Oncall Midwife

I have always wanted to be a private midwife, providing individualised care to women. Being oncall is part of that role. I’ve been that midwife twice before in Perth, supporting friends when giving birth. But now I find I’m providing this service on the end of the phone. Supporting women in remote villages of Papua New Guinea! And I’m in Perth, one of the most isolated cities in the world because of its geographical isolation from other cities.
Last year I had the most amazing experience to give guidance to Vivien, a village birth attendant from the village of Kambaramba, who was supporting a woman who had been in labour for 2 days and was having difficulty. After a few phone calls and lots of praying, the woman spontaneously gave birth and both mother and baby were safe because of the actions of Vivien.
Well, last month I had another experience of being the oncall midwife and this time it was to Vivien herself. She was expecting her 7th baby, not by choice but by chance, due to the lack of family planning available to women in this remote area. When I was in PNG last month with the charity, Living Child Inc. which I founded last March, Vivien was meant to come to our training in Bunam. Sadly, the boat she was meant to come on broke down and her husband also said she was feeling ‘heavy’ and unwell as she was due her baby very soon.
I spoke to Vivien on the phone a couple of times and she reassured me she was going to go to Wewak to deliver. We discussed the fact it was her 7th baby and so she was at high risk of bleeding after the birth. This birth would also be just 13 months after her last baby was born.
Prior to travelling to PNG on this most recent trip, Vivien’s husband had sent me a text message asking for a carton of condoms because he didn’t want his wife to die because she was pregnant. Sadly this is a common fact for many couples in PNG: if you have sex, there’s a very high chance the woman will fall pregnant, and there’s a very high chance she’ll die. Every day 4 women die in PNG from pregnancy related problems. And from the stories I’ve heard from the people along the Keram River villages, the rate is much higher.
So, on this particular evening, as I was settling down to have dinner with my family in Perth, Western Australia, I had a call from Vivien. “Sara,” she said, “Please help me. I’m in labour for 3 days and am very weak”. I could hear in her voice that she was weak and I was thinking, “why is she not in good labour with her 7th baby. There must be a problem”.
“Where are you Vivien?” I asked, hoping to hear that she was near the Boram hospital.
“I’m at home. Sara, please pray for me”
My mind was racing. This is not good. 3 days of spurious labour. The baby must be in an unfavourable position. I knew it would be dark and it was too late to call Samaritan Aviation as I presumed that Mark, the pilot, would not fly at night.
‘Are the contractions strong Vivien?”
“Not too strong. They come every 30 minutes”. This did not sound like active labour. She was showing signs of a very long latent phase of labour which is not a good sign for a woman who has had 6 previous babies.
Vivien was showing two signs of high risk for birth: more than 5 pregnancies and a long pre labour.
Silently I was praying to God to give me wisdom and the right instructions. It’s actually quite hard talking on the phone to someone who speaks another language. It’s much easier when you can see their face and use signals and actions to emphasise your message!
“Vivien, have some tea or water to keep strong and have some rest. Can you have some kaikai (food)?”
“I’m too weak for kaikai, but I’m taking tea”
“Ok, good. Now you must rest and in the morning travel down to Angoram so that you can get the Saman Balus to Boram hospital. I will call Mark and let him know”
“Ok. Thank you Sara”
“”Can you feel the head low in your pelvis?”
“Yes, the head is down”, she said.
I’m praying for you Vivien.”
I said a prayer over the phone for her.
I came off the phone feeling helpless. I knew as a midwife that it’s not a good sign when a women is in labour for a few days without having strong regular contractions. Something was stopping her from getting into good labour. I was thinking perhaps the baby was lying across the cervix or that there was some placenta in the way. I felt angry too that she had not followed my advice to travel to Wewak, but I also knew that is was always complicated. I was learning fast and from bitter experience that life in remote PNG is hard. They make decisions based on a whole different set of rules and values and I had to respect that.
‘Lord,” I prayed, “How many times have you brought me to this place where I feel totally helpless. And how many times have you shown me that you are an amazing almighty God who can do the impossible. I’m going to have to just trust you completely.”
I decided to send a facebook message to Mark to warn him that there may be a callout in the morning.
I put my phone next to my bed that night, half expecting a call from Vivien, but hoping that all would be fine and in the morning we’d be able to organise for her to get to Wewak for review.
At 2.30am I woke up from deep sleep to the sound of my phone vibrating on the bedside table.
I could see that there were 3 missed calls from Vivien since 1am.
“Oh no”, I thought, “The spirit is willing but the flesh is weak”. I was angry with myself for not hearing the earlier calls. I jumped out of bed and tiptoed through to the kitchen where my laptop computer is. I closed the door so as not to disturb my sleeping family and rang Vivien via Skype.
Isaac her husband answered.
“Vivien no good”, he said, “She lusim blood”.
My heart sank. Isaac passed the phone on to Vivien and she spoke in a very weak voice.
“Sara, please help me. Me lusim plenty blood”
Immediately I knew there must be a problem with the placenta and that’s why she was losing blood now. It was making sense. She needs to get to the hospital for a c section as soon as possible.
“Vivien, you must get in the boat and get to Angoram where the Saman Balus can pick you up.”
“No,” she said, “Saman balus land behind the school”. She could hardly string the words together. She was very weak and I knew she was in a life or death situation. If the placenta was covering the cervix both her and the baby would die as the cervix tried to open. In these situations the placenta bleeds as it is pulled away from the wall of the uterus and the blood supply to the baby is cut off. The baby dies from lack of oxygen and the mother dies from massive blood loss.
I was now feeling desperate and prayed to God as I spoke to Vivien, to help me give the right instructions.
I told her to tell her husband to call Mark and tell him the situation. I then prayed for her over the phone and sent a text to her with Mark Palm’s number.
There was a part of me that doubted the whole story. Maybe she was stringing me along to get a free flight to Wewak? Maybe I just didn’t know my stuff and was jumping to conclusions about her situation? Maybe I was getting it all wrong and how could I really diagnose a problem over the phone anyway?
I sent a skype message to Mark’s phone telling him that Vivien was now bleeding and needed to be picked up.
An hour later I had another call from Vivien and I could tell she was scared and very weak. She managed to tell me that Isaac was walking somewhere to call Saman Balus. She was asking me to help her and I felt so helpless. Eventually I told her, “God is bigger than me Vivien. Trust in the Lord. Saman Balus will come and get you soon.” And again I prayed for her over the phone.
I then prayed to God as I fell into bed feeling so useless because I wasn’t there to provide hands on care. I told God how helpless I felt and how confused I was about what the problem was for Vivien. I also felt frustrated that I couldn’t get into direct contact with Mark because it was still so early in the morning in Wewak and I wondered whether he would think I was crazy and overreacting in this situation. I told God I trusted that He is sovereign and that he knew exactly how Vivien was. I asked that Mark would get the message at the right time and be able to make a decision about retrieving her.
All of a sudden there was a message from Mark on facebook saying that he hadn’t heard from them yet. I felt deflated. Do I tell him to just get in the plane and go get them or do I trust that God will prompt the right decision at the right time. I chose to trust God and prayed like crazy.
I fell into a deep sleep.
At about 6am my time I woke up suddenly and looked directly out of my bedroom window to a magnificent reflection of sunrise on a tree. Immediately I felt God say to me “Vivien will be ok”. As soon as that thought hit me, my phone beeped to say there was a facebook message. It was from Mark to say, “I’m in the plane going to get her”.
My heart sang for joy as I realised what God was doing.
My family, who had followed this journey with me and felt such sorrow at what was happening, were now joining me in celebrating as we realised that the Saman Balus was on its way.
I prayed for Mark and the mission to rescue Vivien.
It was reassuring to hear that she was very weak and it was good that they picked her up. Then later that morning, I cried tears of thanks when I heard from the Obstetrician at Wewak hospital, that she had indeed had a major placenta praevia. That means that the placenta completely covered the opening of the cervix and there was no way the mother and baby would have survived without a c section.
I felt overwhelmed with thankfulness. Validated as a midwife and reassured of God’s amazing love and provision for his people. I also felt so thankful to God for His amazing gift of connecting Living Child to Samaritan Aviation. What team work!

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