Mother Health International—motherhealth.org

Mother Health International’s Mission and Model

Editor’s note: This article first appeared in Midwifery Today, Issue 115, Autumn 2015.
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Mother Health International (MHI) is dedicated to responding to and providing relief to pregnant women and children in areas of disaster and extreme poverty. MHI is committed to reducing the maternal and infant mortality rates by creating healthy, sustainable holistic birth centers using the midwifery model of care.

Mother Health International was founded in 2007 after midwife Rachel Zaslow spent several months working in a government-funded hospital in Northern Uganda at the end of the civil war. The hospital was functioning at what the WHO estimated to be over 10 times its capacity. Women were turned away in labor or sent to walk home minutes after giving birth, often bleeding to death on the road home. Women who were admitted to the hospital were often treated violently by the hospital staff for not “pushing fast enough” or failing to bring their own piece of plastic on which to give birth. These conditions made the hospital a traumatic, dangerous place to give birth in an area already ravaged by war.
Over the last seven years, MHI has worked in coordination with local midwives who serve their own communities. They work to build Earth Birth Centers, which are country-specific maternity centers run by local midwives. Mother Health International helps to physically build structures, develop culturally competent protocols, work hand in hand with traditional midwives to develop skills and create sustainable methods for obtaining supplies and emergency equipment.

Each clinic provides: comprehensive prenatal care, both on site and through mobile outreach programs into rural areas; education and support groups for pregnant women; labor support; postpartum care; transport to and from the clinic for laboring mothers and postpartum families; ambulance services for emergencies; postpartum follow-up of babies from birth until six months; and education and support of traditional midwives.

Creating spaces where women can access comprehensive care and also join in community restoration efforts is intrinsic to our mission. Our outcomes make it clear that our model works to reduce maternal and infant mortality. Simultaneously, we are combating the violence and trauma that women often experience giving birth in overcrowded and understaffed hospitals. When women do not see pregnancy as a potential death sentence they take care of themselves and their children differently. Our model allows women to participate actively in their daily health care. Women are treated with respect and given one-on-one attention.

—Rachel Zaslow

Pilot Clinic:

Ot Nywal Me Kuc Birth Center

MHI’s pilot clinic is in Northern Uganda. This birth center called Ot Nywal Me Kuc (House of Birth and Peace) is located in Atiak, 20 miles south of the border with South Sudan. The closest hospital is 50 miles away in Gulu. The birth center itself is government approved and employs traditional midwives. On average, 45 women give birth each month at the clinic, and many come every week for antenatal care.

In Northern Uganda, a woman has a 1 in 25 lifetime chance of dying during childbirth. The infant mortality rate is 10 times higher than anywhere in the Western hemisphere.

The MHI clinic in Uganda has seen over 2700 deliveries in the last three years. They have never lost a mother and their infant mortality is 12/1000, compared to the national average of 54/1000. They attribute this to one-on-one care that integrates nutrition, counseling and holistic support from prenatal through labor and delivery and into postpartum care. In 2013, 1842 women gave birth at Ot Nywal Me Kuc. Among them were thirteen sets of twins. Additionally, they saw 1776 women for prenatal care, and 182 women received family planning education. They employ three full-time traditional midwives and two full-time nurse-midwives.

Haiti’s Soley Lavi Birth Center

Mother Health International also introduced its presence in Haiti following the 2010 earthquake. The need for comprehensive health care in Haiti is clearly established. More recently, data collected and interpreted by UNICEF found that Haiti has the highest infant and under-five mortality rate in the entire Western hemisphere. Maternal mortality rates soar at 360/100,000; the average rate at this time in developed countries is 16/100,000 (UNICEF, 2013). Mother Health developed the Soley Lavi Birth Center in Haiti, where services offered include antenatal care, nutritional support, labor/delivery support, and postpartum care in Jacmel.

Over the past few years in this region, women have increasingly chosen to birth their babies at home. This increase in homebirth has caused a shift in need and a decline of the need of birth services at Soley Lavi. In response, Mother Health International shifted its focus to provide support and collaboration with traditional homebirth midwives. These midwives (called matrons) provide support to homebirth midwives in Jacmel and surrounding communities. Soley Lavi remains open to provide resources and outreach to community members; it is supported by Direct Relief International.

Key Success Factors: Sustainability

Cultural and environmental sustainability are the cornerstones of MHI’s birth model. Ot Nywal Me Kuc in Atiak, Northern Uganda, is a solar-powered and self-sustaining birth center. The work of Mother Health International is governed by the conventions of local leadership, renewable resources and clinics that financially sustain themselves. The model works to combine renewable Western practices with traditional methods.

Services at Ot Nywal Me Kuc are offered free of charge, and women are asked to contribute to a project that helps to sustain the clinic. Women have choices when fulfilling their volunteer hours. They can work in the garden, participate in a sewing collective or a beading project. The food grown in the garden goes into the clinic kitchen to feed pregnant, laboring and postpartum mamas. Other projects include sewing Moon Pads (reusable menstrual pads which are sold locally and internationally), baby slings, maternity and baby clothes, creating local crafts and jewelry. Each of these projects is earth-friendly, fair trade and organic. The products are sold and the proceeds go back into purchasing supplies for the clinic.

Cultural Sensitivity

Traditional midwives are women who practice midwifery as it has been handed down to them from generation to generation. Replaced over several years with a biomedical approach to childbirth, traditional midwifery has almost been eradicated in many places around the world. MHI is committed to preserving traditional midwifery knowledge and valuing its importance as a culturally-specific approach to women’s health care.

Most NGOs and models of formal education function along a continuum of colonization and charity, which assume a “West is best” mentality. Despite the government’s push towards hospital births, it is estimated that 80% of births in rural areas take place with traditional midwives, which makes them critical health care providers and crucial to community restoration efforts. We believe that holistic and restorative reproductive care is essential to a future of peace and development.

—Rachel Zaslow

Respectful Care

A large population of clients at Ot Nywal Me Kuc is made up of displaced people with severe past war trauma. Chronic stress affects mortality rates of mothers and infants, as does exposure to war and suffering. Rape and sexual violence are often used as weapons of war in times of civil unrest. In one study, the women refugees who had experienced rape and sexual violence in this context reported higher incidences of health concerns, such as perinatal health problems, impaired mental health, lack of appropriate health services and discrimination (Berman et al. 2014).

Midwives at Ot Nywal Me Kuc are attuned to the possible dangerous manifestations of trauma during pregnancy, labor and delivery. They have found that approaching women affected by war violence, trauma and poverty with dignity, respect and gentle, loving care is much more effective in the long run than the hierarchical and controlling treatment that has become commonplace in some nearby hospitals. There are many explanations why this compassionate birthing assistance is not as widely practiced in the government hospitals. The nearby government regional hospitals in Uganda are not equipped with enough supplies or providers to serve the number of people who need care. Often there is no water, no access to gloves and medication, scant electricity and other resources needed to make a facility successful. Comprehensive health care is difficult if not impossible to offer in this setting. Gentle birth has not been an option in the hospital setting, and sometimes, attended birth is not an option. There simply are not enough care providers for patients. The Mother Health birth model sees gentle birth as a human right to which every woman should have access and it has founded its birth center on that basis.

Competency in Care

In Uganda at Ot Nywal Me Kuc, traditional midwives provide prenatal and postpartum care for women by travelling by bicycle or motorbike out to the homes of these families. Mother Health International’s founder, Rachel Zaslow, has asked the question, “How do we train people to become professional midwives without undermining the wisdom of traditional midwives?” In asking this question, she pioneered a brilliant tool allowing traditional midwives to flag complications or potential complications for the fetus during pregnancy.

The HeartString is a color-coded bracelet that allows midwives who cannot read, write or count to monitor fetal heart tones in pregnant women and infants. Using a sand timer that is set to 15 seconds and a Pinard horn or fetal stethoscope, traditional midwives listen for the fetal heart rate (FHR), pressing a bead each time they hear a fetal heartbeat. When the sand timer is emptied, the birth attendant observes where she has landed on the HeartString. If she is in the white section, the FHR is depressed; in the green, the FHR is in a range of normal; in the red, the FHR is high. The HeartString is a low cost, easily produced, culturally adaptable tool. It is a solution for traditional midwives to accurately assess fetal heart tones and ultimately determine fetal distress and initiate appropriate plans to improve fetal status. By working within local infrastructures to offer practical tools for traditional midwives to improve outcomes, MHI believes that they will have the long-term capacity to increase women’s ability to access care and thus radically reduce perinatal mortality.

Mother Health has a Mobile Midwives program that sends midwives into rural villages each week to care for women who are unable to travel to the clinic. Reaching out to women in this way has facilitated a decrease in maternal and neonatal mortality in the area. Regular prenatal care ensures that mothers are nourished, sexually transmitted infections and other illness are treated, baby’s growth and well-being are tracked and issues are noted before they become emergencies. This makes the population of women automatically lower risk for seriously life-threatening emergencies at the time of birth and postpartum. Tracking children who are born at the clinic in this same way means that the wellness of each child is followed to make sure they are part of a network of support if and when illness occurs.

Love and Compassion in Action

In addition to the many tangible examples of love and compassion in action, such as HeartStrings and the various fair trade projects, here is a story of Agnes, a young Ugandan woman reflecting on the birth of her first daughter at the birth center in Atiak. This story has been translated from Acoli to English.

I came here several times when I was pregnant. They tested me, they gave me tea and I went with it home. And then on the 11th of May at night, I started to feel pains very strongly. I called these people at the birth house around 2 am, and I told them what was going on. They came immediately and picked me up. When I arrived at the birth center, there were three midwives there to help me. They walked with me and told me I was going to make it through. They fed me and gave me tea, which gave me strength to continue. I gave birth around 5 am. Giving birth was not easy. I felt like I might die, but these people helped me. After I delivered, they massaged me and gave me something under my tongue. It really helped me; the pain and bleeding stopped.

They gave me clothes for the baby to take home. They even gave free water and I didn’t have to haul it myself. They also give food. I don’t know of any other hospital in Uganda that gives food. I ate so well and it gave me strength to feed my baby. When I got back to the village, I gave the phone number of the birth center out to two women. We called and the midwives also came here when it was time for my neighbors to give birth. I like this place. I came back for postpartum care and to work on beading because they really helped me and I want them also to help others. Before this place, most women gave birth at home alone because if you go to the government health center, there is no hope, no care. They will leave you alone or even beat you. Even my husband was happy that I was there. He said, “Go to them! They will care for you!”

I encourage some people from home to come here. I had not gotten any clothes for my baby yet, so they helped me make my baby beautiful. The midwives really think about our people’s problems and share with us. They really help. I am now proud of being a mother. Now some people respect me. Even my husband respects me more because I gave him a baby and we love her. I am 20 years old and proud to be a mother.

Future Plans

In the case of an emergency, which constitutes a need for the woman to go to the hospital during labor, delivery or postpartum, the birth center arranges for a ride to the hospital. The nearest hospital is three hours (50 miles) away and the ambulance for MHI is no longer functioning.
After a successful fundraising campaign in 2015 to purchase an ambulance to transport high-risk women to the hospital, there remains an ongoing need for fuel and maintenance of this life-saving vehicle. To find out more or to contribute, go to www.motherhealth.org/mobile-midwives.

References:

  • UNICEF. 2014. Fulfilling the Health Agenda for Women and Children: State of the World’s Midwifery Report 2014. Accessed August, 2, 2015. www.countdown2015mnch.org/documents/2014Report/Countdown_to_2015-Fulfilling%20the%20Health_Agenda_for_Women_and_Children-The_2014_
    Report-Conference_Draft.pdf.
  • Zaslow, Rachel. 2015. Personal Communication.

About Author: Kay Sandberg

Kay Sandberg is the founding president of Global Force for Healing, a visionary nonprofit which convenes the Healthy, Compassionate Birthing Network of global grassroots projects for underserved, remote communities based on the midwifery model of care (www.globalforceforhealing.org/project-one/). Kay lives in Ashland, Oregon, and is a member of Southern Oregon Birth Connections (SOBC).

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About Author: Shane Carnahan

Shane Carnahan is a registered nurse in Ashland, Oregon. Shane has spent a great deal of time advocating for women and families in childbirth locally as a midwifery apprentice and as a certified doula. As a nursing student, she was an active member and media/communications chairperson of the OHSU Nursing Students without Borders university organization and an intern with Global Force for Healing, a local nonprofit organization. She is the mother of a 13-year-old boy and an advocate of human rights.

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