Do Not Throw Away Your Confidence

As I went to sleep the night after the accident I prayed to God, ‘I’ve lost my confidence. Is this a sign from you that we are not to proceed in the morning on our trip to Angoram? Lord, you’ll need to show me very clearly that we are still in your will and that it is safe for us to travel tomorrow. I’m not going unless I feel at peace and have a sign from you’.

I was talking straight with my Heavenly Father. That’s the thing I just love about Him. He’s big enough to take my deepest thoughts and fears. And I think He loves it when I speak boldly to Him. First.

I slept well and in the morning woke up to my phone beeping with a new text message. It was a verse from my friend in Perth. All that she knew was that I’d been in a vehicle accident and had asked her to pray for us. The verse she sent to me was from Hebrews 10:35, it read, “So do not throw away your confidence; it will be richly rewarded.” Tears pricked my eyes. I felt God speak directly to me through that verse.

My eyes fell on the next verse: “You need to persevere so that when you have done the will of God, you will receive what he has promised.”

That was all I needed to feel at peace that I was still in the will of the Lord and could proceed knowing with confidence that He was with us. I had renewed strength and gathered up the team ready for the journey to Angoram.

This time we travelled in convoy with the Angoram District Administrator. Our trip was bumpy, but uneventful. We were delighted to arrive in the small riverside town safely. The team was introduced to the District Health Program Manager and a timetable for the next few days was discussed.

That night we settled into our small but cosy dorm rooms. It was hot and humid. The sounds of insects was loud, but soon our songs of praise and thanks echoed round the place like perfume to the heavens. We were so thankful to finally be in Angoram, the town that always we past through quickly due to so much fear. I felt we were on the cusp of something quite special that was going to happen in Angoram. ‘The Lord is good’, I thought, as my head hit the pillow that night.


Midwifery Beyond Borders


P8250143.JPGI’m currently in Johannesburg waiting to travel home to Perth after spending a few days in Nairobi, Kenya providing Reproductive Health training to field workers from an emergency humanitarian relief organization. On my way to Kenya it suddenly dawned on me the significance of the name of my blog: Midwifery Beyond Borders. There is an incredible shortage of midwives with global experience who can support and encourage skilled birth attendants SBA in low to middle income countries where the maternal death rates are highest. I am certainly stepping beyond my borders and into areas I never thought I would, even could step into.

I’m also starting to see a pattern in the type of work I do. Throughout my life, even as a small child, there has always been a restlessness with the status quo: I can see how things can be done better or see a gap for a new program, new intervention, new idea, new way of doing something. I remember as a young adult struggling with this; as a woman in my thirties, wondering why I could never just be happy with how things were and accept them; and now in my forties starting to creatively accept that this just who I am. Inevitably my new way of thinking or doing something, rubs people the wrong way, especially people or authorities that are keen to maintain the status quo! I’ve always had a strong sense of social justice and speaking up for those who don’t have a voice, even when it means confronting those in authority. This has not been easy, and many times I have recoiled in fear and trembling! The driving force for me is the fact that God is sovereign, above rulers and authorities on Earth, and if He opens a door for me to move through, I know that I can trust Him to give me the courage and the boldness to speak truth and speak up for those vulnerable people. My favourite verse is Jeremiah 1:9, ‘Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.”

The training that I do is not for people who are in settings where there is good governance, well-structured health services and well qualified health workers. I’m finding that I’m in areas where there is very little: poor leadership, few to no properly skilled birth attendants, hardly any resources in terms of simple equipment to provide a health service, environmental challenges, social inequalities and injustice. Those in authority quote the standard World Health Organisation WHO guideline mantra: “1. All women should give birth with a skilled birth attendant SBA at a health facility. 2. There is little benefit in training traditional birth attendants.”

So what do you do when there are no skilled birth attendants in the area? What do you do when there are no functioning health centres? What happens when there is a natural disaster or war and women don’t have access to health care or a SBA? What about the fact that women are not getting an education, so are not able to be trained as skilled nurses, midwives and doctors? And so the number of qualified health professionals is very low to be able to serve the needs of the community. What about women who have experienced terrible sexual abuse and violence at the hands of men, and then their only option for birth with a SBA is a male attendant? Is that fair? And what about the women who are from minority groups, displaced from their homelands and expected to birth with a SBA who treats them badly…verbally and physically abuses them? These situations are not unique, not unusual, in fact they are the norm for many women in low to middle income countries (and I have to sadly add that this happens in high income countries too!).

Many organisations and governments take a hard line approach to the WHO recommendations and I’ve heard stories where countries ban giving out clean birth kits to traditional birth attendants in remote areas because they don’t want to encourage women to birth at home. And yet there are no other options for them. Is it right that we take a hardline approach to women in trying to get them to birth in a health facility when there are so many obstacles and such poor services? Is it right that we marginalize village birth attendants or lay women attending to pregnant women and blame them for maternal deaths?

I don’t think so. I believe this is a top down approach that violates the rights of women, disregards their concerns and fears, and punishes them for circumstances that in many ways, are out of their control. It also further isolates them and promotes suspicion of modern healthcare. At the heart is the fact that I don’t believe that women want to die in childbirth; they want to survive, they want their babies to survive and thrive. The fact they don’t get to a health facility says more about the poor quality of the service and the attendants than it does about the behavior of the women. There are also many men who don’t want to see their wives die in childbirth and who live with the consequences of losing the mother of their children. Generalised statements about men I don’t believe is helpful either.

In my experience in remote villages of Papua New Guinea, women are desperate for better care in pregnancy and birth. Many men too want to know more so that they can help the women in their villages. When they have travelled to a Health Centre they have been let down: verbally abused, demeaned, sent home, made to wait…sometimes as long as they are close to death and then die (yes, this is true and I have heard many stories of this nature). Now this is not to say that there aren’t any caring health staff out there. There are and I have met them, but I have to say they seem to be in the minority. And, there are not many trained staff either. Many have had little training and little to none continuing professional education or support. Their health facilities are rundown and lack basic necessities such as clean water, soap, even a simple Blood Pressure cuff. I think we need to hear the voices of the caring health staff more…sadly I think they’re silenced.

I heard from a field worker who was in the midst of the Ebola crises in Sierra Leone earlier this year, that when people were in quarantine due to exposure to someone who was ebola positive, not even pregnant women were given care or support during childbirth. They birthed alone in their homes. Not even clean birth kits were distributed and explained. Many pregnant women suffered terribly during this crisis and died.

Women cannot be denied services just because they choose to birth at home (or are forced to birth at home) because there is inadequate healthcare. I believe it is important to start somewhere and that somewhere is building the trust of the women and community in the home. As skilled birth attendants we need to show women care and kindness so that trust and respect in the information we provide grows. We have an obligation to improve the quality of our care and services by improving cleanliness, working hard to improve our knowledge and skills and provide more outreach programs. Getting out amongst the people to increase their education about simple health messages can make a difference. The people feel that you haven’t forgotten them and do care about the state of their health. Myths and untruths can be gently refuted. Key health facts need to be communicated regularly over time. As their knowledge grows about how their bodies work, what is important for a healthy pregnancy and safe birth, when and how to get help, I’ve noticed that their confidence grows and so does trust.

So, caring midwives out there. Who is going to join me to be the voice of the women who have no voice and bring quality care to women of childbearing age in desperate situations?



First teaching …

ImageFirst teaching session

Monday 27th August. The day had finally arrived. The time had come which we had been planning for 9 months. Amazing! We were going to meet the women and start our sessions. The night before Lyn and I had spoken with Mike about how to begin.  Early on in my preparations to come to PNG I had realised not to plan too much. Be flexible and see what they want from me. I had also come up with the 4 L’s – Listen, Learn, Look and Love see blog

Mike encouraged us to share our own stories about birth, bring in the personal to forge links and relationship with the women. Me, we. By sharing our story we were opening ourselves up to them, being vulnerable before them. Very soon I realised that these women were no different to me. Their hopes, dreams, desires were the same. Except that they were suffering from the terrible loss of so many mothers and babies.

We were expecting about 30-40 women to attend. As we walked into the church there was no one. Then a couple of women came along. I was beginning to feel that perhaps I’d read the whole situation wrong and there’d just be a handful of women. I handed the brown baby doll with placenta around to them to look at and handle – they loved that. Then the floodgates opened! All of a sudden there were women everywhere! Babies too. Older children were chased out by the women!! They peered over the low screen that surrounded the church. It was incredible. Now the room was full of expectant faces – all looking at us. I remember looking across at Lyn and we just gave each other a knowing look: Wow! Ok, let’s do it.

Heidi had been assigned to interpret for us. She was a very shy young woman who was not very confident, but she did a great job. I knew I had to speak slowly and clearly using simple terms. Waiting for her to interpret for me allowed time to think more clearly about what to say next. I welcomed everyone and told them how pleased we were to be there.  I then explained to them what we planned to do for the morning session. I then introduced myself – that I was a midwife, that I was married to Richard, that I had 2 sons aged 11 and 9. I then went on to describe my birth experiences. I used the doll and the pelvis to explain how Ryan had got stuck after a very long labour and so I needed a caesarean section. They understood the whole concept of long labour, baby getting stuck, but their experience of that kind of labour is usually the mother and baby dying. I went on relaying my Vaginal Birth after Caesarean VBAC of Matthew – again another long and difficult labour. They got it. We were on the same plane.

Lyn then introduced herself and while telling the stories of her births, I used the doll and pelvis again to illustrate what had happened for her. The women were mesmerised and seemed to hang off every word and watch intently.

Then it was time to hear from them. I tell them that we have heard that many women die in Papua New Guinea when giving birth – big visible nods around the room. The women are actually very shy and do not speak of their own experience, but when we ask them why they think women and babies are dying, they begin to share their experiences. Immediately the floodgates are opened. From all over the room stories were told. In my diary I’ve jotted down the reasons for women dying: Mostly from bleeding, placenta stuck, mum exhausted and unable to push baby out (both die), baby dies inside the womb and then the mum dies as well, Malaria and other infections. The reasons for babies dying: umbilical cord not tied off properly, infection and baby too small and weak.

The women tell us that a woman in labour lies flat on her back throughout labour and does not move. Then another person pushes on the pregnant belly to help push the baby out. I want to cry… I can see it now: a woman in agony, unable to move from her back, others pushing on her belly and probably traumatising the uterus causing it to rupture or else not clamp up after the placenta (belum) is delivered, hence the woman exsanguinates to death. They also tell me that women pull on the umbilical cord to get the placenta out and many times the uterus (haus belong bel) comes out as well. Oh dear!

Before I left Australia I remember reading a book called “A Book for Midwives” published by the Hesparian Society. They publish books and resources to assist health carers in the third world. All the material has been donated free of charge by experts in their field. The textbook for midwives was excellent and so practical. A comment that stood out for me at the time and which flashed through my mind was that many village birth attendants have not had any formal training, have taken on this role because they have watched many births and heard stories, but what can happen is that wrong practises get passed on through the generations just because that’s how things have always been done, rather than there being any education about the practise. So, even though what I heard made me want to cry because some of the practises were probably contributing to the deaths of the mothers and babies, I had to show great respect and restraint and very gently educate them about how the body works to labour and give birth. I certainly didn’t want to be pointing fingers, rather encouraging them to be the advocates of change through better knowledge.

After listening to the stories of women dying – we were told over and over again it was ‘many’- it was obvious that they were traumatised, feeling hopeless and desperate about all these deaths, I had some divine inspiration. I thanked them for sharing their pain with us. I then encouraged them that each woman sitting there that morning was either a chicken or a pig (read previous blog because they were there wanting to learn and make a difference for the women in their villages (by this early stage I only thought there were about 5 villages represented, later on I learned there were 19!). I congratulated them on their willingness to serve the women in their communities and told them that they could make a difference and help save lives, by sharing what they learn through the week and then telling others. I reminded them that if everyone does a little bit, small steps, big changes can happen. They were nodding their heads vigorously. I then suggested that we pray for all the souls of women and babies that have died in the past and ask God to help us be women of change, to learn many things this week that will make a difference to the lives of women and babies in their villages.

Now remember, when they pray it all happens together, so there was this beautiful moment where all the prayers of the women rose up to heaven. It was a truly memorable experience and I just knew that God was there with us and that He heard our prayers.