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Robin Lim, CPM

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Birth on the Edge

Posted: 04/ 9/2012 12:42 pm

Imagine... I have been given this opportunity to communicate with anyone who clicks onto my blog, anything I want to say concerning my passion for mothers, babies, families, pregnancy, birth, postpartum and breastfeeding, and the politics surrounding all of the above!

It's a huge responsibility and, honestly, I'm feeling a little intimidated. Where shall I begin? There is so much I wish to say to each of you about all of it.

Sitting here tonight, I feel your hearts and it occurs to me that there is no hurry to speak it all at once, for you will be kind and patient readers.

My favorite way to share what I know of these issues is by talking story: true stories of my life, and of the many lives which I have come to know and have become intimately involved in. So I'll start with some of my last 24 hours at the Bumi Sehat community health and childbirth clinic in Bali, Indonesia.

Last night began with a call for help!

I was feeling pretty good about horizontal and the prospect of catching up on some much needed rest. As I lay there, waiting to disappear into the black well of sleep, I was reviewing the day: Our weekly pediatric clinic, with doctors specializing in holistic solutions for children with special needs, had gone well. I made a mental note to find out how the two new patients, children from upcountry, who had no legs, were doing. Two mothers had had lovely births during the day, one a waterbirth. Both new babies were breastfeeding well when I left for my much-needed shower. Clinic Bumi Sehat was relatively quiet and peaceful, and with three skilled midwives on duty, I reassured myself that I would sleep through the night.

11:33 p.m., the phone rings. It's our young midwife Rena, "Ibu (mother) please, come quickly! Some tourists are here with their hurt baby. And they only speak English."

A note: I sleep in my clothes. A history of frequent emergency calls has taught me that the extra minute getting dressed is time I often cannot afford.

Peddling, like crazy, downhill, my trusty red bicycle gets me to the clinic in less than a minute. Wailing, in the arms of very worried parents, I find a distressed, but healthy, strapping toddler. "He fell... but it was just down one step. Is it really possible that it's serious?" probes the concerned British father.

Deal with the trauma first: I reach for the homeopathic Arnica and administer a dose to the not-so-little Oliver. Almost immediately, his wailing ebbs into deep sobs. Gently placing my hands on his right arm is all it takes and I know that we are looking at one, maybe two broken bones. Midwife Agung Mas hands me the Arnica ointment as we try to relieve some of the trauma topically. I used a large elastic bandage to stabilize the arm, strapping it securely to the child's body.

"Our ambulance can take you to a good hospital." I reassure the worried parents and carefully give them information about x-ray, insurance, language support, etc. We calm the parents and make sure they use the WC (toilet) before the 45-minute transport to the hospital. One of the midwives has already called Pagi, our ambulance driver, and he has the ambulance waiting. Midwife Rena, who has the best English skills, accompanies the family to the hospital.

I have been on shift for most of the last 24 hours, but, now that I'm here... I check on the postpartum moms and new babies, joke with our night crew of midwives and watchmen, and then peddle home at almost 2 a.m. The slight incline begins to feel mountainous now and I push my trusty red two-wheeler the last 20 meters home, manage a quick rinse and collapse into bed next to my insensate husband.

Just before 5 a.m., my hand phone is buzzing madly. I am up instantly, knowing that it must be an emergency: A newborn is having difficulty breathing. I am off and running down my stairs and out into the darkness.

Just minutes old and Baby Wisnu is struggling -- no cry, but good muscle tone and his color is improving. His lungs are filled with liquid, including meconium, meaning that sometime either before or during the birth process, this baby was struggling, made a BM and then aspirated some of his poo.

Our midwife, Ibu Ketut, is delicately suctioning with a delee, while midwife Mala gently pats baby's back to help clear his lungs. I adjust the baby's angle, so that his head is lower than his body and give the baby a homeopathic medicine to dry out his lungs. Out of his distress, he begins responding to the gentle ministrations of our midwives helping him make the transition into earthly life.

I help the mother, Ibu Lestari, to deliver her placenta. I reassure her that her baby will be fine, as I suture a small perineal tear. Just as everything seems to be coming together, she starts to hemorrhage.

In the 1980s, a UNICEF study conducted by Dr. Inne Susante found that maternal demise from postpartum hemorrhage was the leading cause of adult death in Bali. Sadly, hemorrhages are still seen all too frequently here. At Bumi Sehat, we counsel every mother, during each of her prenatal visits, about the importance of sound nutrition in preventing childbirth emergencies and in improving out-comes for her and her baby. Fortunately, we are able to give each expectant mother prenatal vitamins, due to the generosity of our friends at New Chapter (vitamins) in Vermont. Even so, it's an uphill battle against malnourishment and the impact of one of its main culprits "New Rice," a strain of high-yield white rice that has replaced the nutritious red rice that was once the staple food of this region. It's now a leading factor in the alarming rate of women hemorrhaging after childbirth.

I am lucky enough to have anti-hemorrhage medications at hand, and Ibu Lestari's bleeding is abated. Midwives Ketut and Mala have been gently stimulating the baby while continuing blow by oxygen. After waking Dr. B and Dr. Nilan, and asking them to come help us, I join the two midwives. We continue to work diligently to bring the struggling baby into good, regular breathing and to dry up of his lungs. We pray for a good lusty cry from baby Wisnu.

While we are resuscitating the baby, Rosa, a young first time mother from Sumba arrives. She's 3 centimeters dilated and her blood pressure is high. Dr. B treats her with acupuncture and reduces Rosa's Systolic BP by 20 points, but her labor continues like a freight train.

Two hours after birth, to our great relief, Baby Wisnu has a lusty cry and feeds well at his happy mother's breast. Our midwifery team convenes in the nearby kitchen, jubilant over the successful resuscitation of Baby Wisnu, and hungry, having worked all night. As they prepare a meal for themselves, they serve up red rice porridge and hard boiled eggs for each new mother.

I slip into check on Rosa and find that she has quietly progressed and is actively pushing. Fortunately, my Indonesian biographer, Windy, has been shadowing me and is at hand. "Run and get the midwives. Rosa is having her baby, right now!" I glove up.

This poor girl is even less fortunate than most of our expectant mothers at Bumi Sehat. Rosa's diet has consisted of white rice, coconut oil and salt, with an occasional package of noodle soup. Because their lives in Sumba were so hard, they left home to come to Bali, in search of a brighter future.

Her baby girl comes tiny, yet full of life. The father, positioned on the birth bed to support his new wife from behind, is weeping. For this young man, this moment is one of promise and joy coming amidst all of their hardship.

Two babies before breakfast... Just right for Bumi Sehat.

Learn about Bumi Sehat for ongoing operations and to help realize our dream of building a new clinic. The CNN Hero prize money is enough to make a good start, but a proper earthquake-resistant clinic, one that will accommodate our patient load, will cost an additional $700,000. We know we can do it with the help of our loving partners worldwide.