More than one way to save lives at birth

PATH’s Jolayne Houtz is in Kenya as part of a small team observing our work there. She sent us this story from Bungoma County.

Janerose Temko’s mud-brick home is just a five-minute walk through maize fields and coffee bushes to the Chepkube Dispensary, which we visited this week to learn about PATH’s efforts to improve maternal and child health. Yet until this year, Janerose, a mother of three, had never visited the facility for prenatal care or childbirth.

Janerose’s first two children were born at home with the help of a traditional birth attendant. But when it came time to deliver her third baby, Janerose decided to give birth at the dispensary. When we visited to learn more about her decision, we got an up-close look at what happens when the old ways come face to face with newer methods of caring for women and babies during childbirth.

Woman holding infant swaddled in white blanket.

Janerose and her two-month-old daughter, Ruth. Photo: PATH/Eric Becker.

In wealthy countries, having a baby isn’t usually a life-threatening proposition: the risk of a woman dying from pregnancy or childbirth is about 1 in 8,000. But in poorer communities, the risk can be as high as 1 in 17. Part of PATH’s work here is to improve those odds by educating women about ways to make childbirth safer.

For the first time, prenatal care

When Janerose was five months pregnant, a community health worker supported by PATH dropped by to talk about the importance of prenatal care. Janerose knew the woman; she was a member of her church and a trusted neighbor. So for the first time, Janerose went for checkups during pregnancy. And when her labor started, she made her way to the clinic.

There, Janerose delivered a healthy baby girl with the help of a community health nurse named Joan Amonyatta, who joined us at Janerose’s house to hear her story.

If she has another child, Janerose told us, she’ll go to the clinic again. While her two older children were born healthy at home, it took a long time to heal from their births. During labor, her traditional birth attendant told her to push before she was ready, even slapping her to get her to respond.

Moreover, Janerose noted, the birth attendant didn’t use sterile gloves—a serious omission once you know infection is a leading cause of maternal deaths, with nearly one million newborns dying from infection each year.

Blending old and new

As Janerose told her story, a woman approached her home. It was Violet Tamnai, the birth attendant who had helped Janerose deliver her first two children.

Violet looked wary as she sat down near Joan. Her position as a birth attendant is respected in the community—a calling that is often handed down within families. Alienating her could damage ongoing efforts to reach mothers and babies with health services. With a tense silence settling on the group, I wondered if Violet would accept Janerose’s decision to reject home birth in favor of delivering at the clinic.

Finding middle ground

Then, Dr. Alfred Ochola, PATH’s technical adviser for child survival and malaria in Kenya, began the delicate work of finding middle ground. The importance of traditional birth attendants must be recognized, he told us. Birth attendants know the women in their communities on a deeply personal level. They know when they are pregnant, when they are in labor, and when things are going so wrong that the life of the mother or the baby is in jeopardy.

Alfred turned to Violet. “If there is a case you cannot deal with, it is important that you recognize that this woman is the one who can deliver the baby,” he said, pointing to Joan. “When you hold on to them too long, we lose the baby, and even lose the mother. Please, let them go. That way, we save a child.”

Violet nodded gravely and sat a little taller, the tension easing as Alfred spoke. And I realized that both Violet and Joan have essential roles to play in the ongoing struggle to protect mothers and babies. Combining the personal relationships built by traditional birth attendants with the tools of trained health care providers can help boost the odds of a healthy pregnancy, a safe delivery, and a thriving newborn.

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