask. 

“About $1 US. “

“How much are they earning?”

“Maybe $4 a week.”

“So ¼ of their total weekly income must go to this visit and this does not count lab work and pharmacy and the four hours to walk to and from the clinic.

“How much to have your baby, in town, at a hospital?’

“It starts at $50 US dollars but you pay more for medicine.”

“Two months of their yearly income. “

“Is family planning free?” 

“Nothing should be free in Haiti.”

“Healthcare is free all over the world.”

“Not in Haiti.  I need to be paid.”

“You are being paid and you got a free education.”

“I need more.”

The debate, over health care, rages in my country as well.  However, even the most conservative politician, understands that prenatal care for all women is a sound social and economic investment in the long -term well being of a community.

 The countries with the best maternal and newborn outcomes provide medical, social and economic support to the newest members of their society.  The yet to be born are nourished, given medical care, and once born given time to be breast fed and provided with a free education.   Mothers are offered an opportunity to choose when and if they will have more children.   Many give mothers paid time off in the last weeks of pregnancy and ample time to care for their newborn before returning to work.  

One of the new midwives providing care

doctors in Haiti and many part of Europe, complete a social year as a gift to their community for a free education.  The social year doctor is pretty much against free care, prenatal care and midwives.

“There are very few pregnant women in this area.”

“But there are so many children.” I reply.

“Well, even if there are pregnant women, they don’t like prenatal care.”  He explains.   “Haitien women do not like prenatal care.”

I had seen women walk miles for prenatal care in other parts of Haiti.  I am confused and the midwives were hired, I thought, to meet an identified need.

“Have they ever had it?”

“No.”

I always consider the possibility that I am wrong and wrong in another person’s country is even worst.  I walk around on the roof and consider.   If no one comes because it costs, then why have the new midwives?   Is health care a human right or something only a few can purchase?  For my own country, I want health care for all. It is what I want for all women, everywhere.   I toss my cards with every pregnant women needs free health care. 

The young doctor, who is also the clinic director, was born and raised in these mountains.  I am at the clinic for over a week before I see him.  When I do, he smiles and quickly agrees to free prenatal care.  Within two weeks, there are pregnant women sitting on benches, waiting for care.   The new midwives are smiling and doing the work they were trained to do.  I breathe deeply and smile.

The lineage of midwives; trees, frogs and the future of birth

The lineage of midwifery

Trees, frogs and the future of birth

A frog prepares to make the journey down hill to a pond where she will lay her eggs

The wisdom of catching babies, like other skills necessary for human life, was passed down from one generation to the next. It was deeply embedded in the tribes and bands that made up our early human families.  It continued, in this way, throughout the world for hundreds of thousands of years.

Women knew how to cook, gather food, create shelter and some amongst them became skilled at baby catching.  They knew of plants, of prayer, and of positioning mothers for birth.  With their hearts and their hands, they birthed millions of babies and although women died; we can see by the world’s population, that many, many more lived.   Our history books love to tell of the great generals who fought battles and forged empires but I stand in awe of the midwife who night after night walked out of her home and despite all the odds against her, helped preserve and build the life of her community.  

As I listen to the stories of women and midwives, I feel myself wanting to preserve this lineage.   I ask them if they have trained a new midwife to take their place.  They look down.  “It is not like that now.  Women feel pain when they have babies and go to the hospitals.   We are not suppose to use teas or baths. We are not allowed to deliver babies and besides we are old.” 

I am not trying to idealize beyond reason.  The midwives, of old, worked in isolation without the broad collective wisdom of books, research and modern science.   They worked, as my stories showed, in the midst of famine, migration, war and climate change.   They worked within societies where men considered women their property.  They worked as slaves and servants.  They were often called to do this work because someone, in their village needed to and often with little pay.  They were woven deeply into the fabric of their communities and the families they served.  They were village midwives.

Like the old growth forests and the spotted owl; I want to preserve this legacy, this lineage.   I see myself standing amongst the logged landscape of Ghana, Haiti and Oregon and trying to explain why these trees matter.  I want to say that if you cut down all these trees, the people will one day starve.   It will change our climate, our water supply, our animals, and our fish.   “These trees are holding our whole world together.”   Some people sit in trees, trying to protect them.  There are protests, lobbyists and lawyers all trying to save these last trees before they are all gone.   When you walk in the vast logged areas of SE Asia, you see that the people, who once supported their communities, are starving.   The entire system has been uprooted.  People who once took only the trees they needed for homes, boats and tools, stood and watched while powerful, outside forces took every last tree. 

I try to stand, on the logged landscape of childbirth and explain why it matters.  I can feel the trees falling around me.  I am trying to scream over the sound of the chainsaw but it is too loud.   I watch the lineage of midwifery struggle to survive.  Like the elephants of Cambodia, they look for safety and then slowly, slowly walk away.

Midwives today, in their many reincarnations, rarely serve a village or a community.  In my state, most midwives belong to a hospital, a large practice, a birth center or an insurance plan.  They are not community midwives.   They rarely, if ever, serve a community as primary caretakers of the women and babies of a neighborhood.   The mother’s health plan, the county plan, their insurance dictates where they go and where the women they serve will give birth.   In my community’s health center there are no midwives.    The mothers do not gather for a prayer and a song and wait together telling stories and laughing.  It is cold and quiet and empty. 

This place, where I live, is a place beside the forest where two rivers meet; a place once rich with wetlands and ponds.   The river is a superfund site and no matter the millions they spend, they cannot restore it to its original health.  The frogs from the forest try to make their way to the river to lay eggs and are squashed by cars and trucks and trains.   Trying to reproduce becomes the greatest hazard of their life.  It is not that laying eggs did not always have its hazards.  Frogs are the food of many animals.  They and their eggs could have been eaten but they knew when it was a certain temperature and when it was raining, you and all the other mother frogs headed downhill towards the ponds by the river.   They did not stop doing this because giving birth to tadpoles became harder but because their ponds were cut off, filled in and polluted. Birthing tadpoles did not become more difficult but the environment for giving birth in did.

In the lineage of midwifery, birth is normal.  Like the frogs trying to get to the river, women know how to do it.  In the ancient wisdom of birth, midwives allowed women to slip into the place of birth and wander out into their own real or metaphoric rice paddies and give birth.  They are given space to do what they have known, by instinct, how to do all along. 

 40% of women in the United States give birth with a surgeon who cuts their babies out of them.   They have been convinced that birth is dangerous, painful and something to endure.  On the other hand, women who want a natural birth feel desperate to orchestrate the perfect water birth with the exact right music, people and candles.    

But midwifery is not where you give more but how the well being of children are brought into our community.  In this way, each village or neighborhood has their own band of skilled midwives who care for their communities newest generation with love, education and support.    They protect this process, this new generation as a normal part of any healthy community.   In this model, normal prenatal care and birth happen within the community and is never tied to insurance providers.    Women can walk to their prenatal care with other women where they learn and feel supported by the their midwives and their community.   They will be able to choose, as they can in Canada, where they give birth; at home or in a birth center with a hospital available when needed. 

In the lineage of midwifery, birth is rooted in the food systems that nourish the mother and her unborn baby.  It is rooted in clean air and water free from contaminants.   Midwives help to create a nest for the next generation that is safe, clean and provides equal opportunity for children.  They work with farmers, schools and community leaders to protect the next generation.  The first thing a new midwifery student learns is how women and children are doing in the village she will serve.   She will discover the obstacles children face and how she can work within that community to empower women and families to make the village better for children.  The well being of mothers and babies and families is locally crafted and cared for.  This is the lineage of midwifery.   

Midwives can be educated, have standards, have access to life saving medicines and procedures and still be rooted in the history, culture and ecological systems of their communities.   

I am making all this up.   It is based on what I saw in rural Cambodian health centers and my experience as a midwife and a teacher.   I see midwives being trained to do hospital births and midwives being trained to do water births and no one being trained to do village midwifery care.   It is not that midwives and even doctors don’t want to do this.   The insurance companies and the laws that support them to do allow for it; at least not easily.

The midwife I met in Cambodia told me that her father planted thousands of coconut trees for the people of her village.   There were mangoes and many other things to eat but then the Khmer Rogue cut them all down to make rice fields and sold the rice to China for weapons.   She said in those times, there was enough food for everyone.   “When they cut down the trees and sprayed the land, the babies were not as healthy.”

In my village, when they let people build factories that pollute the land or transport explosive chemicals across the landscape the children will, in one way, or other suffer.   In the ancient practice of midwifery, the midwives sit down and have a voice to say this will not be good for the next generation of babies.  It will cause hunger, birth defects and harm to the parents.  All the technology, all the surgeries and monitors and induced births will not protect a child from environmentally induced illness and disabilities.  It is like the women told me.  It was not birth that killed our children; it was war and famine and being poor.

By taking birth out of the community and out of the home we have actually failed to protect children.   Our country works so hard to make sure that babies are born alive and the mother feels no pain and that the baby has every cute new item on the market that we fail to use birth to protect the long-term best interests of children.   We know babies need to be exclusively breast fed for six months but we allow a 12-week maternity leave.   We know vaginal births and early skin-to-skin contact protects babies from many health problems for many years.  We know that inductions have caused many babies to be born prematurely and suffer learning disabilities but we struggle to create birthing practices that are deeply rooted in community and long term well being. 

The traditional midwives of the world are endangered like the old growth forests and the spotted owl. They were scorned, looked down upon, burned as witches, outlawed, marginalized and called dirty.   No matter how much a small village may have loved them and trusted them, they were eventually rooted out as countries sought to improve maternal and newborn health.

I see this lineage.  The midwives are paddling the waterways of their ancient homeland.  They are in ships carrying immigrants from far away places.  They are riding in wagon trains and on horseback.    I also see, in my country, women struggling to conceive and afraid to give birth.   I see schools struggling to connect education to the greater purpose of building a healthy, equitable society.   I watch all the disconnected, competitive forces cutting down the real and metaphoric forests around the children and wondering why they cannot grow.  

The frogs of the forest face many obstacles.   The city has let non-invasive plants take over the forest destroying habitat and trees.  When they head down to the nesting ponds, not only do they face polluted ponds but also they must cross a highway and a railroad track.  Despite all this and the death of hundreds of frogs each night, they keep trying to get to the birthing pools.  Good- hearted people stand out there with buckets and pick them up and carry them to the ponds. 

The DNA of birth is strong. It is the way we protect and care for the next generation.   It is not simply a matter of getting the baby out alive; it is the journey that the mother, father and their extended community make together.  It is the way we use all the tools of breast milk, hormones, protective microbes, intelligence and bonding that help children thrive in a community.

Birth has been cut off.    There is a highway and a railroad and a polluted pond between most women and the reality of community cherished care of the newborn.  There are great political and economic barriers present in connecting the care of the family to the communities they live in with midwives. 

We know that certain plants and animals are indicator species.  This means that the loss of them is a sign that the whole ecosystem is in danger.   The widespread, elective loss of vaginal birth and breastfed babies is such a sign, I believe, for the human race. 

The village midwife walks tenderly in the world.  They are experts in their community and its unique challenges and obstacles.  The midwife works with others to help teens make healthy choices.  She gathers women in her community together for safe, healthy places to give birth and raise children.   She is based in her village. Her main work is the time it takes to grow a baby safely and the months of breastfeeding.  When these things are tended carefully, the place and nature of birth will change with it.  The question will become how we sue our precious healthcare dollars for the lifelong benefit of our children. 

The Geography of Birth

The Geography of Birth

The land I walk on, was born from the sea; rising up as the waters receded, leaving a rich, fertile place where rivers emerged from mountains.  Surrounded  on all three sides by the ocean, it is blessed with all forms of sea life and a clear view of the horizon where other lands also grow and shift with the changing climate.  

Small bands of people from Africa, left their land hundreds of thousands of years before these stories take place.  Women, in small communities, crossed the Red Sea into present day Yemen.  From there, with intelligence and cooperation, followed the coastlines and rivers to populate the whole of earth.   As they made their way they settled, hunted, fished, learned new technologies and developed new ways of living. They also formed families and had babies.   These babies, in turn, grew up and had babies of their own. Some people stayed and created semi- permanent  communities while others continued to explore new lands and make the slow ,perhaps a mile a year, migration towards what we now know as South East Asia. 

The geography of birth explores the patterns and processes that helped women give birth safely in the context of their landscape and cultural experience.  It examines how women adapted to change, used natural resources, shared information and cared for the young.   The birth practices of most humans was tied to the landscape they lived within.  Much of what we know about the migratory patterns of humans is from the study of archeology.   Today we can learn through the sharing of stories.

Archeologists, who study the bones of  ancient people, report that there are almost no signs of babies being buried inside a mother’s pelvis and few burials of mothers and babies together.  They consider that if there had been significant problems with childbirth, there would have been more mothers and babies born together but there is little evidence of this.   This along with the vast evidence of the human ability to populate the earth, helps us to believe that birth was and is inherently a normal and safe part of the human experience.   In the Geography of Birth we look at outside influences; those people or events that changed birth practices and how they impacted the safety of women and babies.

The first evidence of these modern, human ancestors in SE Asia. were found in a cave in present day Laos; people who lived hunted and gathered the food of the rich peninsula.

Archaeologists believe that some people, following the coastlines went to Australia.  Others pushed up to China and others remained in present day India.   For most of these 200,000 years, people lived in small tribes and bands following migratory animals and seasonal crops.  There is no part of human migration in which women were not giving birth.  There is no historical event, war or act of genocide that was not also accompanied by women giving birth.

Like many people everywhere, the people of Southeast Asia developed a desire and ability to make permanent structures, grow crops and domesticate animals.  They developed pottery and iron works and sophisticated systems of working with stone and wood.  As these systems became more sophisticated, the people spent more time in permanent villages.  These villages grew larger and over time turned into city-states.  Meanwhile people were navigating and continuing their exploration of the coastlines and seas.  People from the north, south and east came to the land to settle and trade.  Some, who came to trade, never returned home. They married and stayed bringing new thought systems, technologies and beliefs.

During this time, in every place on earth, people believed in some form of earth based spirituality in which the natural world is filled with spirit. The rivers, the sea, the trees, the mountains, the flowers and the sky were all deeply connected to a force that slowly becomes known as God.  Just as small city-states began to develop, so did larger, more structured religions.   Hinduism would make its way to SE Asia from India.  The Chinese would bring Confucianism and Nepal would give them Buddha Later the French and Spanish would bring Christianity.  

What was once small bands of people roaming one landscape; free to hunt, gather and fish as they needed became a land divided into kingdoms and dynasties that often followed former tribal routes. Their formation and decline was often closely linked to the landscape and their use and misuse of natural resources.   Rulers joined forces with the world’s great religions to create monarchies linked to God and heaven. Societies that had enjoyed equalitarian life styles became divided into rich and poor; ruler and slave.   Empires such as the Khmer and Cham became prominent and then declined.

The Chinese pushed down from the North, as smaller tribes worked to survive and consolidate their resources.  The Europeans made their way too around the globe and set out to colonize many lands including SE  Asia. People who had once had power over their own futures were forced to work to create great wealth for colonial powers.  What had been one peninsula of free roaming people was divided into Vietnam. Cambodia, Thailand, Laos and Burma.  Their borders would be determined by treaties made in Paris.

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A version of this story can be told all over the world as people, countries, religions and ethnic groups fought for survival, wealth and power.  The deaths of millions of mothers and babies was and is a consequence of  greed and a desire for power.   I am assured, by the women, I interviewed that childbirth was far less the cause of death than political and economic warfare waged on innocent people.

There is no way to wage a political, economic or religious war without hurting and killing mothers and babies.   The woman who first walked out of Africa is our common genetic mother. Some call her our Mitochondrial Eve.  I feel confident that the first band of people that left Africa, did so out of a love for their children and a wish to secure a better future for them.   It is the same reason my son set out on a boat across the South China Sea and why my daughter walked through landmines to reach Thailand.

We honor all the women of the world, when we take care of one another and the amazing, bountiful land that has taken care of us for all these generations.  I love listening to the stories of the oldest midwives left on earth.  I want to know, how they survived war and famine and an ever-changing society.    I  believe they have the power to teach me the vast lessons of graciousness. 

I will try to paint for you, my unknown reader, the stories of birth I have collected in a backdrop of geography, archeology, history and religion.   I feel my way along the shores of my own uncharted territory; following streams within the ever-changing seasons of my life, using birth and midwives as the star in the dark night as my guide.

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My Journey Continues...to Southeast Asia

An Introduction

In 1980, my family grew to include children who had fled the conflict in Southeast Asia.   They made their way to refugee camps in Thailand and Indonesia by foot and by boat and then as, orphans and unaccompanied minors, they arrived aour house in Portland, Oregon.  I was thirty-two years old, pregnant and already a mother to two young boys.  My husband was in medical school.  We felt that love could accomplish all things and were children ourselves of the idealism of our generation.  Our old wooden house would burst to overflowing as we faced, unprepared, the joys and challenges of bringing young people into our community who were sick, frightened, homesick and lonely.  

Thirty-three years later, I made a trip to Vietnam and Cambodia with two of those now grown children. I had been to Cambodia twice before with my daughter but it was my first visit to Vietnam.  I had volunteered as a midwife in Haiti and Gahanna and wanted to spend some part of my trip with midwives.  They had grown up with a midwife- mother and knew this to be my particular and peculiar passion. 

I was interested in how Vietnam and Cambodia’s midwives had managed through bombs, famine, genocide and years of conflict.  I wanted to know how they became midwives and who helped them along the way.  I wanted to know how their new governments had made the transition from war to peace while improving the maternal and newborn mortality rates of women and children.   I wanted to know the situations in which my own children were born; of the practices and women who helped them take their first breath and survive.

I had wanted to offer the midwives of my children’s countries some small gift and so

before leaving, I had decided to offer training in newborn resuscitation through Helping Babies Breathe.  I packed training materials and 40 ambubags to give to local birth centers.  My children helped me to make contact with many local clinics and others I found through NGO’s working in the countries.   Through them I gave many workshops, observed birth in a variety of settings and had an opportunity to meet many midwives. 

I had become a midwife in the post  Vietnam war years, when many of us struggled to create a way of life that would eliminate the causes of war.  During this time, we formed food co-ops, schools, community gardens, and some of us were drawn to birth.  I was working in Head Start and saw the harm of drug and alcohol use on the unborn child.  I saw the need for parenting to begin long before my four- year old classroom.   A co-worker asked if I would go to her teen age daughters birth classes and birth.  It was my very first birth and I sensed then that in that place I could find, for myself, the moment where heaven and earth touched.   After so much conflict from war, the civil rights movement and protest I felt a possibility of healing and peace.

I began my journey, as a midwife, slowly but without hesitation.   In Cambodia, a midwife told me she was woken by a dream that told her to go and help a neighbor in labor.  We are all perhaps, offered these dreams but it is often hard to get out of bed and follow them.

This is how it was for me, both as a midwife and as a mother.  Once I knew that children from the refugee camps needed homes and families there was really never any turning back.   Once I began to listen to the story of birth there was no choice but to listen.

While women in my country were making connections between war and corporate control over every part of our lives, the women in Vietnam and Cambodia were struggling to heal their communities and their families.   Over and over again the women and the midwives told me that it was not birth that killed them or their children but war and famine.  Most women had many children during this time and all, that I spoke with, lost several to starvation and a lack of basic medical care.  I was reminded over and over again how deeply war impacts women and children and their ability to survive and protect one another. 

In these stories, I try to capture the impact of war but also the resiliency and courage with which women preserved their families and their communities.   As the guide in My Lai said, “It is hard for your generation of Americans to come to Vietnam.”  It was often very painful and full of heartbreaking memories.  Coming face to face with the lasting harm of Agent Orange on newborns left me sobbing with embarrassed, powerless, pent up tears.

Years ago, I had stood in silent vigils  asking for the war to end.  It felt right, no matter how difficult, that I make this vigil and stand beside the women and midwives of Cambodia and Vietnam.  I tried to feel peace and to let my heart, so broken by the actions of my own much loved country, heal. 

I am forever thankful to my children’s families who fed me, introduced me to older midwives and helped me find my way from place to place.   For all the cups of tea, laughter and nights spent sleeping together I am grateful.  To all the midwives of the world who deliver each and every baby with a silent prayer for peace in their hearts.  For all women who deserve to give birth in peace and to raise their children with enough food, a free education, health care and a clean environment.

A photo of my children who came from Cambodia and Vietnam as adults.