Motherbaby Placenta: State of Emergency
by Robin Lim
© 2014 Midwifery Today, Inc. All rights reserved.
[Editor’s note: This article first appeared in Midwifery Today, Issue 109, Spring 2014.]
It is the season in which we celebrate birth, yet I cannot sing one Christmas carol. If I try, I risk that the dam I have built to hold back the tears unshed will break, and I will cry a deluge.
“So why, Ibu Robin (grandma, lola, midwife, alleged ‘hero’), don’t you have the courage to cry?”
To be honest, I am afraid that if I let slip one tear, I will drown. You see, I have been in and out and into the Philippine disaster zones. I have seen the bodies, of those who still had decades of beauty left to live, lying by the roadside due to the biggest storm ever in our human history to make landfall. Typhoon Haiyan, known to Filipinos as Yolanda, was the grimmest of reapers. In the aftermath she has left 14.9 million people affected; 4.1 million people displaced; 5632 confirmed dead; 1759 reported missing; 26,000 reported injured and uncounted millions homeless. Those “counted” dead must have registered death certificates. Every pregnant woman I meet whose husband and children were killed has not registered them. The grandparents who lost their six grandchildren and daughter buried them in a small space they cleared by their devastated home because they did not wish to place their loved ones in a mass grave. Only four of the seven lost are accounted for, but the grandparents will not report their dead for fear of being punished for burying them on sacred family ground.
As I am told these and many stories, my eyes remain dry as stone. I am afraid that if I begin to cry, my team will fall apart. I fear that Teresa, Lucibelle, Tina, Jun, Riko and I will no longer be able to find the pregnant and lactating mothers, their children and the remains of their families’ food. How, if we break down, will we buy a thousand tarps to provide a little shelter from the rain? When a young homeless father is asked, “What do you need?” He says, “Only a bolo knife. I have the rubbish of my house and with that one tool I can make something from this corrugated tin scrap and broken bamboo to shelter my children. Their mother has died; they need to stay dry.” We can deliver the long bolo knives, the buckets to catch rain, the hygiene kits and some food, but we must not begin to cry. And the songs sing, “Soon it will be Christmas day.”
What does this have to do with placenta? Placenta is the mother-root. In times of strife it is even more essential that we respect her and that we keep her intact with our babies, so they can receive their full supply of oxygen, iron stores and stem cells. It is the birthright of every child to have time to transition and achieve optimal health supported by the delay of umbilical cord severance. For babies born into disaster, it is a matter of life and death. I believe that the simple gift of patience on the part of the birthkeeper can save lives. Immediate clamping and cutting of the umbilical cord robs our newborns of up to 150 ml of blood—one-third of their God-given blood supply. They desperately need this promise of health and intelligence, especially when born in a kind of purgatory on Earth. Remember, when these babies go home from the makeshift hospitals or maternity tents where they were born, there is no home. Their mothers will breastfeed them, which is absolutely the only way they can survive, but the mothers are dehydrated, hungry and living in the open.
Expectant and postpartum mothers thrown into disaster have limited, if any, food, potable water and shelter. Many grieve the loss of loved ones, livelihood and lifestyle. Having been a midwife in post-tsunami Aceh and in Jyogja, Padang and Haiti after earthquakes, and now in the typhoon-devastated Philippines, I see that pregnant women in these circumstances are more likely to have premature and stillborn babies. Their risk of hemorrhage, hypertension and eclampsia is also greater.
In addition, the accepted medical ritual of clamping and cutting the babies’ umbilical cords puts postpartum mothers at risk. In Michel Odent’s recent article, “Preventing Postpartum Haemorrhage,” he speaks of the vulnerability of the peak of oxytocin released by mother after the birth of the baby, which facilitates the safe delivery of the placenta (Odent 2013). He says that distractions, such as cord cutting before the birth of the placenta, can potentially increase the risk for hemorrhage. He says, “The negative attitude towards colostrum implies that, immediately after the birth, a baby must be in the arms of another person, rather than with his or own mother. This is related to a widespread deep-rooted ritual, which is to rush to cut the cord…. This is how one can explain that most postpartum hemorrhages, and therefore many maternal deaths, have been for thousands of years the consequences of inappropriate cultural interferences” (18–19).
Midwives, doctors, birthkeepers: please, ask yourselves, “Am I, by habit, unconsciously interfering with the motherbaby dyad and unwittingly sabotaging the survival and optimal health, intelligence and humanity of mothers and newborn babies?”
We live in critical times. Apparently the rise in temperature of the Pacific Ocean caused Haiyan to become a superstorm. The typhoon season is not over, but the Philippines has already suffered 26 typhoons this year. Additionally, on October 15, 2013, the Visayan island of Bohol was destroyed by a 7.1 earthquake. This disaster left all the Bohol childbirth clinics and most of the hospitals and public health clinics without light or running water. Many are not yet reopened; those that are operate in darkness and in the absence of proper hygiene.
The problem of disasters, both natural and unnatural, is not going to go away. How we prepare ourselves, how we survive and how we heal in the aftermath will be determined by how well we stay human. Odent finishes his article by saying: “It implies that, at a planetary level, we routinely block the maternal release of the love hormone just after the birth of a baby” (19).
Birthkeepers, if you find yourself making excuses for clamping and cutting the umbilical cords of babies soon after birth, please slow down. Please, consider the consequences for mother, baby and humanity. It is not enough to touch the cord a few seconds or even minutes after the baby’s birth and say, “It has stopped pulsing; let’s just cut it.” I am challenging each of you to just let it be. At Bumi Sehat Bali (post-terrorist bombings) and Bumi Sehat Aceh (post-tsunami), we are waiting at least three hours before clamping and cutting any of our babies’ cords. Babies born at night will have their umbilical cords cut or burned sometime the next morning. Families who wish to leave the baby-cord-placenta trinity intact until it falls away in a few days with no violence at all are of course offered that option.
The Mercy In Action camp, where I witnessed the birth of three babies in one night, is also waiting hours before separating babies from their cord and placenta. Mothers and babies are never separated by Vicky Penwell, CPM, and the Mercy Filipino midwives.
I have also witnessed and assisted with birth at the East Visayan Regional Medical Center (EVRMC). At EVRMC electricity is provided by a generator that is often out of fuel, and there has been no running water since the storm. The Philippine health authorities acknowledge the wisdom of delaying the clamping and cutting of babies’ umbilical cords. Delayed cord severance is strongly recommended, but in practice cords are routinely cut by habit immediately after birth. Births are attended by doctors who are themselves traumatized by the disaster and numb to the need for tenderness in the birth room.
The Mercy midwives of the Philippines have kept statistics that prove their maternal survival rate is 10 times better than the national average, and their infant survival rate is 4 times better. Bumi Sehat in Indonesia has brighter babies and a 100% rate of breastfeeding as a result of keeping babies, cords and placentas intact. By honoring the placenta and umbilical cord, we are achieving a standard of motherbaby-friendly care, which is astounding in its gentle success and crucial in disaster zones.
My mother is Filipino; the Philippines is my motherland. My country is hemorrhaging. If you can help, we need funding to keep the relief that Bumi Sehat/Wadah Foundation, holding hands with Mercy In Action, provides. Here are sites that offer opportunities to give: bumisehatfoundation.org; bumisehatfoundation.org/donate-to-philippines; AMillionMothers.org.
Because of the disaster and what I perceive as a motherbaby placenta state of emergency in the world, I did not spend the words in this article to tell you all about the many reasons that our placentas are sacred. My book, Placenta: The Forgotten Chakra, can give you the bigger picture. You can buy the PDF of the book and other books I have authored online at bumisehatfoundation.org or via Gaia Books: gaia-d.com/robin-lim-e-books.
- Odent, M. 2013. “Preventing Postpartum Haemorrhage.” Midwifery Today 105:18–19.
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. In 2006 Ibu Robin received the Alexander Langer Peace Award in Italy. In 2011 Lim was named CNN Hero of the Year for her work in maternal and child health in Indonesia and disaster zones. Currently Lim and the Bumi/Wadah Foundation have adopted full responsibility for the Medical Relief and Childbirth Camp in Dulag, the heart of the Philippine Disaster zone, where an average of 40 to 60 patients are seen per day and two to seven babies are born in the tent each night.
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