First thoughts on Midwifery in Nepal

Before I have even set foot on Nepal soil I find myself pondering about what I will bring to it. What will I bring that is unique? Why will I be needed there? I have gained some good knowledge of the current maternity system there, through using Nepal as an assignment about how they are faring with achieving the Sustainable Developmental Goals for reducing maternal and child morbidity and mortality. For all developing nations the challenges are nearly the same and are summed up with famous Three Delays;

Delay in decision to seek care due to;

  • The low status of women
  • Poor understanding of complications and risk factors in pregnancy and when to seek medical help
  • Previous poor experience of health care
  • Acceptance of maternal death
  • Financial implications
nepal women

2: Delay in reaching care due to;

  • Distance to health centres and hospitals
  • Availability of and cost of transportation
  • Poor roads and infrastructure
  • Geography e.g. mountainous terrain, rivers

3: Delay in receiving adequate health care due to;

  • Poor facilities and lack of medical supplies
  • Inadequately trained and poorly motivated medical staff
  • Inadequate referral systems

These are the same issues in every country struggling with high maternal morbidity and mortality rates. So much effort is put into improving these areas, and rightly so. The effort is put on saving lives and improving quality of life, things that we in highly developed nations often take for granted.

I feel like Australia was once there too, long ago in its infancy as a nation. Struggling to provide professional care to women in childbearing years, pioneer women out on cattle stations, farms, even in the towns. Plenty of traditional birth attendant women filling in the role of care provider. These original Australian midwives, or wise women, did not have evidence to go off, only experience. Just as in Nepal, there would of been unsafe practices done, not intentionally but because they knew no other way.

Eventually birth was moved out of the home, traditional birth attendant women made to no longer practice. Which for years actually made the situation worse! Now there was definitely no one out in the remote towns helping women. The new medical practitioners, arrived from overseas usually, did not want to train the local wise women in basic skills, they wanted to get rid of them all together. Thankfully in developing countries now days, focus is on training existing birth attendants as well as adding programs to attain professional qualifications.

Maternity care became focused on safety, risk, and getting women to birth in hospital. For years, women had “safer” births however came out feeling like they had been abused, unsure of even what had been done to them. I recall many older women, including my grandmother describing horrible experiences in labor and birth. There was no support person, an ugly tiled room, with a bed smack bang in the middle of it (actually that still hasn’t changed), bright lights and you had to stay on that bed, put your legs up in those ghastly metal stirrups, and do as your told!

Now we can’t build expensive birth centers in every village with rain forest murals to look at, with lights that dim, and surround sound for your playlist to plug into. Not achievable. But we can treat women with respect and love, that doesn’t cost a cent, and making a few homely adjustments can also be very affordable.

nepal women 2

Sometimes I think there is that unsaid thing, as soon as you walk through the hospital door you have to go by the hospital rules, the hospitals decisions for your birth. This is changing greatly, finally, as women are educated and care providers partner with women instead of tower over them.

How does this Australian history link back to Nepal? Cause I love history and I think we should always learn from history.

When I go to Nepal, along with focusing on safety, risk, and education, I want to focus on choice, on respect, on partnership. I not only want women to come through pregnancy and birth alive and well, physically, I want them to feel empowered and happy with there experience. I want them to skip home (over the hills and mountains) back to their village, and tell a wonderful story of how they felt safe, respected and treated with dignity at the birth facility. Actually no matter where I am, women’s right to choice in pregnancy and labour is a huge passion of mine. When I see it not happening its the one thing that hurts me the most, and I feel my outrage deep down in my belly.

I don’t want Nepal to do exactly the same as Australia and what alot of other nations did. I want them to do it better! I don’t want choice to be erased, only to have to be fought for and found again decades later. I would think any woman, any nation of women would utilize health care more if they knew there choices, culture, and body would be respected.

Nepal won a Millennial Development Goal (MDG) award for reducing its maternal mortality rate by 48% between the years 1996 and 2005! They are leading change in the developing world! Do you think they could of done that if they sacked all the traditional birth attendants? No way! They have utilized what they already have. And as I was searching for volunteering opportunities a couple months ago I found that the message was the same from everyone, hands on help from internationals is not so much needed as education of the existing local health workers. This means that they have developed an improved number to the maternity workforce, and it is education that is most important now. Education will provide lasting change, change that will stay long after non governmental organizations leave.

So these are my thoughts this morning, as I eat porridge and procrastinate about writing another essay for my final semester of midwifery.

I know many more pondering will arise as I spend time in Nepal later this year, I may come up with completely different ideas. But for now, across land, and ocean in Australia, I ponder what a little, baby, midwife like me, could do. xox

nepal 2




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