April 15, 2015
Volume 17, Issue 8
Midwifery Today E-News
“International”
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In This Week’s Issue



Germany conferenceMeet Robin Lim at our Germany conference!

Robin is a mother, grandmother, author, poet, midwife and educator who lives in Bali with her husband and children. She is a founder and executive director for Yayasan Bumi Sehat Birth Center in Bali and splits her time between the birth center and the Tsunami Relief Clinic in Aceh, Sumatra. She will be teaching or co-teaching several sessions, including Human Rights Issue: Premature Cord Cutting, Solving Common Complications, and Pillars of Midwifery: Insight, Information and Intuition.

Learn more about the Bad Wildbad, Germany, conference.



Quote of the Week

Did I offer peace today? Did I bring a smile to someone’s face? Did I say words of healing? Did I let go of my anger and resentment? Did I forgive? Did I love? These are the real questions. I must trust that the little bit of love that I sow now will bear many fruits, here in this world and the life to come.

Henri Nouwen


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The Art of Midwifery

Suffering in childbirth need not be the norm, for without drugs and without medical interventions imposing iatrogenic risks, healthy, well-supported women, carrying healthy babies, may make the passage of childbirth with dignity, surrounded by people of their choice, with joy, grace and even pleasure. The gentle birth movement advocates for the basic human right of women to labor and deliver their own babies with respect from their health care providers, with support for their choices and privacy. Furthermore, families and wise health care providers are advocating for the rights of babies to be handled in a way that does not impair their future health, well-being, intelligence and longevity, i.e., delayed umbilical cord severance and skin-to-skin uninterrupted contact with mother following birth. Clearly, much of the trauma experienced by mothers in childbirth and babies at birth is preventable.

Robin Lim
Excerpted from “When Pregnancy Goes South: Keeping Birth Gentle,” Midwifery Today, Issue 113
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Question of the Quarter

Is Childbirth Education Available in Your Country?

Midwifery Today asked its country contacts (midwives, doulas, doctors in various parts of the world) the following questions: What is childbirth education like in your country? Do women have access to childbirth classes? What about doulas? Is doula help encouraged/accepted/utilized at births in your country?


Ghana

Before the year 2000, there were no childbirth education classes in Ghana. What women had was the normal health education on pregnancy issues that was given to them in the antenatal clinics. The information was very weak and inadequate and that inspired me to start a structured form of education for women with the concept name “Pregnancy School,” thanks to the support of ALACE in the US.

Currently, childbirth education is organized in some of the antenatal clinics. Fortunately, the Ghana Health Service is encouraging all midwives to organize pregnancy classes in their health facilities.

Ghana has no doulas. In times past when women labored at home, they were supported by the entire family. Most women now are birthing in hospitals and they labor all alone. Doula help is not encouraged. I have raised the issue on doula support at various platforms and I intend to start doula training soon.

Abena Odum Okra


Iran

In Iran, we have childbirth classes, which are always located in midwifery clinics. Classes cover two kinds of childbirth preparation. First, theoretical childbirth classes give couples some practical techniques, such as massage and short exercises. Second, prenatal exercises classes, which are usually held three times per week for mothers, help to strengthen their ligaments and muscles to prepare them for the power of childbirth. These classes incorporate aquanatal exercises, yoga, Pilates, belly dance and Zumba. We at the midwifery association have waterbirth classes and workshops for midwives and doulas plus Waterbirth International workshops and internships.

For further information regarding childbirth classes here, you can go to my clinic website or my Facebook page, Samt VMC.

I am a waterbirth lecturer and educator and have been on many TV shows and had many interviews on IRIB broadcast.

Leila Mostofi


Afghanistan

The only way you can learn about childbirth in Afghanistan is through secondary education as a midwife, nurse or medical doctor. There are some health education classes during antenatal care, but these are very basic and based on health system priorities. For example, at the moment, infectious diseases are the priority for the Afghan government, so women receive most of their health education on those topics. We don’t have doulas in Afghanistan but we have community health workers who are doing health education as well. The level of knowledge and skill of our community health workers makes them inadequate as doulas, but they are really helpful for referral and follow-up.

Sabera Turkmani

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Conference Chatter

Midwifery Today is proud to have Robin Lim as one of our featured speakers during the Midwifery Today conference in Germany. Robin Lim, the 2011 CNN Hero of the Year, or Ibu (Mother) Robin, as she is known in Indonesia and throughout the world, is working to change health care in Indonesia with her Yayasan Bumi Sehat health clinics. The clinics provide free prenatal services, delivery and postpartum care to mothers. They also provide much needed general medical care.

After birth, babies are often held “hostage” by a hospital until a mother can pay her bill. She is allowed in twice a day to see the baby, feed him/her and change diapers. Many babies are given up for adoption because of this.

According to the United Nations Population Fund, three out of five women giving birth in South Asia do so without a skilled birth attendant on hand. “The situation is bad,” Lim said to CNN. “Babies are unattended, deliveries have become commercialized and mothers die from hemorrhage after childbirth because they can’t afford proper care.”

Everyone gets treated like royalty at Lim’s clinic, whether they are able to give a donation or not. Choosing to become part of the solution helped Lim get through personal tragedy. “Each baby and each adult deserves a clean, healthy, loving environment.... Those things are basic. Those are a human right.”

Lim will speak on the human rights issue of premature cord cutting, teach “Solving Common Complications” with Elizabeth Davis and Gail Hart, and participate in a variety of roundtable discussions and panels throughout the week in Germany.

Join us and Ibu Robin in Germany, 21–25 October 2015.

— Misha, Midwifery Today’s new conference coordinator

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Featured Article

Breastfeeding Support at Yayasan Bumi Sehat: A Student Midwife’s Reflections

As a fourth-year midwifery student, I had the opportunity to go to Yayasan Bumi Sehat in Nyuh Kuning, Bali. To learn from Ibu Robin Lim and to gain experience in the art of midwifery was a dream come true. For many a budding birthkeeper, attending births, receiving babies and caring for women during childbirth are the most appealing areas of midwifery practice; indeed, inside the birth room, one masters essential midwifery skills. Until only a few days ago, I believed that the birth process marked the birth of the mother. Although birth is a profound rite of passage through the doorway of motherhood, I came to learn that sometimes the true birth of the mother is hallmarked by the mastery of breastfeeding. This insight was gifted to me only a few days ago when I was asked by Ibu Robin to visit one of our new mothers at her home. This is my story.


“Is it normal that my baby is shrinking?” asked the 38-year-old, single Indonesian mother. Alarmed by her question, I explained to her that “shrinking” was not normal or desirable for a baby. I began to probe further into her circumstances. I looked around her home and saw a baby bottle with some milk inside, a breast pump, a sleeping one-week-old baby and a mother who appeared stoic and exhausted. As she explained to me that she was pumping her milk every few hours to feed her baby, I asked her why she wasn’t simply breastfeeding. She told me her baby did not like her breast and preferred the bottle. She explained that her baby had “terms and conditions” and that she would only suckle her breast after she got the bottle. As I questioned a little more, I found that the baby was very jaundiced, dehydrated and appeared somewhat lethargic. Alarm bells started to go off in my head, and I knew that this baby and mama needed help.

After a discussion and consultation with Ibu Robin, we decided it was best for both mama and baby to stay at the clinic in order to test baby’s bilirubin; if we found it to be above normal, we would then initiate blue light therapy (12 hours on, 12 hours off the bili blanket—no separation from mother) to treat the jaundice and to provide around-the-clock breastfeeding support. After some negotiating with the mama, she agreed to come to the clinic so we could treat her baby and support her efforts to establish breastfeeding.

Ibu Robin asked me to “take this challenge” and commit to supporting this mother to fully breastfeed her baby. I reluctantly agreed, knowing from some past experience how difficult provision of breastfeeding support can be. I made the commitment to spend the night with the motherbaby, sleeping next to them in order to provide the encouragement and support needed to get the baby to accept the breast.

During the first feed at the clinic, the baby screamed and screamed and would not take to the breast. After a while, I felt my resolve starting to melt; maybe we should just give her a bottle, I shamefully thought to myself. There were times when I felt anger toward the mama for not listening to the advice I was trying to give her, such as “Be sensitive to baby’s early hunger cues” and “Don’t try to feed a screaming baby; console her first, then put her to the breast” or “First get yourself comfortable, then bring baby to your breast.” After what felt like a long while of persisting with no positive results, I decided to take myself out of the equation. It became apparent that the tension both the mama and I were experiencing was being transferred to the baby, making it more difficult to calm her down.

Feeling somewhat like a failure (being sleep deprived after a long night of births wasn’t helping), I walked over to Ibu Robin’s home to express my frustrations. I hoped some fresh energy and a new perspective would help the situation. It worked! A cup of tea, some food and reassurance that I was human and doing quite well really, all helped settle my heart down. After easily changing the feeding position to football style, which earlier the mother had refused to try, the baby accepted the breast and suckled for 40 minutes. We all felt a great sense of relief!

Lindsey Jean Stirling
Excerpted from “Breastfeeding Support at Yayasan Bumi Sehat: A Student Midwife’s Reflections,” Midwifery Today, Issue 113
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Birth Revolution Update

The Revolution So Far

[This update was first published in Midwifery Today magazine, Issue 113, Spring 2015.]

The Birth Revolution is like the slow food movement—it takes time to cook, it tastes best in community and a small taste leaves you wanting more.

At the Midwifery Today conference in Byron Bay, Australia, on a warm and windy afternoon on the sandy beach, we sang our Birth Revolution song (“We are here for a birth revolution, babies deserve the best…”), wore the Birth Revolution turquoise color, danced the Birth Revolution dance (spontaneously created) and wrote “Birth Revolution” in the sand. Byron Bay will never be the same.

Two Fijian midwives arrived just as the beach party ended. When they learned the reason for our gathering, they said, “We definitely need a Birth Revolution in Fiji.” They gave me a turquoise shirt with matching earrings and generously offered to have turquoise clothes made with “Birth Revolution” embroidered on them. And so the revolution grows—organically, naturally and now stylishly.

My good friend, Deborah Allen, likes to write the word birth like this: BEARTH, marrying the words birth and earth. If you think about it, more respect for Mother Earth would certainly translate into more respect for birth. Right now, heavy-handed industrial interests have trumped natural systems on earth and at birth. Birth, Mother Nature and all that is sacred should be regarded as such and not be at the disposal of monetary interests.

If you agree, then join the revolution. Create an action and post it on YouTube.

Our action on the beach was fun and included folks from the greater community.

Another symbol of the Birth Revolution is the Liberty Bell to celebrate “belly freedom”!

Onward!

Diana Paul gave birth to all three of her children at home. Her husband was “midwife” for the first two and Peggy Vincent for the third. She practiced as a midwife for 10 years and then picked up her camera, filmed births and started the nonprofit, Love Delivers. She is the producer of Birth Day, Attending Birth, Miss Margaret, Five Countries, Six Births, Seven Babies, and several custom videos.


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