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