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Bokoro’s Story | Giving birth in the mud

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Seeing a woman give birth on a small board in the mud has given the term “in the trenches” a whole new meaning for me.

 

In my twelve years of work in developing nations I’ve never seen birthing conditions quite like this.

Bokoro and her new baby after giving birth in the mud in Papua New Guinea.

She reclined on a board not even as wide as her body with two small logs running perpendicular on one end, presumably for a place to rest her head.

A tattered tarp was strung between sticks and a tree on one side, not even large enough to shelter her from the rain.

We stood in ankle-deep mud – clean water nowhere in sight.

Where Bokoro gave birth under a tarp in the mud in her village in PNG.

But there she was – a beautiful, healthy mother, holding a beautiful, healthy baby girl, just minutes old.

Bokoro was clearly uncomfortable but didn’t say a word.

Earlier that morning we had visited her after learning she had started contractions the night before. Our volunteer midwife Faye performed her first and last prenatal check and we all smiled during the precious moments Bokoro heard her baby’s heartbeat for the first time through the fetal doppler.

Since the baby was not yet fully engaged and her contractions seemed mild we left Bokoro with a clean birth kit and explained how to use it to the teenage sisters that would be helping her deliver.

Showing Bokoro's sisters how to use a clean birth kit.

Glad to have seen such a healthy-looking mama, we left her to their care knowing the baby could come later that day or in several days time.

A few hours later the girls came to get us. Bokoro was in third stage labor and the “baby’s home” (the placenta) was not coming out as it should.

Angharad, our volunteer doctor from New Zealand, was able to remove it before hemorrhaging threatened Bokoro’s life.

Angharad helping during third stage labor.

Bokoro shuddered as the rain picked up and her tiny newborn daughter began to get wet.

Angharad holding Biro, Bokoro's baby.

Going inside I found the baby bundle that we had dropped off for her earlier that morning. I pulled out a beanie and a small blanket and a terry cloth diaper that we used to wrap the baby and cover Bokoro’s shoulders.

Bokoro's baby girl, Biro.

My friend Jen huddled in the mud behind her and wrapped her arms around Bokoro’s shoulders, providing her back support so she could begin to rest and warm herself. (This is what love in action looks like, friends.)

Someone got a large banana leaf to shelter the baby from the rain.

Biro under the banana leaf.

As villagers began to gather to see what was going on, my heart was breaking for this woman.

She had just given birth in the mud, shared one of life’s most intimate experiences with strangers who didn’t even speak the same language, and now other villagers were showing up to watch our medical volunteers at work.

I acted as crowd control, trying to get some privacy and peace for Bokoro.

Once I had dealt with the curious spectators, I scaled the shaky ladder and peered into Bokoro’s house asking her husband if we could bring her inside.

Bokoro's house in the village of Mirowu, Western Province of PNG.

Surely they wouldn’t leave her outside in the rain with her newborn baby? Surely.

He agreed that she could come in and I held the baby while others helped lift Bokoro through the bamboo floorboards into their thatched home on stilts.

With my heart rate raised I couldn’t help but think “one in seven, one in seven, one in seven” over and over again – the shocking statistic of women who die in childbirth in rural Papua New Guinea.

Helping Bokoro into her house.

Seeing this was hard enough. I’m not sure how I would have responded had she not been one of the “six” who survived.

After making sure that mama and child were near the fire and checking that baby was latching and sucking well, we left them alone to rest and nurse.

Bokoro resting by the fire with her baby.

Several hours later we returned to check on Bokoro and her baby, who had since been named Baro. Faye weighed the baby — a healthy birthweight of 2.75 kilos (6 pounds) — and vaccinated her against the very real threats of Hepatitis B and OPV/Polio.

I thought of the disputes in my own nation about vaccinations and the conflicting research findings, but knew in these circumstances that for Baro to have a fighting chance at life, vaccinations were her very best option.

The events of that day changed me.

I knew that the poverty in this area was acute—if the Western Province was a nation of its own it would be the second poorest nation in the world—but seeing this dear woman give birth on a tiny board surrounded by mud was beyond my comprehension.

It shocked all of us, in fact.

As I left her house my emergency situation get-it-done-calmly-and-efficiently mode switched to raw emotion as the reality of what I had witnessed sunk in.

I began to weep as I thought of my brave sister groaning and pushing in mud.

How many times had I sat rubbing my pregnant belly in the mother and child clinic waiting room, grumbling about the two-hour wait?

How disappointed was I when I learned that women share double rooms in the maternity ward of our local hospital in Australia instead of having the privacy of a single room to recover?

How often had I thought about my “rights” to give birth like this or like that?

Just exactly how much had I taken for granted??

In the mud where Bokoro gave birth in the Western Province of PNG.

Bokoro is one of many.

I later found out that it’s common in remote villages like Bokoro’s to give birth outside of the home in a makeshift shelter set up specifically for childbirth.

In a larger, more developed village where a Health Station is located and many women give birth in the care of the clinic, I shared Bokoro’s story with Antonia, the head nurse/midwife in charge of the facility. I wanted to know if her story was common and ask why women like her don’t birth inside their homes.

Antonia told me that in villages like Bokoro’s they believe the men will get sick with coughing and shortness of breath if they see the blood associated with childbirth.

I then asked her when the women would normally return to their homes and was told they stay outside until the lochia stops – anywhere from two to four weeks postpartum.

Even now I get a lump in my throat when thinking about Bokoro’s story.

One on hand, it was an amazing outcome against all odds – a healthy mother and healthy baby. But it was also heartbreaking to see the conditions that so many like her consider “normal”.

Not only is childbirth a very real risk to a mother’s life in this area, but babies are born into an environment where the odds are utterly stacked against them.

More than ever I’m convinced that clean birth kits can make a difference, as simple and seemingly primitive as they are. I had conviction before, but now… now I’m absolutely positive.

Clean birth kits are only a part of the solution.

We don’t know exactly how much of the clean birth kit Bokoro’s sisters used that we had dropped off earlier that morning. Had they washed their hands with the soap? Did they wear the gloves we provided?

We know they didn’t use the plastic sheet – we were disappointed to see it still folded up neatly when we arrived as Bokoro’s bare back pressed against the board underneath.

But we do know that they used the string and the blade to tie and cut the umbilical cord – that alone a vast improvement from using a rusted machete, a piece of wood, or a rock to cut the baby’s cord.

Would Bokoro have survived if our doctor wasn’t there to remove the retained placenta?

I’m not sure.

Would Bokoro still be shivering outside in the mud, waiting for her lochia to dry up, while trying to nurse a newborn and tend to her other two children?

I can only speculate.

Maternal health in the developing world is a critical need.

I have as many questions as I do answers, but this I know: maternal health is a serious, serious issue in this area and health education and resources are desperately needed.

They don’t need algebra or chemistry, how to write a haiku or the dates of the Second World War. But they do need to know the importance of clean water and hand-washing, malaria prevention and basic nutrition. They do need to know about antenatal care, clean birth environments, third stage labor, and maternal care after delivery.

I’m more determined than ever to use my voice and any skills and resources I have to make a difference.

Bokoro’s story is a happy one of new life and beginnings, but how many of her friends and neighbors aren’t here to say the same?

How many families are missing a mother tonight?

Bokoro before giving birth in Western Province, PNG.

Dear friends, I hope you always remember Bokoro’s story and that it moves you with gratitude for your own privilege. I also hope it moves you to make a difference in nations where they have so little. We really can make a difference, if only we are willing to listen, learn, and give.

Adriel Booker

 

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47 Comments

  • Reply Gwen 13 September 2012 at 12:50 pm

    Even knowing her story and seeing pictures prior to this telling of it can’t diminish the impact your words and pictures give it – powerful. Heartbreaking to read but so glad you were there in order to relay it to the rest of us. May we all be changed along with you and may all the efforts of your team and future teams continue to bring change and hope to Bokoro and the communities of PNG.

  • Reply Rachel J. 13 September 2012 at 1:07 pm

    Amazing. Thank you for sharing this story. So glad to hear about how the birth kits are making a difference in these women’s lives, and so thankful for the outcome for Bokoro and her baby. We definitely take our comfort for granted.

    And welcome home! :)
    Rachel J. recently posted..My 1st Blogoversary & GiveawayMy Profile

  • Reply Brenda Jise 13 September 2012 at 4:23 pm

    Wow Adriel! This story definitely moved my heart and I found myself in tears just thinking of how much I took for granted with the birth of my daughter. I will not forget Bokoro and her story. But like you said, she is one of many and I don’t want to merely be heartbroken over this but be thinking if there is something i can do. Thank you for your ministry friend. Brenda

  • Reply Katie Carr 13 September 2012 at 8:52 pm

    Thank you so much for sharing this! I couldn’t wait to read the full story and was so excited to share it with my friends and family. It puts a real face on Clean Birth Kits and why they are so important. It also shares a new perspective on what is normally laughable – First World Problems. I grumbled about having to call my insurance when they didn’t cover my Rhogam shot and it never occurred to me that there are so many women out there who are giving birth in mud and staying outside for weeks trying to care for their new babies.
    Thank you for all you do and for all you are teaching us!
    Katie Carr recently posted..Tropical Smoothie Fundraiser!My Profile

    • Reply Adriel Booker 14 September 2012 at 1:20 am

      Oh yes Katie! I am not exempt – I’m learning so much too! Thanks for helping to share this important story.

  • Reply Jennifer 14 September 2012 at 12:00 am

    I have been waiting oh so patiently to hear your stories from your trip. Thank you so much for sharing Bokoro’s story, it gave me chills and made me appreciate every step of the birth of my son. Thank you so much for going out there and helping these women!

  • Reply Anna 14 September 2012 at 1:53 am

    So awesome! I have been checking every day this week and waiting impatiently to read these words! Incredible story and I am sure just the beginning of what you saw. Passing this along to friends and woman who helped with Birth Kits and praising God for the small difference they are making in these woman’s lives. Thank you for your willingness to go and share. God Bless.

    • Reply Adriel Booker 14 September 2012 at 10:22 pm

      Yes Anna, I certainly have more stories to share from our incredible time with these incredible people. But Bokoro’s story was the one that was most “important” for me to get out there. Her story needs to be told and retold so that we can see more like her receive the help and care that they need. Thanks for doing your part!! x

  • Reply Rachel 14 September 2012 at 9:18 pm

    I cried. I don’t really have words to express how I feel right now (let’s blame that on preggo brain). I’m just so really happy that not only did you manage to gather so much help in making the birth kits but you actually got to be a part of the distribution and that’s so essential for people to see. You know how dearly I would’ve loved to be there too and how much Jason and I have already talked about ‘next year’ hoping that it could be a real possibility for us to join you guys too! Thank-you for working on our behalf!!! And thank-you for sharing the stories here.

    • Reply Adriel Booker 14 September 2012 at 10:26 pm

      So glad that Bokoro’s story is stirring people. It was an amazing privilege to be a part of her life and I hope my sharing her birth story will not only honor her, but will be a help to others like her.

  • Reply With full hearts we return | the bookers down under 15 September 2012 at 1:32 pm

    […] also published Bokoro’s Story on my blog – the most personally impacting story from our time there. Her story (and the […]

  • Reply Jessica 16 September 2012 at 2:25 am

    This is so amazing, Adriel! I’m in awe of you for organizing all of this, and for spreading this message far and wide. What an incredible story. It certainly gives me some perspective about the tiny, insignificant things that didn’t go as planned at my hospital birth. What an incredible blessing you have been and continue to be to all of these women.

    (I do think that perhaps Bokoro deserves a measure of modesty if her photos are posted for the world to see – perhaps you could put a little bar over her chest in these photos?)

    • Reply Adriel Booker 16 September 2012 at 5:09 pm

      Yes, perspective indeed. Me too.

      I so appreciate your concern for Bokoro’s modesty. In her culture it is completely normal to have breasts exposed as a mother. (Not just in birth, but anytime if they are a mama with child.) Had I posted any photos of her with her thighs exposed… well, that’s another issue entirely – very culturally inappropriate. They consider it immodest to have anything above the knee showing of the legs. :) But yes, I did double check with more than one trusted local (both male and female) before I shared any of these types of photos publicly. xx
      Adriel Booker recently posted..how i’m learning to discipline rowdy childrenMy Profile

  • Reply Krystle 16 September 2012 at 11:33 am

    I read it and cried. And then read it to my husband and cried again. We are so so blessed, and I had no idea how it was out there. Breaks my heart. So thankful for the happy ending, and thank you for continuing to be an advocate for these mommas

  • Reply Monika Gerritsen 17 September 2012 at 10:22 am

    Thank you so much, Adriel for sharing Bokoro’s story. I am grateful that you are able to get the birth kits and information to us. Each mother we help has a positive effect. It would be so nice for these communities to have a “Red Tent” for women to birth their babies and share their wisdom.
    Blessings,
    Monika

    • Reply Adriel Booker 19 September 2012 at 4:21 pm

      Yes, it would. Some of them do have a place allocated like that. But unfortunately, many of them don’t yet. Appreciate your help in caring for these women.

  • Reply Nicole Laws 19 September 2012 at 12:05 pm

    Simply an amazing unbelievable story. I can’t even begin to imagine witnessing such a powerful experience. I am so happy to hear that Bokoro and her baby managed to survive. Your post/her story is something that needs to be heard. It makes me feel even more of a calling to help be an advocate for these mothers in under develop countries. Something needs to change. I am happy the the Childbirth kits are making a difference. Thank you so much for sharing such a powerful story.
    Nicole Laws recently posted..Chocolate Pumpkin Bundt Cake…Healthy Recipe MakeoverMy Profile

  • Reply Lindsey Whitney 20 September 2012 at 11:44 pm

    Wow, Adriel. This is just so beautiful. I’m crying as I read it… especially when I think about how indignant I’ve been about birth situations here in the USA. Thanks so much for sharing. We miss your posts!

    Lindsey @ GrowingKidsMinistry.com
    Lindsey Whitney recently posted..New Friends at #CMLeaders!My Profile

  • Reply Teresa Brown 21 September 2012 at 2:58 pm

    Hi Adriel, I go to Westside and have been following your blog for a while. What a beautiful story and I am glad that Bokoro came through the delivery safely. I am so glad you are making a difference for these women and children. Our God is so good to provide people like you and all the volunteers making a difference in these women’s lives.

    Teresa Brown

  • Reply Denise Madill 22 September 2012 at 12:25 am

    Adriel. It was wonderful to read your storey about Bokoro and to get a grasp of the difference you and the other volunteers have made. One birth at a time right! It’s hard to comprehend that a box of gauze pads and gloves we donated way over here in Frankford, Ont, Canada hopefully made a new life a little safer. Thnx for your storey, but most just thnx, Denise

    • Reply Adriel Booker 23 September 2012 at 8:08 pm

      Hi Denise. Thanks so much for doing your part to help too! xx
      Adriel Booker recently posted..born againMy Profile

  • Reply Giving birth along the Bamu River | Stories from Papua New Guinea 28 September 2012 at 8:32 pm

    […] thousands of lives… and millions of opportunities. If you haven’t already, please read Bokoro’s Story (my hero who gave birth in the mud) and Josephine’s Story (my mama-loving sister who lost her […]

  • Reply hi guys, it's me. « The Mommyhood Memos 16 October 2012 at 11:39 pm

    […] New Guinea. I still think about the women I met there daily. I think about their struggles, their strength, their resilience, their precious babies… and I want to continue writing about them, sharing […]

  • Reply I love my kids 26 October 2012 at 9:18 pm

    As sad as this story is, the sad reality os that alot of women give birth in these situations, we cant do much to help but with a bit of help and more people to go to these remote areas to give a helping hand the better. I have 2 kids first one i had an epidural 2nd one had a 12 pound child natural wile my first was only 7 pound, i experienced child birth like all those woman have because they never had drugs to help ease pain, i wish i had pain relief but imagine those women with nothing not even a proper shelter over there heads or warmth for the baby, but sometimes all we can do is sit bak and let this happen, even in our own backyards theres ppl have it worst off too and if our country cant help theor own people than whats tosay we can help our neighbouring countries? Till we wake up and help oir own people on our own backyard than we could make a difference for them too. A sad reality but a truethful event too

    • Reply Adriel Booker 18 February 2013 at 10:10 pm

      I think we have a responsibility to help our neighbors near-by, and also those far-away. Neither should be at the exclusion of the other. But the women that I’m talking about here don’t even have ANY access to resources like our neighbors around the corner do. And it’s not so much about drugs/no drugs, it’s about hygiene, safety, knowledge about third stage labor, etc. I’m talking about life and death stuff. And yes, I too have experienced childbirth with no medication. But I’ve certainly never given birth on a board in the mud while being rained on. Anyway, I’m so very glad you’ve had two healthy babies. That is just wonderful. They are such a precious gift. :)
      Adriel Booker recently posted..How I knew I was pregnant before I knew I was pregnantMy Profile

  • Reply call the midwife | 30 October 2012 at 9:01 am

    […] there was a time when i didn’t know people birthed like this. […]

  • Reply Meg Wirth 13 February 2013 at 1:59 am

    This is an amazing story. Thank you for sharing it. We would love to cross post on our blog if you are willing.. or even a portion of it. Papua New Guinea is so rarely covered at least in the U.S.!

    • Reply Adriel Booker 18 February 2013 at 10:00 pm

      Hi there Meg. Not sure what you mean about cross post? Do you mean copy and paste it into a new post on your site? If so, then no – please don’t do that. But if you’d like to copy a few lines or quote a paragraph and then link here that would be totally fine of course. (Thanks for asking.) And yes, these stories need to be TOLD and HEARD!! Let me know what you had in mind if I’ve misunderstood. xx
      Adriel Booker recently posted..How I knew I was pregnant before I knew I was pregnantMy Profile

    • Reply Adriel Booker 18 February 2013 at 10:04 pm

      And let me know if you think of other ways we can partner together in relation to maternal and infant health. I’m ALL ears!! :)

      p.s. Have you seen the Bloggers for Birth Kits initiative or Project Baby Bilum? Both are for helping mums & bubs in PNG.
      Adriel Booker recently posted..Sometimes, I don’t love all that well.My Profile

  • Reply Karen Darragh 18 July 2013 at 4:25 pm

    WOW! How lucky are we to live in Australia where we are looked after very well while pregnant, through child birth and after care. I have shared your link on my F/B page and asked my friends if they would like to help out making up some kits. When do you need them sent out to you?
    Karen x

  • Reply Practicality 19 July 2013 at 7:58 am

    This was a touching post.
    I am wondering why the women don’t get together and build a ‘birthing hut”, a dry, clean place where they can give birth.
    I am also impressed that the husband allowed his wife back in the house- against his cultures values.
    This might indicate that the men are willing to change their attitudes a bit.
    I am also wondering why the plastic sheet was not used.
    Finally, if the beanie & the blanket were mot available, what were they planning to use?

  • Reply I'm diggin' it | 10 August 2013 at 1:37 am

    […] bokoro’s story: giving birth in the mud […]

  • Reply Headed to Papua New Guinea… again. (Can I get a whoop, whoop?!!) | the bookers down under 16 August 2013 at 8:54 am

    […] area is where Baby Umi, Bokoro, and Josephine are from if you remember my stories from last year (Giving Birth in the Mud, Umi & Project Baby Bilum, the Sunshine Project, etc.). I’m desperately hoping we can […]

  • Reply I Am From (A Synchroblog with SheLoves Magazine) | Adriel BookerAdriel Booker 1 October 2013 at 9:25 am

    […] bokoro’s story: giving birth in the mud […]

  • Reply Catherine Meyer 12 February 2014 at 1:40 pm

    Hi Adriel,
    As I read your post about Bokoro’s precious child and her astounding entry to this world, my own precious 8 week old is sleeping safely in his bassinet next to me. And I am worried about a little SNIFFLE that he has. Perspective, hey!

    I have been floored numerous times throughout my pregnancy and post natal care by the health care that is provided to us FOR FREE in this country.
    I am so thankful that Bokoro’s birth was safe despite the context and that your team was on hand to help with the third stage. How much we take for granted in Australia!

    I know you wrote this post a few years ago, but I was wondering if you are still involved with providing the safe birth kits to PNG? How could my church get involved in making and sending some over?

    Much love, Catherine

    • Reply Adriel 13 February 2014 at 10:32 am

      Hi Catherine. First of all, huge congrats on your own healthy, beautiful little baby!! Wonderful, wonderful. :)

      Yes, I am still involved in this work. Here is the link to the FAQ page about making the kits: http://adrielbooker.com/bloggers-for-birth-kits-faq/

      BUT, I am redirecting the kits to other centers now (medical ships based in Hawaii and New Zealand, which also reach into the Pacific) because we now have MANY birth kits ready for distribution through our Townsville ship already. Email me when you’re ready to make or mail your kits and I’ll let you know where to send them in NZ!! themommyoodmemos @ gmail . com

      Thanks Catherine!! x
      Adriel recently posted..Every Mother (Really Does) Count | Thoughts on being a know-it-all and changing the worldMy Profile

  • Reply Love A Mama Midwifery Scholarship Fund: A Mother’s Day Gift that could change a generation - Adriel Booker 28 August 2015 at 4:51 pm

    […] bag) can also significantly reduce the incidence of life-threatening infections. (My friend who gave birth outside in the mud can […]

  • Reply Bless Babies and Mamas around the World 1 November 2015 at 6:49 am

    […] Bokoro’s story – giving birth in the mud […]

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