Monday, August 17, 2009

The Earth Birth Style

The other day I was laying in bed getting over a headache brought on by a rooster and a church service. I was brought back from the edge of sleep by Rachel, who walked in like, hey, do me a favor and hold this baby while I tend to its mother. Then she laid the infant against my chest and rocked exit. The baby was no more than two hours old; the remnant of the cord that bound it to its mama still hung from his belly button. It was a mellow creature, concerned only with sleeping and sucking on its fingers. If I moved at all or breathed too deeply, it would fling its limbs and make these noises that were just damn cute. It was a five pound ball of cuteness come to join me for a nap.

It is rare that the subject matter of a practice, once it has has been cleaned up, anyway, is so bloody adorable. But such is the Earth Birth style. They have averaged one birth a day since they have been here. Most of the births that they attend happen here at the compound, the site of all of their supplies and the best place to work with the TBAs who usually bring the birthing women in. On occasion, they get a phone call that brings them to a location out in the bush, sometimes miles away from the main road or the town center. Before they rolled up on the scene, there was only the maternity ward at the Atiak health unit to assist with births. It has maybe 6 beds and a staff of two nurse midwives. But Uganda has the third highest birth rate in the world and most of these births happen here in the north. When one considers also the war that waged in this region for 20 years, it becomes obvious that childbirth in Atiak has been in a prolonged state of crisis.

Of course, this problem has not escaped the notice of the government and NGOs. The past is filled with organized efforts to make things better. But these efforts have affected the scene either minimally or adversely. The wackness of these programs is derived from a general assumption of the unconditional goodness of western, hospital-based methods and training models. Even when they can potentially be effective, such programs need continued supplies of resources that this region simply does not have and won’t get any time soon. When the crisis of a particular area is declared “over,” the supposedly humanitarian attention it receives fades away. And when those streams dry up, people suffer from lack of care, just like they did before. This is why those Doctors need Borders.

Of course there are the attempts at training. But a problem with training programs is that they are one-sided. Perhaps the trainers presume the supremacy of their sources of knowledge. Perhaps they are forced to carry out a plan that was not drafted in the field. Whatever the reason, training programs, particularly those aimed at birth practices, have done more to eradicate the community’s ability to meet its own needs than help it. In the wake of World Vision, we find traditional birth attendants whose methods have earned them legal restrictions in their ability to attend births. The primary source of help has been trained out of its practices and pushed into obsolescence by the government.

But the birth rate looms in a country that has a host of other infrastructural problems. And Atiak is ground zero. Miles away from electricity, running water and a hospital, it feels the lack of care acutely. Rachel and Olivia want to shave some degrees off that angle.

The Earth Birth squad has carefully studied the previous styles. They have worked in sorry maternity wards and spoken with world vision officials. They have worked out theory in the halls of NYU and Rutgers and have rocked practice in New York and Brazil. The fruits of fundraising efforts have given them enough to properly start their program, to begin construction of a birth clinic in Atiak and conduct continuing workshops with the traditional birth attendants who want to get back in the game.

Until the clinic is built, the site of most of their work is at the contemporary compound in which the little baby slept in my arms. His arrival was attended by Olivia and a native TBA, Christine. By attending births together, they can share knowledge and observe one another’s practices. They talk about these practices at twice weekly meetings, where everyone learns about traditional styles and modern western practices that can be sustained. The point is to do whatever works in the context with the resources that are available. If you don’t have a clean razor, use the sawgrass to cut the cord. Since you don’t have pitocin, do nipple stimulation. Let her give birth in that position that works best for birthing the baby; there is no need to be confined to her back during labor. And so it goes. Find the most effective, sustainable practices and support them long enough for them to ride out with minimal external support.

Rachel returned to pick up the baby from me just as it appeared to be getting hungry. I brought it out to its mama, who began to give it booby snacks. In the great ideal, one day we won’t even be around to hold the little ones. I guess I gotta pinch their cheeks while I have the chance.

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