Written by Harriet Howells
It is illegal to give birth on the island I was staying and so the local midwives are not trained to deliver. Their roles involve assisting to transport the mother to the Rural Health Unit (RHU) or hospital during labour and are involved in the pre and post-natal care. They work for the Department of Health and are similar to barangay (village) health workers. They spoke of prenatal tests which are carried out in the health centre on the island, however I could not see any equipment. I queried what these tests were and was told that the height and weight of each mother is taken, as well as her blood pressure. There were no blood tests and most definitely no scans available but I was assured that birth defects were very rare.
Midwives and barangay (village) health workers
Postnatal care is done at home and lasts for forty days. The most important time however, occurs two days after birth when the mother is bathed in water which has been boiled with leaves of a particular tree (pictured below). The leaves are burnt as incense and the whole body of the mother is smoked to prevent secondary illness due to the labour. Particular attention is taken to any openings of the mother, particularly the genital area as it is believed that the smoke from the burning leaves keeps the inside of the body warm and promotes healing.
The smoke of these leaves promote healing after birth and prevent secondary illness
I asked the midwives what care they would like to see offered. Their first response was emotional support. They told a story about a young mother who was struggling to give birth due to her age. As there is no pain relief she was screaming and they believed she needed mental preparation before going into labour and emotional support afterwards, but it is not available.
I was also told a story of a mother who had gone to the RHU but returned and gave birth that night in her house. Her husband called the island midwives as the placenta had not been delivered and the umbilical cord had not been cut but they do not have the knowledge or equipment on the island. They helped the mother and baby on the forty minute journey to the RHU by boat and tricycle for the placenta to be delivered. Following this, I asked if someone were to come and offer training, would they want to be more involved in the birth, or if that responsibility be too much. They all smiled and expressed how eager they were to learn and to be able to birth on the island. I did not expect the readiness of their response and nor that they would all feel this confident and eager. They told me that the Department of Health did not offer any programmes to close the gap between barangay (village) health workers and midwives. Encouragingly, a nurse whom I was living with is planning to teach some basic midwife training, such as, clamping the umbilical cord for emergency situations, especially as there has been an increase in cases recently of mothers who haven’t had enough time to reach the RHU. A midwife told me that she knocked on the door of a house in another barangay so that the mother could birth there whilst travelling to the RHU.
The main challenges that the midwives believe they face are:
- Lack of technical knowledge and support
- The fact that mothers want to deliver at home and it can be difficult to advise them otherwise
- The number of houses per barangay (village) health worker
- The cost of care when treatment is out of stock
The women told me that it is custom to birth with a traditional healer and that most mothers feel more comfortable with this. However, these people are not trained and this is partly why maternal deaths are so high. Furthermore, there is only one trained midwife and nurse for each barangay and they visit only two or three times a month. Treatment at the RHU is free and an initiative by PhilHealth gives 500PHP (7.5 GBP) to each mother who delivers there and 300PHP (4.5 GBP) to the barangay (village) health worker who refers that mother. Postpartum medication is also free. However, if it is not in stock at the RHU the mother must pay for it at the pharmacy. There appeared to be a fear of being admitted to the RHU as food is not provided and it becomes more expensive to stay there than at home. Other problems include transport, particularly at night when the tide is low and it can be very difficult to leave the island. The road on the mainland has been concreted in the last few years which has halved the journey time, but they told me that it was once very difficult on the tricycle, particularly for mothers in labour. There is a rescue phone line and if the barangay (village) health workers are finding it hard to get to the RHU a midwife can come to them.
The walls were covered in posters and bright handmade displays
The midwives were passionate about their jobs but felt restricted and wanted to do more, particularly with people on the island who do not have the funds to travel to the RHU. It was obvious that the women cared about their roles as soon as I walked into the health centre because the walls were full of colourful posters and handmade displays educating people about maternal and child health. I loved my time on this stunning island and hope that if I get the opportunity to visit again some of these barriers will have been overcome.