May 9 update: link to News article about childbirth in Nepal
Thought I would pass this along to all my nursing friends who are interested in Nepal but who also are specialists in Maternal-child health. I usually focus on adult care, and this is new to me. There is now a Midwives Society of Nepal, formed in 2010, which I only learned about today.
and they are on FaceBook, of course.
Witness Birth in Nepal
Here is a link to a video about childbirth in rural Nepal.
it’s titled “Witness – Birth in Nepal”and it is two years old, though I only just saw it. I consider it to be excellent. it shows: the role of women when the husband works in India; the pressure to conform from the community;the role of lay midwives; the challenges of transportation in Nepal; issues related to HIV; daily life in a village; and also, a brief shot of the “delivery kit” widely used throughout rural Nepal.
It is in English and Nepali with English subtitles for the Nepali parts.
Role of Women
The single biggest problem in Nepal, if you ask me, is the role of women in society.
Here is an excerpt from my book in which I described the practices surrounding childbirth:
Maternity and Nativity
Around this time, Padma was spending every waking moment studying obstetrics. She divided her time between outpatient, inpatient and postpartum. She had learned how to check a cervix, I could sometime see her waving two fingers in the air like imaginary scissors, and I would chuckle at the recognition that she was processing her new found skill. She was now able to track the progress of labor, and evaluate the mother. At the dinner table, we were incredulous when she reported that she had seen an eight-year old boy take a mouthful of breast milk from his mom while they waited o see the mom’s new baby in the postpartum clinic. And she also told us more about childbirth in rural Nepal.
The Maternity Ward at Mission Hospital was not a place where I had much business. I knew that men did not attend childbirth in Nepal. This is true even for the father of the baby. Women don’t attend cremations; men don’t attend childbirth. A simple system. In the geographic area served by Mission Hospital, there were ten thousand deliveries a year, but only fifteen hundred took place in the hospital. The vast majority of babies were born at the mother’s home. In a high percent of cases, this really meant that the home delivery took place in a cowshed behind the family farmhouse.
Whoa. It sounded strange to me at first. Many of the houses in Palpa district were constructed of sun-dried bricks made of mud that was usually dug up right on site. In such a house there would be a dirt floor, reinforced by cow manure to give the walking surface a springy smooth appearance. It is porous. If you have ever been around during a delivery, you know that when a baby is born, he or she is accompanied by at least a few liters of the mother’s amniotic fluid and blood. If a woman delivered the baby in the house, all these body fluids would drip onto the floor, and soak in. The only way to clean the floor is to get a shovel and dig up the floor. By contrast, if the woman delivers the baby in the shed, the body fluids are be absorbed by the straw, which is a lot easier to replace. So I suppose that was the logic. The obvious problem with giving birth in the shed is lack of hygiene. Over a five year period the government and public health groups succeeded in decreasing the number of women giving birth in the shed. The government was also trying to decrease the incidence of neonatal tetanus.
When I heard about the cowshed issue, it made me rethink the nativity of Jesus Christ. In Nazareth, it may have very well been the case that every woman in Biblical times gave birth in the stable. The Bible does not give the statistics to determine whether this was unusual or not. In the West, when the nativity is told, we hear the phrase “no room at the inn” and we are conditioned to feel sorry for Mary, as though Mary was being singled out, but maybe Mary was being treated the same as every other woman of her day.
The next thing Padma told me was that most forms of contraception only became legal in 2003. Adolescent pregnancy was widespread. On a walk to the Bajar there were always a number of teenaged girls carrying babies. I learned to look for the vermilion painted at the part of her hair near the forehead, and to try to estimate the age of the woman more closely. If the vermilion was there, she was married and the baby was hers, regardless of how young she may have looked. I wondered how old Mary was when Jesus was born.
In Nepal every nurse receives midwife training during their undergraduate education, and every nurse in Labor and Delivery was qualified to conduct a delivery. The doctors only got involved if there were complications or if a cesarean delivery was needed. Padma was hoping to deliver some babies this summer, and if it was going to happen, she would need to build the trust of the midwives first. She would also need to be assertive and find the right time to jump in and be in charge when the time came. She would need to work with the doctors as well. Padma had a lot on her plate. We were all hoping she would get her wish. Al told us about nearly dropping a baby when he did obstetrics; and we teased Padma about whether she would drop her first baby on the floor. They are slippery.