Australian midwife Sharon Hemetsburger assists a young mother to give birth to her first baby in Papua New Guinea. Here’s how it unfolds.
It was 4.25pm on Tuesday, May 2, when Priscilla’s rather stunned baby boy made his entrance into the world. It was her first baby and, like women all over the world, she was exhausted. In stark contrast to the private maternity unit where I had worked in Brisbane, this was Anguganak in the Sandaun Province of Papua New Guinea. Distance wise, it’s relatively close, but in terms of similarities the two places were worlds apart.
Just a little earlier I had entered the birthing room (impossible to call it a “suite” as we do in Australia) partially out of curiosity but mainly out of my love for all things midwifery.
Priscilla was in the transition stage of labour. It was hot, the air heavy with humidity, beads of perspiration lining her upper lip and her body slick with sweat. I could feel the perspiration trickling down my back and I was just standing there. Sun blazed in the dirty windows onto the stained unpolished wooden floors, no air conditioning or fans – in fact, no electricity at all.
In the peak of a contraction Priscilla cried out “Mama” – agony evident in her voice. She was young, perhaps 18. Most women are unsure of their date of birth here in a place where time and dates have little significance.
Her mama was present, standing shyly by the door a metre or so away from her daughter. “Shhhh,” was the resounding sound around the room by the local nurse, her mother and aunt. I felt the indignation rise in me but silenced it for the moment as there were other issues causing me distress.
Pricilla was lying on her back atop a high ancient birthing bed on a white plastic sheet, no material in sight. A very modest people, Priscilla was naked, her dark skin contrasted against the thick white plastic. “Can I just cover her with her skirt?” I asked, feeling horrified at her lack of dignity.
Grabbing the skirt I placed it across her breasts. It is the usual practise to remove women’s clothing so it won’t get soiled during labour. Often it is the only clothing they present with, and what they need to wear after the birth.
“Mi laik kirup” she cried (I want to get up) in Pidgin. “NO” was the immediate reply from the nurse in charge. In my head a war of thoughts began.
“Am I a woman’s advocate? How do I respectfully challenge the nurse? Should I challenge her?” “Can I ask why she can’t move?” came my reply.
“She will tear if she gets off her back!” stated the nurse. I took a deep breath, praying for wisdom and a respectful reply.
“There is no head on view, can’t she move positions? She needs to find what is comfortable for her don’t you think?”
A nodded reply was all I needed. Priscilla now given the freedom, moved with surprising ease onto all fours and with each contraction sat upright on her heels, legs apart. I stood close by – supporting her when I could.
In the room, the nurse sat over by the bench on a stool, tired from a long day’s work. She walks an hour or so daily down a mountain to get to work and will make that journey home after the delivery. She receives a meagre wage that has recently been cut by 30 er cent due to budget restrictions.
Priscilla’s husband is nowhere in sight, being near a woman’s monthly bleeding or child birth is considered ‘Tambu’ – or not allowed – in this culture. Men believe they will get asthma in later life if they do.
Priscilla’s mum and aunt remain by the door, looking concerned but not close enough to touch her. My heart went out to this young labouring woman and as a midwife, I cared for her like every woman deserves to be cared for. Nothing spectacular, just the usual, back rubs, wet cloth, words of encouragement, sips of water and allowing her the freedom to choose her position. Pain relief as we know it is not an option – there simply is NONE!
Priscilla was grunting and pushing in her modified squatting position. She pushed beautifully and was soon told to roll over on her back as more and more of the baby’s head became visible. Instruction was given by the nurse for her to grab her legs behind her knees and push hard with each contraction.
The nurse readied the episiotomy scissors taking them out of the shallow bath of betadine where they were being ‘sterilised’. There was no need for them, Priscilla’s baby was born, cord quite firmly wrapped around his neck, thus the cause of his rather ‘stunned’ appearance. Had the fetal heart been listened to during the 2nd stage of labour – as we do in Australia – would we have heard signs of distress?
The newborn was placed on the mother’s chest for skin to skin and I used the green drape in the waiting metal cot to cover him and perform some tactile stimulation. He was soon crying. Priscilla grabbed her slippery bundle, holding him close, relief evident all over her face.
Syntocinon was given, and the 3rd stage complete within 10 minutes of the delivery. Grandma produced a worn bunny rug to wrap him in whilst the suturing was being performed by the nurse. With questionable sterile techniques, much discomfort and fading light, the tear was sutured.
Priscilla immediately got up to wash in the wash room with cold bucket of water retrieved by her mother, it was then I left her.
The next morning I found a smiling Priscilla and her baby under a mosquito net tucked into the plywood sheet that was her mattress – the Anguganak Healthy Motherhood Project bag opened next to her. The baby was wrapped in a clean soft flannel bunny rug with the knitted teddy placed beside him.
With hugs and exclamations over the contented baby, I surveyed the surroundings. The maternity ‘ward’ or beds were at the end of a long room shared by a male patient sick with malaria, nothing but distance separating them. This same room hosts all ill people including TB patients.
Curtain-less louvered windows, at least screened but all filthy, are the only source of light. Dirty concrete floors are matched by paint peeling from the grimy walls. A toilet facility outside the back door is long drop encased in plaited bamboo. Showering occurs outdoors next to the rainwater tanks with buckets of cold water. Lucky the weather is so humid and hot, cold water here is actually pleasant…
Breaking my thoughts Priscilla’s mum asked me what my husband’s name is. “James” was my reply. So, much to my surprise and honour the baby was thus named. Tears sprang to my eyes, I was so touched.
I was then able to explain that my husband was born under a tree in a Highlands village also in PNG. He was fortunate to be educated in Australia, completing his high school and university qualifications and is now a civil engineer. My intention of telling them my husband’s story? To instil purpose and destiny over this new life who now carried my husband’s name.
Today Priscilla will be discharged, her only pain relief is a leaf used to rub between her fingers. No car awaited her with a baby capsule to transport her home, no, she had a mountain to climb. Literally. Behind the hospital, a mountain named 15C (the number of corners or curves it takes to climb the mountain) that virtually went straight up, and Pricilla’s village is on the top of that mountain!
So with baby James in her billum (string bag), and a swollen and painful perineum, she started her journey to her village and to commence her new role as a mother.
Upon reflection, this story portrays one of the main purposes of our trip to Anguganak, safe motherhood. Because Priscilla chose to hike down the mountain in early labour and deliver in the health centre, she and baby James are alive. She was attended to by a skilled nurse who, if complications had arisen, was there with some resources to manage them. Simply receiving the IM Syntocinon shot and effective 3rd stage management was enough to save her from haemorrhaging – a complication that causes many maternal deaths in the villages of PNG.
Our aim with education and the help of the baby bundles is to encourage more women like Priscilla to choose a health centre birth over a village birth. Far too many women are dying from preventable causes in this land so close to our own – where child birth is rarely a matter of life and death.
There is obviously still much to be achieved – all women deserve kindness and choices in labour and beyond, but with our support and ongoing education, one can only hope practises will slowly change. Women will be treated with dignity and respect in the Health Centres, so they can deliver safely, go home and be there to watch their children grow up.
A right mothers all across this planet deserve to enjoy.
Australian midwife Sharon Hemetsberger spent some of her childhood in PNG and speaks pidgin. Last year she returned as a volunteer maternal health trainer to take part in the Anguganak Healthy Motherhood Project run by Debbie Butters and funded by Send Hope Not Flowers.