Addressing Critical Knowledge Gaps in Newborn Health

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Photo Essay: A rural birth in Nepal

 
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Eking out a living

Nineteen year-old Maheshwori Devi Bishwokarma is pregnant with her second child. Despite being three days past due, Maheshwori continues to work herding goats, scratching out a living in the Himalayan foothills of Nepal. Her husband, who lives and works in neighboring India, comes home once a year.

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A difficult first birth

The birth of Maheshwori’s first daughter two years ago nearly killed her. Manisha was breach and took three days to deliver. Maheshwori is terrified that the same thing will happen again. “I am very, very scared. I just might die this time.”

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Delivery in a cowshed?

Maheshwori plans to deliver in the same place she gave birth before – in her cow shed. When women are menstruating or giving birth, they are considered to be ritually polluted and must stay outside of the home, often in cowsheds or cement rooms near toilet facilities.

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A timely intervention

An aid worker traveling with the camera crew examines Maheshwori and determines that her unborn baby is also in a breach position. Because of the dangers associated with such a delivery, the aid worker makes a case to the village elders that a skilled birth attendant should be brought in to assist with the birth, rather than relying on an untrained traditional birth attendant

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A happy reprieve

The village elders consent - Maheshwori won’t have to give birth in the cow shed.

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Calling in an expert

Yasodha Ojha, a skilled birth attendant, was brought in from the Mawa village, three hours away. She delivers nearly 50 babies each month and is known throughout the district for her birthing skills.

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Lifesaving kit fits in palm of hand

Yasodha brings a clean delivery kit with her that contains inexpensive but essential items that fit into a box the size of a deck of cards. Most kits contain a small bar of soap for washing hands, a plastic sheet to serve as the delivery surface, clean string for tying the umbilical cord, a new razor blade for cutting the cord, and pictorial instructions that illustrate the sequence of delivery events and hand-washing.

Clean delivery supplies help women and newborns avoid infection during home births.

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Mother endures difficult labor

The birth is still not easy. “I’m dying, I’m dying,” weeps Maheshwori.

Nepal has one of the highest maternal mortality rates in the world. Each year, more than 6,000 women die during childbirth. Most of them give birth at home, without the help of a skilled or even a trained attendant.

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Immediate steps to keep infant healthy

Seema is quickly wrapped in blankets to prevent hypothermia and immediately placed to Maheshwori’s breast to begin breastfeeding. Breast milk contains antibodies that help protect infants from common childhood illnesses.

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A brief rest for new mother

Maheshwori sits with Seema outside of the cow shed. “I’ll rest for seven days,” she says. “But then it’s back to work: I have to pound the rice, carry water, cut grass, and chop wood.”

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