Giving birth in a rural health unit

Written by Harriet Howells

National figures record ‘3’ to be the average number of children per Filipino family. However, this does not reflect those living in rural areas or below the poverty line where fertility rates are consistently high. During my time in the Philippines I was fortunate enough to observe two births at the rural health unit (RHU) – these were the fifth and fourth births for the mothers.

The first birth I witnessed was very quick. The mother arrived in the morning and was expected to give birth in the evening. However, when I returned from lunch, at around one o’clock, the mother was being taken into the delivery room and I was invited to join. I was being told to ‘catch the baby’ when it was born. I stepped back and raised my hands saying ‘no, I’ve never done this before!’ in a panic, but the midwives kept insisting that this was the time to learn – I had to disagree. As there is no running water, we washed our hands by pouring water from a bowl using a small pan. I looked around for soap, but there wasn’t any around. Outside of the delivery room was a selection of indoor shoes with no apparent theme; from these I opted for a pair of small pink wellington boots and put on a face mask. I was now ready to enter the delivery room. This was completely new to me and I was anxious of what I was about to observe.


The hand wash station for the delivery room uses water which is collected from a well and stored in buckets for use

Two midwives delivered the baby but I was told that there can be between one and three midwives, depending on how busy the RHU is. Considering there was no pain relief available, the mother seemed quite complacent and hardly made a noise during the whole ordeal. The midwife rubbed her back and talked with me and others who were also observing. I could not help but notice that there did not appear to be much empathy or comfort besides the back rub from the midwife.

After a while, the mother complained and was helped onto the bed, within minutes a head appeared and with just one more contraction it was out with a loud click of the hip! The midwife pulled the baby and quickly untwisted the cord which had wrapped around his neck. At this time I was very glad that I had declined helping as the teamwork of the two midwives was slick and I could sense the panicked rush of the situation. Freed from his cord, the baby was placed on his mother’s chest for warmth and bonding. This is mandatory for at least one hour and midwives must wait until after this to weigh the baby. Shortly after the birth a midwife enticed the infant to suckle and once the baby had latched I congratulated the mother and left her to be cleaned before being reunited with her family.


Feeling the excitement of observing the first birth of our stay at the rural health unit

The following day the mother sat with her husband and sisters in the maternity ward waiting to go home to the rest of her children. She told me that she had married at 18 years old and had her first child a year later. Ever since, she had had a new baby every two years and was now 29 years old and had given birth to her fifth child.

The RHU midwives are very busy and there had been another birth that night after I left. This was a home birth of a still born child. It was estimated that the infant had died two days before as a result of a urinary tract infection (UTI). This was a shock to me as UTIs can be picked up quickly by simple tests at home in the United Kingdom and are often easily treated. Conditions like UTI do not cause infant death regularly back home and it was chilling to meet people affected by conditions which I considered to be almost unremarkable.

During a 24 hour shift at the RHU I observed a second birth. It was almost midnight when a woman arrived in a tricycle with her husband who was carrying a bag containing baby clothes, blankets, and pillows. They had travelled a long journey far-away islands. The mother was 26 years old and this was her fourth birth. She was small and in a lot of pain but fortunately three midwifes were on the night shift to attend her. Again, the mother had her back rubbed by the midwives whilst they laughed with each other and the mother, to some extent, was ignored. The atmosphere was very relaxed and a midwife accidentally phoned someone on her mobile phone! She panicked as the screen turned off as a result of clicking too many times in the rush of trying to end the call! I wondered what the mother must have been feeling, unable to see what was on the phones that people were playing on. Being accustomed to emphasis on confidentiality and patient centred care I could not help but find this strange.

Once again, I was asked to catch the baby but again I declined. If the first experience had not put me off enough, the mother had terrible leg cramps and I was afraid she would kick whoever got within range. The baby was positioned slightly low during the birth and the pain caused the mother to scream out. To my shock, her mouth was covered by the hand of a midwife who then instructed her to be quiet. There was only a frosted, glass door between the delivery room and maternity ward where her husband was waiting. Oblivious to the struggle that his wife had been through, he was presented with a beautiful clean baby in white knitted cardigan and mittens. Without a friend in the delivery room or the option of pain relief and arriving exhausted from travelling the uncomfortable journey to the RHU, I felt overwhelming respect and admiration for the strength of these women and will never forget these wonderful experiences.