This is a common birth experience in remote parts of Tibet, where there are virtually no resources to ensure safe births. Had the midwife not intervened with IV fluids, uterine massage and other basic measures, the mother would have become another heartbreaking statistic, one of the 500,000 mothers worldwide who die each year in childbirth, according to the Salt Lake City charity that trained the midwife, known as One H.E.A.R.T. (Health, Education and Research in Tibet).
Most births in rural Tibet take place in an outbuilding or tent, sometimes on a cold floor covered with yak dung. Mothers are often alone and rusty shears are used to cut the umbilical cord, which exposes the newborn to tetanus or other infections.
"You can't meet a Tibetan woman who hasn't had a newborn death. When you interview them, you'll find some who have lost two or three," said Arlene Samen, who was working as a high-risk obstetrical nurse-practitioner for the University of Utah when she founded One H.E.A.R.T. in 1998. "It affects their entire community."
Dozens of superstitions surround childbirth in Tibet, most of them harmless, such as the belief that a husband can ensure a safe birth if he wears his clothes a certain way. Some believe that pregnant women should avoid fetching water, lest the task causes the umbilical cord to wrap around the baby's neck.
"There are many beliefs that prevent them from seeking help or having a stranger deliver the baby or going to the hospital," said Samen, recently named a CNN Hero by the cable network and also singled out by the Dalai Lama as an Unsung Hero of Compassion in 2001. "They believe the blood from childbirth is polluting, so they don't want to contaminate the home."
The charity's operations are led by Addie Koster, a Dutch midwife who has worked in the world's most troubled regions, including Afghanistan and Rwanda. She is now in Liberia setting up a school for birth attendants.
Based in Llasa, One H.E.A.R.T. hopes to impart basic rules of health care: Births should take place in a warm, clean place and be attended by at least two people. Babies must be dried and wrapped, their airways kept clear.
"They know to look for danger signs. They don't know about high blood pressure, but they know to watch for headaches, swelling, whether the baby is moving. If the woman gives birth at home, the family knows how to recognize danger signs, knows how to do uterine massage, put her feet up, not to aspirate, so you turn her head to the side, to start breast-feeding," Koster said. "If things go wrong, they know what they can do while they arrange transfer. They need to make sure there is a tractor in their community and cash to pay the driver."
Outreach workers also provide pregnant women with $50 birth kits, containing a tiny hat to keep the newborn's head warm, blankets, a clean razor and tie for cutting the cord, prenatal vitamins, misoprostol tablets to induce contractions, surgical gloves, a sterile sheet, clothes and soap for cleaning the baby, and gauze.
Routine use of misoprostol for labor induction is controversial in the United States because it triggers strong, painful contractions. But in the developing world, postpartum use of misoprostol, a cheap ulcer medication that comes in a tablet, is credited with preventing fatal hemorrhages by speeding uterine contractions.
Creating a statistical picture of Tibet's maternal health is difficult because official numbers are unreliable.
"Our numbers are integrated into Chinese statistics, and this gives a false picture. We can only base it on our own outcomes," Koster said.
One H.E.A.R.T. recorded six maternal deaths and 40 neonatal deaths among the 600 births in Medro Gongkar in 2003, the year it established programs there. The next year, two mothers and 30 babies died. Since then, 17 babies have died but no mothers.
One H.E.A.R.T.'s key initiative is training birth attendants, who return to their villages to serve as midwives. These health workers now attend 36 percent - more than 200 - of Medro Gongkar's births.
"They earn little salary, but they are very confident," Koster said. To date, 78 midwives have been trained, including the one who was summoned to help the mother bleeding by herself. She spent two hours getting to the village on foot.
"The mother was near death. This family had heard none of our messages," Koster said. "She started an IV, gave misoprostol, got the placenta out. She stayed two days. She knew what to do. She really saved this woman."
nmaffly@sltrib.com
Births in Tibet
Two-thirds of all births occur in the home.
Utah-based One H.E.A.R.T. works in rural Tibetan communities providing simple training and equipment to improve birth outcomes. Learn more at www.onehearttibet.org.
Source: One H.E.A.R.T.
