Safety Shall Be My Going
I recently read an article titled “Human Rights Beyond Survival” by Hermine Hayes-Klein. Her writing struck me with its obvious statements yet floored me with the reality that it is not obvious in so many instances. I found myself profoundly affected with the reality of what our team is working towards in regard to the issue of safety in giving birth.
Hermine wrote “No family should lose its mother, when access to good nutrition and prenatal care, skilled providers and emergency services could have saved her life…The assumption that facility-based, medically managed delivery is the best way to ensure safe childbirth has been complicated by evidence showing both that planned hospital birth doesn’t significantly improve maternal and perinatal outcomes, and that many women avoid hospital birth because they do not feel safe going to the hospital to give birth.”
There was so much of what she wrote that was relevant for the women here that we seek to serve. This isn’t an argument about facility birth versus home birth, its deeper than that. Absolutely no family should lose it’s mother. It overwhelms me each time, and how much more must it crush and grieve the family. The longer I spend in this culture, the more I see that the perception of safety is key. Access is also key, but sits second to the concept of safety. The sense of safety isn’t simply the safety of a live birth. The reality is that many women do not feel safe going to the hospital. In a post conflict time, they fear the ethnic bias, they fear the distance and means of getting there, and overwhelmingly they fear the unkind and sometimes brutal care given to women having babies here. I am routinely told that women fear being scolded, and that they fear the routine episiotomy that is guaranteed with a hospital birth.
Many women fear the language barrier and the stories they have already heard, the reliance on something unfamiliar, but most simply I believe they fear the unknown. They crave the comfort and security of their home. This sense of security keeps them at home longer than is sometimes safe. As we seek to understand this idea of meeting the need, I learn that it is not simply about having a skilled midwife available. In my western mind, this midwife has the onus of responsibility. However, in many of these remote village situations, the voice of the midwife is often small, despite their training. The voice of the community is more responsible and its understanding as to the importance of safe care is vital. The community thinks “having a baby is risky business” and lacks understanding that it doesn’t have to be risky. Sometimes there is a brutal pragmatism that I find overwhelming. One village head said, “Women have babies all the time, chances are she will be fine.” When the mortality rate is 721:100,000 live births, the chances are not necessarily that she will be fine.
Prior to my wedding in February, a friend took me aside and told me that nearby another woman had passed away after giving birth just days before. She had delayed transfer following heavy bleeding post-partum. At times since then, I have thought about the options open to me should I have a baby. Will I have safety? Yes! Will I have access to quality care? Of course! Do I trust the people who will inevitably care for me? Absolutely yes! I can definitely answer these questions, because I have knowledge and I have choices. I won’t submit myself to a style of care that I don’t trust. There are always some risks that I cannot account for, but for the most part, I don’t face the limited options of these women. I accept that I am privileged. I have the means to make a variety of choices to give myself the opportunities that these women don’t. It’s the reality of this that pushes me. The reality that too often fear replaces the beauty of birth. The reality that for some, pregnancy and birth really is risky. I believe that it doesn’t have to be that way. I believe that there is room for choices based on knowledge to create a different narrative for these women. Our team has chosen to help write that narrative with the women of this area, to create safety and best outcomes.
Mon Parker is an Aussie Midwife living in Kyaukkyi, Myanmar, with her husband. She is a tiny bit obsessed with how people give birth and works with EMA on this very issue.