In this compelling piece, international doula Tammy Ryan gives us a glimpse of the challenges doulas and midwives face when working in an international context, especially in areas around the world where resources and knowledge of compassionate maternal healthcare are limited. While honoring the local perspectives is a critical part of working abroad, this piece about Tammy’s experience in the Congo sheds light on some of the dangerous practices, and the lack of skills, that contribute to high maternal mortality rates in many parts of the world.
In July of 2008 I went on my first trip to the Congo, Burundi, & Rwanda as an international doula.
One of the first things you learn in Africa is that time means nothing. We were taken to a small retreat center in Burundi where we would be staying for a few days before embarking on a journey to serve laboring mothers in Congolese birth clinics. Our hosts told us they would be back soon to take us for food. After waiting for nine hours, and us both in tears thinking we had been left behind, they finally returned.
Eventually the day came when we would cross the border to the Congo. Crossing can be scary, as you are searched, questioned, and have to pay a bribe before you are allowed to cross over. Corruption in the Congo is prolific, and women in the Congo suffer great abuse on a daily basis, not just in childbirth. Furthermore, many of the midwives in the country have died from old age or conflict in the country and therefore their skills and knowledge are not being passed on. It is for that reason that we had gone there to teach life-saving knowledge and skills.
Among other important knowledge, we educated them about when they needed to make the journey to a birth clinic. An example of useful skill we taught is a way to determine whether or not a mother has Diabetes: have her pee in a jar, set it in the sun, and if the ants come she has diabetes. If there were no ants, it meant no diabetes. We taught many skills like this, and the women were so enthusiastic to learn since so often birth does not have a good ending. We also helped them establish a “Midwifery Garden” so they could grow crops to sell and make money for their families, even while they were helping at a birth.
During our first night on site I was called to the clinic to help a young mother. The local practitioners wanted to see how Americans assisted birth without an episiotomy. Someone had apparently visited the site before and taught them this skill, which they subsequently decided should be done to every woman. I assisted the mother and as the baby was crowning all seemed to be fine… until the baby was born not breathing. Since they are so accustomed to babies not surviving birth, the child was just set aside to die. However, I began CPR and was able to get the baby breathing. Neo-natal resuscitation is not a skill a doula uses in the United States since we do non-medical work, but I was grateful for having the basic knowledge of the procedure.
Shortly after, as I was trying to catch my breath, the doctor came to me and said the placenta had to be removed from the woman’s body immediately. In this village, they believe that if the placenta is not removed right away, bad spirits can enter the woman’s body. I told the doctor to just wait, that it had only been five minutes since the birth, and that it would come. The doctor ignored what I said. With all her might she slugged mother in the stomach, and the placenta fell to my feet. Blood went everywhere.
The entire staff assumed she was bleeding because I did not do the episiotomy. Without adequate equipment or skilled midwives by my side, I began to hard massage the uterus. I tried everything I could think of to save this mother, as she lay there bleeding out. Finally I inquired as to what they normally do in this situation, and I was told that we must wrap her in cloth and wait to see. Given the resources, there was nothing else to do, so I agreed.
I saw this mothers again on day three, when her family came to get her for the two-day walk back to her village. She was unable to stand, so a makeshift gurney was constructed to carry her home. I have never been able to find out if this young mother lived.
Recently, I was asked to join a team of midwives who work in a clinic in Tanzania. The organization is LifeReach International and the mission is to enrich the lives of pregnant women, valuing them, and preserving life. I have been asked to go as a doula preceptor to help educate the women of Tanzania on doula skills and childbirth education. I will be there to set up programs and competency skills for the doulas to help assist the midwives. The focus is on group prenatal care with childbirth prep classes, training childbirth educators, training labor support companions, midwife training and multicultural midwifery. Every single one of these skills is need in Tanzania, and all over Africa, because of the widespread mistreatment of women.
Please visit http://babymatterstanzania.wordpress.com to see how you can help.
Tammy Ryan, CD(DONA),BDT(DONA)CCE has worked with pregnant women for the past 18 years. In 2002, she became a certified Birth Doula with DONA International and has since been working to improve childbirth practices among women across the globe. For the past five years Tammy has been a Certified Birth Doula Trainer for DONA International traveling to all parts of the United States training new doulas. In 2010 she became one of a few trainers for DONA International who is able to teach the proper use of TENS. Tammy has been a guest speaker on many venues including speaking at the DONA International Conference in St. Louis in 2007 & 2011. She has been a guest speaker on TV, radio, and at universities. She is the current 3rd Party Coordinator for DONA working with insurance companies for reimbursement for doulas. In June of 2007 she was awarded a $5,000 grant from Avon for the doula program she started for the teen mothers in the maternity home. Tammy has been married for 25 years to her very supportive husband. They have 3 boys, ages 22, 21, and 18.