MERGING MIDWIVES

I would like to invite everyone who follows my blog to take a look at my latest project, Merging Midwives.

This project is a cross cultural education exchange that has been designed by myself to help midwives from Bumi Sehat gain further education. Opportunities for professional development in Indonesia are extremely limited, almost non-existent.

A small group of midwives from Bumi Sehat have been invited to Australia for a two week study tour in September 2015. This is a collaboration with a university in Perth and we will attend classes and tutorials, visit the local hospitals, clinics and private midwifery practices as well as host our own workshops to share the role of an Indonesian community health centre with our Australian midwifery colleagues.

I am currently fundraising to cover all the costs involved. We are halfway there but need your help!!

Please take a look at this project and pledge! Support midwives from developing countries so they can give the best care possible to mothers and babies. If you are not in a position to help financially, please share with your family, friends and networks. ThankYOU!

You can visit my crowd funding site here:   http://www.pozible.com/project/197286

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A water birth for Ibu Marini

So I have had a bit of a hiatus these last few months from writing anything here.

I began studying my Masters of Midwifery at the beginning of the year which has kept me pretty busy. I have also been working on a project called Merging Midwives – a cross cultural study tour where we will take a small group of Indonesian midwives from Bumi Sehat to Australia for continuing education. Watch this space!!

However amongst all the study, the planning and organisation, I have still been attending lots of beautiful births.

Ibu Marini came to Bumi Sehat for the birth of her fourth child. Her previous births has been smooth and uncomplicated. As Ibu Marini’s labour progressed it became more and more challenging to deal with the pain and she was feeling overwhelmed. Gung De Soma, the youngest son who was also born at Bumi Sehat and wasn’t yet at school. He was wandering in and out of the room, not sure where he belonged. Ibu Marini kept one eye on him as she dealt with her pain.

Gorgeous family welcoming baby Gung Ketut

One of the midwives asked her if she would like to try getting into the bath. The bath?? She asked. Yes, we said. It can help with the pain…… and it can feel LOVELY! She hopped in the bath and almost immediately began to relax. She took some deep breaths. She smiled. She looked serene and beautiful. Not long after entering the water, Ibu Marini gave birth to a healthy baby boy. He weighed in at 4200gm! Later that afternoon, the older brother and older sister came after school to meet baby Gung Ketut. Afterwards Ibu Marini told us she was amazed at how relaxing and magical the water had been. For her other labours, she had not tried using the bath.

Ibu Marini, tired but happy!

Ibu Marini, tired but happy!

Waterbirth is a safe method of birth that can have many benefits. Many women report reduced pain and there is a better chance of an intact perineum and a lower chance of a 3rd or 4th degree tear. A lot of women feel more relaxed and more in control in the water. It can also be all the pain relief a woman needs, so women who may choose other pharmacological methods can be happy with using only water. You can read more evidence based research about the safety of water birth here: http://evidencebasedbirth.com/waterbirth/ http://www.waterbirth.org http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12194/abstract

Nabi’s gentle landing at Bumi

Lan had her first baby at a clinic in Bali, which was not a terrible experience but not necessarily a good experience either.

She wasn’t able to change her position in labour as the midwives preferred that she stayed on the bed. She said this felt restrictive and she didn’t like the fact that she couldn’t move instinctively.

Lan was given an episiotomy, which is an outdated and unnecessary procedure.

During her second pregnancy, she heard of Bumi Sehat clinic and felt that it would be a better and more holistic place for her to birth her baby. She wanted to try something different as her first experience had not been ideal.

She arrived at the clinic in labour with her husband and young daughter. It was the wee hours of the morning and her husband decided to take their daughter home as she was feeling restless and it seemed there was still time.

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She has arrived!

Lan’s labour moved forward quickly and soon enough she felt that her baby was ready to be born.

Her husband was still on the road.

Lan entered the water and we sang the Gayatri mantra as she gave birth slowly and beautifully to her gorgeous girl. Lan slowly breathed her out into the water with the most radiant smile.

A few minutes later, Lan’s husband arrived and much to his surprise, Lan was cradling their precious new daughter in her arms, beaming out love and strength.

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Opening her eyes for the first time

Thank you for choosing to share your beautiful experience with us.

Thank you for choosing the most gentle and lovely birth for your baby.

What an incredible start to her journey of life.

Pregnancy termination in Indonesia

Disclaimer: This is entirely my own thoughts on pregnancy termination in Indonesia and does not represent the views of Bumi Sehat. I also want to make it clear that the biggest issue I see is a major lack of sex education and readily available contraception in order for women to be in control of their reproductive rights. 

Abortion in Indonesia is illegal.

However there are grounds on which an abortion may be permitted in this country and that is to

SAVE THE LIFE OF THE WOMAN.

Saving the life of a woman could be interpreted in many different ways.

Having a baby could feel as if it is the end of a womans life, depending on her circumstances. It could be a woman who is unmarried or without a partner, a student, a teenager,  someone who is uneducated, without an income, without work opportunity or a victim of rape. Women in any of these situations could feel that there is no other way for them to survive but to terminate their pregnancy.They may feel that keeping the baby will destroy their life. However the decision to have a unsafe abortion may also have major health implications for the woman, including disability or death.

Having an abortion in Indonesia is highly risky. With safe abortion being so incredibly restricted the only option for women is unsafe abortion, which is estimated to represent 11-14% of all maternal deaths in Indonesia. The real numbers may be much higher as most abortions are illegal and therefore unrecorded. Some studies have quoted figures up to 40- 50%. An illegal and unsafe abortion puts the mother’s life at risk.

Safe abortion flashmob in Jakarta

Safe abortion flashmob in Jakarta

The law is very unclear.

Abortion was made illegal in Indonesia in 1918 and the continuing debate surrounding the issue has been greatly influenced by conservative Islamic groups, with the vast majority of the 240 million strong population of Indonesia identifying as Muslim. It is an incredibly complex problem within the cultural, religious and political climate of Indonesia. Many Muslims believe that abortion is forbidden by the Koran.

However there are many Islamic womens’ groups in Indonesia that are lobbying against this as they do not agree that this is the true message. The abortion law that was written in 1992 and revised in 2009 states that abortion is allowed up until six weeks however only in rape cases or where there the mothers health is at serious risk.

If it is a life threatening emergency, the woman must produce a marriage certificate as well as her husbands consent to the procedure. It will only be considered if it is before six weeks of pregnancy. The government recently updated the regulations on abortion in 2014 however it contains no new policy and remains prohibited in the majority of cases. There are no exact figures of the number of abortions happening in Indonesia every year however the National Population and Family Planning Agency (BKKBN) estimate that in 2012 there were approximately 2.4 million abortions, with 800,000 of those women being teenagers.

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A 2008 study by the Guttmacher Institute at health clinics in six regions across Indonesia found that in urban areas, 85% of abortions were performed by obstetricians, midwives and family planning staff. In rural areas 80% of women would seek the assistance of a dukun, which is a traditional healer. The traditional method usually involves drinking herbal mixtures, rough abdominal massage and the insertion of leaves and roots into the uterus through the vagina. Nearly half of all women seeking abortions will turn to a traditional healer first. The most common complications with this method of abortion are bleeding, infection or poisoning from substances used to induce abortion. Women can also experience uterine perforation and injuries to their abdomen and genitals.

The maximum prison sentence for the practioner providing an illegal abortion is 15 years.

The woman seeking the abortion can face up to 10 years of imprisonment.

The World Health Organization states that it is an unmet need for contraception that is the major contributor to unsafe abortion. Millions of women are experiencing unwanted pregnancies as there is not sufficient access or education about family planning and pregnancy contraception. My personal experience reflects this, and the lengthy discussions that I have had with people who work to provide sex education in Indonesia agree.

The number of women that are dying from unsafe abortion and the number of children who are permanently disabled from failed abortions is devastating. Women need to be given options when it comes to their reproductive rights. It is their body, their baby, their choice.

Firstly there needs to be a significant nation wide improvement in the access to family planning counselling and education about sex, particularly in rural areas. Women need to know where, how and with whom they can access contraception. They need thorough education and have access to help when required.

There are a number of organisations that are doing incredible work in Indonesia to address the issue of womens reproductive rights in the face of strong opposition from government and religious groups.

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The Indonesian Planned Parenthood Association deliver an extensive range of sexual and reproductive health services through permanent clinics, mobile services and community distribution with a particular focus on marginalised groups such as street children, sex workers and transgender men.

The Yayasan Kesehatan Perempuan or Womens Health Foundation is a Jakarta based NGO also passionate about the state of womens reproductive health and wanting to create positive change. Below there is a link to an educational fact sheet they have produced.

Samsara is a Jogjakarta (Central Java) based organisation that have a telephone helpline for women wanting to receive education and counselling around unwanted pregnancy and abortion, staffed by volunteers. They are very active within the community and provide an amazing service. It is a highly complex issue and we can only hope that there will be better education available to women in regards to safe abortion in Indonesia in the future.

It is unacceptable that so many thousands of Indonesian women are losing their lives in this way. It is a multi layered and highly complex issue and it is not until there is adequate sexual health education and widespread access to contraception the situation for Indonesian women and their families will improve.

Links:

  • Jakarta post article outlining the ease of which women can access unsafe abortions: http://www.thejakartapost.com/news/2013/02/20/abortion-today-still-secret-easy-find.html

The Ari-Ari

Ari-ari is the Balinese name for the placenta.

It is derived from the word ari, meaning younger sibling.

In Bali, the placenta is an incredibly important part of the birth process. It is believed by Balinese Hindu’s that while babies are in the womb they are protected by the four ari-ari, or four younger siblings.

They are:

Bhuta nyom (amniotic fluid)

Bhuta rah (blood)

Bhuta ari-ari (placenta)

Bhuta tabunan (belly button)

These siblings accompany and guide the baby while it is inside the womb.

They protect the baby and help the baby to be born.

They show the baby the way out.

 

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Baby sleeping peacefully still attached to placenta

Therefore when the placenta is birthed, it must be strictly guarded as it an important part of the family tapestry. This is generally the responsibility of the father. When women give birth in the hospital still the placenta will be put inside a clay pot for the family to take home. The ari-ari is believed to be the spirit guide for the entirety of the child’s life. It is treated with absolute reverence.

Once at home it will then be buried inside a young coconut or the clay pot. It will be buried on the right side of the family home if it is a boy, and the left side if it is a girl. Some families will add objects to be buried such as pencils, a comb, some money or sweets depending on what hopes they have for their child’s future.

If families do not have their own home, often they will release the ari-ari into the ocean. When the placenta is buried or released to the ocean the family will recite the Gayatri mantra, one of the oldest and most powerful of Sanskrit mantras. This gives blessings and prayers for a happy and healthy long life for this baby.

If the child is hurt or upset the parents can go to where the ari-ari is buried and take some of the earth and rub it onto the third eye of the child, calling on its spirit guide for some love and reassurance to calm the child.

It has been interesting to read that historically the umbilical cord has been left attached for some time in both Hindu culture and with Indigenous people in Australia. References to lotus births have been found in the religious traditions of Hinduism, Buddhism, Judaism and Christianity.

At the clinic the practice is to leave the cord attached for hours after the birth and then the family chooses how or if they would like to separate the baby from the placenta. Burning the cord is a common practice and again has historically been practiced in various parts of Asia as it a gentle and hygienic way of separation.

It is so beautiful to be a part of a birthing culture where every single mother, father and family see the placenta as sacred. It is also such a relief to see babies receive all their blood supply because of the common understanding that that is what is best and right, not only for the physical health of the baby but also for it’s spiritual transition to earth.

 

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Burning the umbilical cord to separate it from the placenta

 

 

 

The birth of Arumi

Ibu Cindy and Pak Luffy are both originally from Java. They met in Bali two years ago and fell in love.

Two weeks ago they came into the clinic for the first time when Ibu Cindy was 36 weeks pregnant. We were surprised to learn that she had only gained 5 kilograms during her pregnancy. On average women gain approximately 10-16 kilograms in pregnancy however information on pregnancy weight gain patterns from developing countries is scarce.

An Indonesian study from Central Java suggest that an average weight gain for an Indonesian woman can be between 9-10kg. It can also be heavily influenced by pre pregnancy weight and nutritional status, as well as diet and nutrition during pregnancy.

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Ibu Cindy had a small beautiful tummy and could have passed for about 28-30 weeks of pregnancy. She said that everyone kept telling her how small she was and she had cried at night because it had made her worry about her baby.

They seen the doctor at the local hospital but Ibu Cindy felt scared about birthing in the hospital. She had heard lots of bad stories and she was concerned that they would tell her she must give birth by caesarean.

Ibu Cindy wanted to have a normal birth.

After searching on the internet for a good doctor, they serendipitously came across the website for Bumi Sehat. They decided to come in and see the clinic.  We did a check up and although we were a little surprised that she was small, we were more than happy for her to give birth at the clinic. The midwives trusted that there was no major cause for concern and she was growing a baby to her size. They brought in their results from their ultrasound that showed a normal healthy growing baby.

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A few days ago Ibu Cindy gave birth at the clinic to a gorgeous healthy girl that they named Arumi. She had a quick labour and a lovely birth of a baby weighing 3000gm!

Well, we were all very surprised to see her chubby legs and arms.

And cheeks!

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The parents were overjoyed. Pak Luffy could not stop smiling for days. He said that it was such an amazing experience to see his daughter be born in such a gentle way.

They felt so lucky that they had found the clinic when they did. The love and appreciation that was beaming out of both mama and papa was incredible.

Moments like these are magic.

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Links:

Indonesian study on weight gain in pregnancy :  http://ajcn.nutrition.org/content/75/6/1072.full

I am a Village Midwife – Ibu Maria

Ibu Maria is a twin.

She was born at home in Flores, in East Indonesia. Her mother birthed a baby boy and girl onto the floor of their small village house. There was no hospital, no telephone, no doctor.

There was, however, help from the village midwife and help from the family.

Her mother bled badly after the birth and there were no drugs available to help stop the bleeding. Instead the midwife used a type of jamu, a natural medicine made from turmeric and honey. The bleeding was controlled however Ibu Maria’s mother believed midwives needed more education and more skills. The nearest hospital was three hours by motorbike so it was almost impossible for a woman to make it safely when she was haemorrhaging.

When Ibu Maria was in high school, her mother told her about the story of her birth. She urged her to become a midwife, as there was a severe shortage of skilled birth attendants across the entire Indonesian archipelago and women and babies were dying unnecessarily. The words of her mother stuck and as she grew older she felt that this was the right path for her.

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Working at Bumi Sehat

Ibu Maria became a nurse and returned to East Timor, where her family was orignally from and began working at a clinic on a small island named Pulau Atauro. Ibu Maria provided all types of health care for the small island population. Each month she would travel by longboat to do health assessments in the five districts of the island. There wasn’t much in the way of roads so people generally travelled by boat or by foot. She worked alongside a nurse and a midwifery assistant and they would provide general first aid, childrens immunisations, pregnancy checks, malarial medication, weigh and check the newborn babies and give advice on family planning and general health and nutrition.

During this time, Ibu Maria had married and became pregnant with her first child. She had met her husband in Timor and he had since returned to Bali to take care of his parents who were growing old and needed support. Ibu Maria travelled to Bali to be with her husband for the birth. Afterwards she returned to the island in East Timor to continue working. She loved her work and it was a beautiful place to live. She lived there alone for the next four years and took her small daughter with her everywhere while she was working. She also finished her midwifery diploma!

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Working with the younger midwives of Bumi Sehat

When she moved to Bali to be reunited with her husband, she again worked alone in a small clinic. Ibu Maria was the village midwife, just like her mother had dreamed she would become. She would assist at 5 to 10 births every month. Often women would come to the clinic to birth their babies or Ibu Maria would go to their homes. She said that back then births were much more easy compared to now.

Women would rarely haemorrhage, they would not need suturing and there were very few complications. She associates this with a diet that was more healthy and natural. Ibu Maria believes the rice in Bali was previously of much higher nutritional quality and also MSG was not commonly used. People were more healthy, she said. Her husband would sometimes accompany her to births. He would make hot water and get towels during the labour and after the birth make the mother porridge, boiled eggs and sweet tea. She laughed as she told me how he was such a dedicated birth assistant!

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Ibu Maria

Sometimes she would need to take women to the hospital. This was a complicated and time consuming process. First they would need to find somebody who had a car. Then they needed to find a driver. They would put a plastic sheet down into the tray of the pick up truck or ute. Everything took time, and sometimes if they couldn’t find a car they would walk out to the main road to try and find someone. If women were bleeding, Ibu Maria would put in an IV line to the woman, hang the bag of fluids off the back of the vehicle and jump in the back with her to go to hospital, massaging her uterus the whole way there.

There was also no running water in the clinic where she worked. Ibu Maria would wash all the clinic tools, instruments, clothes, sheets and HERSELF in the river. She would cart water up from the river for drinking and washing in the clinic. Ibu Maria has worked for 20 years at that clinic. She has seen many big changes over the course of time and saw the standard of care improve. Today the clinic has a much larger and more skilled staff of a doctor, midwives and nurses. She was the only midwife there for many years. Ibu Maria continues to work at the clinic usually during the day and works night shift at Bumi Sehat. She is a very skilled and busy midwife and has further training in sexual and reproductive health and can provide family planning counselling and contraception.

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Waiting for the babies to be born. Working two jobs can take its toll!

Ibu Maria is a knowledgable and refreshing midwife. She has a light and cheeky energy that is always welcome in the birth room. Women receive her very well and she has a particular focus on giving women as much information as possible so they can make educated choices.

I often see her drawing pictures or showing women dolls and pelvises to make sure she is getting her message across. She is now wanting to learn hypnobirthing methods, pregnancy yoga and wants to train to become a doula! She already provides very comprehensive care to the women and families that she works with but wants to be able to give even more.

Ibu Maria is incredibly dedicated to furthering her skills and becoming the best midwife she can be.

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Looking good in my sunglasses!