Finding my calling as a fundraiser and grant writer for a birth centre for poor families in Indonesia
If you want to fall in love with the world, really fall in love with it, watch a birth. Better yet, move to a developing country, work as a fundraiser for a birth centre for poor families, have no experience of birth yourself, and then watch a baby born into water.
I was walking home after an evening out when I got a message from Robin. She is a Filipino-American midwife who helped start the birthing centre in Bali where I had just started working as a grant writer and fundraiser. Occasionally, she is summoned with desperate calls on borrowed mobile phones to deliver babies in tin shacks with dirt floors for women so poor they cannot afford to pay the local untrained birth attendants two dollars to help. The family lacks transport. The women have never come for pre-natal check-ups. When Robin gets a call for a birth like this, she tucks several large rupiah notes into her tunic pocket to buy food for the postpartum woman and any other children she may have. She knows from experience that the new mother may not have eaten for days.
Apparently, a woman from just such a family was having a baby. She’d been able to get to the centre, arriving in a bemo, one of the small, public buses that ply Bali’s roads. The twenty-cent fare was contributed by the entire family.
“If you want to see a quiet, gentle birth,” read Robin’s electronic summons, “Come now.”
Robin was adamant that I watch a birth, so I could see the work I was helping to support. Yet, I was leery of watching a stranger’s birth. Wouldn’t I be intruding? Reluctantly, I altered my walk home to head to the birth centre, leaving behind the hum of Ubud—with its shops and sidewalks and restaurants full of overweight tourists sweating profusely in the moist, tropical air—and strolling through the quiet lanes of Nyuh Kuning, a village of woodcarvers. The night was redolent with the smells of incense, smoke from burning garbage fires, and night-blooming jasmine. Street dogs stirred at my approach and sniffed the air for my scent, one loping along behind me silently. It was just after 11 p.m.
Robin met me outside the birth room. “This will be a good birth for your first time,” she said. “She’s a second-time Mom, and fully dilated. The baby will be out soon.”
She took me into the room with her and handed me a clipboard and a pen. “I’ve told her that you are helping record the details of the birth,” she said. She briefly ran over the method of charting fetal heart rates. “This won’t take long,” she said.
“Will she mind that I’m here?” I asked.
“Right now, you could be Richard Nixon, and she wouldn’t care,” said Robin.
The woman was on a bed, half-sitting, half-laying, moaning. She was naked. Her skin was dark for a Balinese, sun-darkened by outdoor work. She had huge, globe-like breasts that hung pendulously across her great, moon belly. Great dark nipples stretched across the top of her breasts, and a dark pregnancy band, a band of darker pigment, stretched across her belly. Her hair was long, matted to her neck with sweat in the hot, still air of the birth room.
A lone fan turning lazily high up on the ceiling did little to dispel the tropical heat.
Another midwife stood nearby while Robin sat on the bed with the laboring woman. The woman’s husband squatted behind her shoulders, supporting her, as she leaned against him. He was clad in jeans and a khaki fatigue top, marked with dark sweat stains. With eyes wide and fearful, he watched every move of the midwives, uncertain as to his role.
The birth centre was atypical in that the midwives expected husbands to be present at the birth and help support their wife. This had been the tradition in the Bali of their grandparent’s generation, but was passing out of fashion now. Some husbands managed better than others, coaxing, coaching, reassuring their wives, while others looked around them with all the composure of a rabbit caught in the headlights of a car. This one was of the rabbit variety.
A nurse moved quickly, expertly, in and out of the room, bringing a receiving blanket for the baby, water with spirulina for the mother, and towels for the blood. I watched and waited. A half hour passed. Then an hour. From time to time, Robin leaned towards the woman and spoke to her softly in Indonesian. After a while, she spoke, frowning, to the second midwife.
She looked at me. “This is taking too long,” she said.
“Is there a problem?” I asked.
“No, the baby’s fine. Two good pushes and he’ll be out,” she said. “But every time she starts to push, she stops and pulls the baby back in.”
The woman was growing increasingly agitated. Her moaning was turning to a kind of guttural screaming, which made something in the lower vicinity of my gut tremble. The woman was thrashing on the bed, knocking her husband as he tried to stroke her arms, to comfort her. Robin was looking very solemn. Every time she spoke to the laboring woman, the woman would cry and moan louder. She was covered in a sheen of sweat that glistened in the glare of the overhead light.
There was a strong smell in the room, like a mixture of every type of odor the body could emit, earthy and musky, combined with the antiseptic tang of amniotic fluid. This was the smell of birth, the second midwife explained to me.
Robin and the other midwife tried to help the woman position her legs apart, but the woman kept pulling them back together again. Robin spoke to the husband, and he nodded. He shifted his position forward so he could hold one of his wife’s legs apart. The second midwife held the other, also open. Yet the woman fought them, wrestling her legs back together, her fists pounding the bed. One of the fists knocked the husband. He retreated to the head of the bed, trying to hold his wife’s shoulders still.
Robin turned and looked at me. “I just don’t get it,” she said. ”This is the second baby. She’s given birth before."
"She says she’s scared to push.”
The woman was screaming and yelling now, hitting out at the walls and the bed. She twisted on the bed, her huge breasts rocking side to side. However, Robin’s reaction was unexpected: she was getting visibly annoyed.
Suddenly, Robin spoke sharply to the woman and, standing up, gestured for everyone, including the husband, to leave the room. I didn’t move, not understanding. Robin waved impatiently at me. “Everyone out. She’s behaving like this because she has an audience. I’ve never seen anything like this. The baby wants to come out and she’s keeping it in,” she said.
The staff and I left the room. Through the open window to the birth room, I heard Robin talking in Indonesian in a firm voice. The woman was crying and even I could understand her. “No, please,” she kept saying.
Robin walked out of the room and closed the door.
“Is this normal?” I asked.
“No,” said Robin, “I don’t get it. She’s had a baby before. I told her two pushes, the baby will be out, and this will all be over.”
The woman was screaming and pounding on the walls. I looked at the clock. Almost 1:30 in the morning. So much for a quick, gentle birth. The odd thing was that I didn’t care. I was happy, almost uplifted. I felt like I could wait for hours.
Robin was apologetic. “I feel so bad that this is your first birth,” she said, “I was sure when I messaged you, that it would be no longer than a half hour.” She paused. “But then, I should have learned by now, that every birth is different,” she said.
She was apologizing to me, but I felt that it should be me apologizing to her, to the parents, for intruding on something as personal, as intimate, as birth.
“I don’t mind,” I said. Actually, I felt energized, almost a bit high. My fatigue had vanished. “I feel like I could go all night.”
She smiled. “That’s the oxytocin,” she said. “The love drug of birth. The room is full of it. Sometimes, after a long birth, it’s the only thing that’s keeping me going.”
During birth, oxytocin is released by a laboring woman in large amounts after the cervix and vagina stretch and distend for birth. Oxytocin works on the uterus to make it contract for birth, causing the milk to ‘come down’ into a woman’s breast so she can start to nurse after the baby is born. It increases trust, and reduces fear. Oxytocin binds mother and child at birth and triggers “maternal behavior,” that is, it binds mother to child. But oxytocin also works on those around a laboring woman. Women present at a birth have been known to start their periods immediately afterwards or crave sex.
Oxytocin is often called the ‘love drug.’
Bali’s Hindu Dharma culture once had rituals that left mother and baby alone to bond in isolation for a period of weeks after the birth, with the mother doing no activity other than nursing and sleeping. Both culture and religion recognized the essential nature of mother-baby bonding, and that something special happened when women were alone with their babies. The culture also treated the placenta as the twin of the child, giving it special rites, and prescribing that it be buried in a certain part of the family compound. Women ‘married out’ in Balinese culture because, it was believed, they could stand the separation from their twin, from the compound where their mother’s placenta was buried, better than men could. Still, they always carried with them a small box of dirt taken from the spot where their placenta ‘twin’ was buried. Sadly, Bali’s Westernized medical programs and the hard sell of infant formula companies have disrupted these rituals.
“What happens now?” I asked Robin.
“I’m going to have to be tough with her. This is the hard part about being a midwife. If she won’t push this baby out, she will have to go to the hospital for a Cesarean. The Health Department has strict guidelines we have to follow. If she can’t get the baby out on her own soon, we’ll have to transport her.”
I knew that a hospital birth, and a likely Cesarean, was not a financial option for the family. They wouldn’t have the money to pay for it. They’d barely been able to scrape together the bemo fare to bring the mother to the birth centre.
Robin returned to the room. I heard her speaking firmly. The woman’s screams subsided; now she was sobbing. She was asking Robin something over and over. Robin stepped back out of the room and stood, waiting. The woman continued to cry and call out Robin’s name.
“She’s begging me not to take her to the hospital,” said Robin.
“She says she would rather die here with the baby than go. But I told her if she won’t push the baby out, we will have to take her. She’s being stubborn. She could do this, but she won’t.”
We all stood outside the room and waited. I looked at the clock again. It was after two. I still didn’t feel tired. I felt somehow bonded with this stubborn woman who refused to push out her baby. I felt a sort of glow. Everyone around me seemed to have it too, a sort of flush in the cheeks, an animation in their faces and voices, despite the late hour. Finally, the woman’s shouts subsided; she was crying softly. Robin returned to the room alone. I heard her talking quietly again. Then, Robin opened the door and gestured the staff back in.
“We’re going to try a water birth. That should help relax her,” she said.
The birth tub was an old spa bath, liberated by Robin from a friend who never used it. It sat, hulking, in a corner of the room. The nurse filled it with water from the small gas heater on the wall, then bobbed a thermometer in the tub to check the temperature. Robin and the second midwife helped the woman sit up on the bed, then stand awkwardly. With a midwife supporting each arm, and her husband trailing in her wake, the woman shuffled ungainly across the floor, her chest heaving, her breasts flopping.
The staff lowered the woman into the water. She sat up with a start and said something in Indonesian. The second midwife and the nurse talked reassuringly to the woman and she relaxed into the tub. Robin turned to me, explaining.
“This is the first time she’s ever been in warm water. Usually, she has a cold water mandi, or bathes in a river.”
The staff directed the husband to sit at the edge of the tub, behind his wife. His legs dangled awkwardly into the tub. Finally, he squatted on the edge, looking uncomfortable, holding his wife’s shoulders tentatively. The laboring woman sank back into the tub, into the water. Her body seemed to lose some of its tension. The second midwife began to scoop warm water over the woman’s breast and belly with a blue plastic pail.
Robin talked steadily with the woman, keeping one hand on the woman’s knee. Soon, the woman was nodding. She was visibly relaxing. Suddenly, a spasm passed over her, she leaned forward and cried out, one hand going to her belly. Robin leaned forward, peering into the space between the woman’s legs. She spoke more urgently as the woman made short, high sounds through her nose. Another spasm gripped the woman and again she cried out, leaning forward. Robin parted her legs, and her right hand seemed to be cupping something between the woman’s legs. The staff begin to chant the Gayatri Mantra which the midwives sing to welcome new Hindu babies into the world. Unaccounted tears sprang into my eyes.
“The baby’s crowning,” said Robin, looking up at me quickly, then looking back into the tub. “Make a note of the time.”
The woman cried out again, and now I could see a whitish-slime-covered bulge between her legs. The chant grew louder. The woman was panting and crying out in short, sharp breaths. Robin inserted her other hand, and suddenly a tiny, white body slid into them, with a long white cord snaking back into the mother’s body. The baby was half in the water, half in the air. The chant reached a crescendo, then fell away. Robin lifted the baby and placed him onto his mother’s belly. “It’s a boy,” she announced.
Suddenly, everyone around the tub sprang into action. Hands held out a small, cotton blanket and wrapped the baby. Other hands stretched a tiny cotton hat onto his head. The baby was breathing now, a great suck of air, then his thready cry filled the room. The mother was crying, her chest heaving. She strained her neck to look at the child. The father was also smiling and crying.
Tears were running down my cheeks too.
I never expected this. I had always wanted children, but never had any. In my technologized, sanitized Western world, I had only seen medical births on film, with all the participants and attendants gowned and wearing masks and caps. I hadn’t expected birth to be so visceral, so sweaty and full of sound. I hadn’t expected chanting that touched my heart. I hadn’t expected this feeling of being in a holy place, watching an age-old rite that somehow was unique to this woman.
People bustled in and out of the room. The woman was helped out of the bath, dried, wrapped in a sarong, and then walked slowly back to lie on the bed, her great moon belly reduced to almost a third its size. As the mother lay down, the midwife placed the baby to her breast. Within minutes, the boy was nursing.
I was watching new life, and it was amazing.
I knew this child was born into poverty, that his life was uncertain. I also knew that because of Robin’s efforts, and my fundraising skills, this birth didn’t place the family in crushing debt to a hospital or force them to use a midwife who would sell the child to cover her bills, which happens in Indonesia. They could use their money to buy food and later pay for school fees.
The mother kept saying the same sentence repeatedly to Robin. I waited in a corner of the room until Robin was finished with the mother, and came over to me.
“She was thanking me for not hitting her,” she explained.
“That’s what they did to her in the hospital with her first baby. They hit her to make her be quiet in labor. That’s why she was terrified of pushing. She was scared that the pain would be too much and she would cry out.” Suddenly, Robin looked tired. “Luckily, her fear of going back to the hospital was greater than her fear of the pain and she pushed the baby out.”
I crept over to the bed to look at the baby. His face was still red and wrinkled from the birth. His mother was touching him softly, as if she couldn’t yet believe he was real. The father kept grinning as he patted his wife. The woman looked up at me, directly at me, and smiled. It was a smile that defied the reality of her hardscrabble life—a smile full of pride, of joy.
Tonight, she wasn’t one of Bali’s poor, who toiled in the rice fields and never quite had enough to eat. Tonight, she was a heroine who had overcome a great struggle. Tonight, she was beautiful. Hair still disheveled, with a damp, rayon sarong wrapped around her, she glowed, radiating contentment, satisfaction, and accomplishment.
The part of me that felt pity for her poverty shriveled and blackened in the heat of her smile. I smiled back at her, and her smile grew wider. She beckoned me to come closer, drawing back the blanket covering the baby. Look, her smile said, I have created life and it is wonderful. She took my hand and held it out to touch the baby. (Later, I would learn that she was hoping some of my luck, the luck of being white and privileged, would rub off on her new son.) I felt his tiny heart beating. He was mewing like a kitten. I felt something melt open inside me.
Here is a brief introduction to the work of Yayasan Bumi Sehat in Indonesia and the Philippines.
(All media from Yayasan Bumi Sehat used by permission)