Home > Midwifery > Akusherka

I had a wonderful opportunity this week when I was asked to speak to a group of medical professionals from Belarus about my job as a midwife. The Belarusian delegation was here for a Community Connections Practical Training Program. “The Community Connections Program, managed by the Bureau for Europe and Eurasia at the U.S. Agency for International Development (USAID) and administered by World Learning is designed to promote public diplomacy through the exchange of cultural ideas and values among participants, U.S. families and local community host organizations.” (that’s from the literature they sent me). In fewer words, it’s a professional exchange program between the United States and countries of the former Soviet Union.

The delegation was made up of 2 obstetricians, 2 neonatologists, 2 pediatricians, 2 professors/lecturers, a non-nurse midwife and their translator. They came to my city and stayed with various host families and spent the week touring hospitals in the area and meeting American doctors, CNMs and others in the field of Mother and Child Health. The program organizer asked me originally to participate on a panel discussion about the topic.

I was nervous about speaking, especially on a panel that would include OBs and CNMs who sometimes aren’t very friendly to us lowly midwives. I was comforted to know that a doula friend would also be on the panel. But, on the day of the discussion my friend sent an e-mail saying that her 3 year old daughter had broken out in a rash and she needed to take her to the doctor to confirm what she thought might be measles. I got over my disappointment about that only to be contacted by the organizer who called to say the group was behind schedule and could I come 2 hours later than initially planned. And she said that I would now be the ONLY speaker. At first I was more nervous than ever but later realized this was the absolute best way for me to do this.

We ended up having a more casual conversation with coffee and snacks instead of a formal panel. I wasn’t intimidated by what an American MD might think of my talk and I had the floor to myself with a lot more time to just talk about what I do.

I started with a brief explanation of the midwifery model of care and then spouted off some statistical data regarding our country’s appalling c-section rate and our place at the bottom of the list for neonatal survival rate (we have the second worst newborn death rate in the developed world). They asked me to repeat that statistic because “that’s not what we were told.”

Then they asked me questions and the first two were the questions that everyone unfamiliar with midwifery always asks: “What do you do in case of emergency?” and “How do you protect yourself legally if something goes wrong?” These questions are the perfect example of how birth is viewed as a catastrophe-about-to-happen. Most have forgotten that birth rarely goes wrong. Later, after giving them my own transport and c-section rates they said “You must take only low risk women.” I said yes and they nodded their heads as if to say “no wonder your stats are good.” I reminded them that MOST women ARE low risk. That birth itself almost always goes well if left alone. It’s when we begin interfering in the normal process that things go awry. I hope they heard that.

One of the guests asked me “do you bring a chair to the birth? where do they birth? how do you sterilize their homes?” I explained that women birthing in their own homes with their own germs don’t need to sterilize things. They need to have things clean and sanitary, but not sterile. I said that I sterilize the instruments and other items I bring into their homes from outside. I told them that most moms give birth on their own beds or sometimes on a birth stool that I bring, or in a birth pool. Then I told them that I had all my supplies in my car. (I didn’t intend to show them things but was on call and had everything with me.) They excitedly asked to see it.

As soon as I brought in my bags and my birth stool they jumped up with their cameras and began taking photos. I opened my bags and laid out my doppler and fetascope and bp cuff etc. and I saw them have a whole new understanding of what I do. I opened up my box of remedies and medications and they reached in to pick things up and turn the tincture bottle and homeopathic vial labels around so they could take a picture and see what everything was.

One of the OBs picked up my fetascope and pretended to listen to fetal heart tones on her colleague’s belly while asking the others to take her picture. The midwife in the group asked to take a photo with me. At the beginning of the talk I had asked who the midwife was and when she raised her hand I said “my sister midwife” and we bonded right away.

I later gave them some brochures about the midwife model of care and a handout of the study printed in the British Medical Journal about midwives and the safety of homebirth.

I also had some questions for them. The background information I was given about the state of maternal and child health in Belarus had a stat that I could not believe and thought must be a typo. The natural population growth in their country is currently negative and much lower than the European average. Despite falling mortality rates among children, birth rates are falling at a higher rate. The World Health Organization (WHO) database says there are 806 abortions per 1000 live births in Belarus. Not a typo, unfortunately. There are other appalling facts about health care in that and so many countries. One of the OBs said “it is our country’s problem.” I replied that unnecessary cesarean surgery is our country’s problem.

So, I just tried to do my part, put my one drop in the bucket. I hope they heard my message that large institutions are are not the place for healthy women to give birth. That birth, when left alone, usually goes well. And that when it doesn’t go well we (midwives and doctors) need to work together to achieve healthy outcomes. If only the Belarusians would go home and say “okay, we have the answer–let’s start training Akusherkas (Belarussian word for midwives)!” If only . . .

My friend who thought her daughter might have measles found out she doesn’t–she has MRSA. An infection with origins in hospitals–a place where healthy people do NOT belong.