November 2004 Newsletter

Yayasan Bumi Sehat, Bali update

 Oct and Nov 2004

It has been a time of togetherness and of learning for us here at the

Yayasan Bumi Sehat.  The midwives, Ibu Nyoman Susanti, Ibu Budi, Ibu Brenda

and myself, Ibu Robin have grown closer with each birth.  We have found that

magical place, in which we feel we are communicating beyond words.  We feel

certain that this closeness benefits the birthing women, their babies, and

their families.  The advent of a water birth tub at the yayaysan (thank you

to everyone who made it happen so flawlessly), has taken us to a new depth

of gentle birth.  As we grow in trust with one another, our expectant women

grow to trust the birthing process, and this is exactly what midwifery care

is meant to be.  We have been blessed to have a devoted staff, taking care

of us, so we can take care of birth.  Special thanks to Sandi, Tini Ibu

Komang, Pak Tunjung, and our nurse, Susatini, who just finished school and

is fulfilling her dream of working beside us.

In October, along with 20 other women, Dr. Sujatha birthed in the yayasan

birth tub.  When her baby boy, Tejas is bigger Sujatha will join our

volunteer staff, in order to offer Ayurvedic medicine/ healing to our

chronic pain patients.

    Many many people helped us recently.  Karen Bender sent her savingsŠ and

her husband¹s company matched her donationŠ  Marie and Nathan Zenack, as

well as Priya and Pradheep of Sakthi Foundation, who make so much possible

long with the vitamin angels in America and all our donors from Austrailia.

Raphiell Nolan and Donna brought together my "Maui Family" and held a

fundraiser. They raised over $4000.!!  Which we are hoping will complete our

savings, so we can finally purchase a transport vehicle.  ASH foundation of

Australia also donated toward a vehicle.  ASH donates money monthly to cover

the salaries for our two Balinese midwives.  Pak Caine and the Dancing

Donors continue to be devoted to our cause.

    Dr. Bobbi (our beloved doctor of traditional Chinese medicine) returned

to America, to make some money, so she can support herself in volunteering

at the yayasan full time.  Hanna, has become so essential to us, brining her

nursing skills, her loving heart, and willing hands.  She plans to return

sometime soon, to rejoin the yayasan sisters.  Canadian midwife, Harvest,

and her amazing son, Aslan, are planning their return to service in January.

    Doctor Mo, came to give chiropractic care.  Because her specialty is

pediatric chiropractic, she was extremely busy.  She managed to work on the

entire village elementary school, including the teachers.  Mo saw dozens of

children with asthma, and chronic illnesses.  We were amazed at the way with

children, how naturally and easily she gained their trust.  We are looking

forward to her return, this time with her own two boys in tow!

    Midwife Shirley Tidy was with us only 8 daysŠ we miss her so much.

Shirley brought us precious medical supplies, plus her heart and baby

catching hands, not to mention her brilliant mind.

    Two of the births Shirley was on hand for were extra significant, and so

I must share them.  Wayan came to us early in the morning, in good labor. We

had been looking forward to the birth as a healing.  Wayan¹s first child, a

beautiful daughter, Putu, died at 18 months of age, due to an illness

complicated by the fact that she was bottle fed.  (There are over 100,000

reported deaths of babies in Indonesia, due to complications of bottle

feeding, causing malnutrition.  Childhood illnesses, which are minor for,

well-nourished breastfed babies, can cause a bottle-fed baby to more easily

succumb to death.

    Wayan¹s dream was to have this baby born healthy, in spite of her

intense grief, and to fully breastfeed.  The midwife who attended her when

Putu was born told her not to even try to breastfeed.  She gave the baby

numerous bottles in the first 48 hours of her life.  The midwife provided

Wayan with a bottle, and infant formula samples.  She gave absolutely no

breastfeeding support, in fact she did quite the opposite, telling Wayan

that her breasts were not adequate.  When I met this young mother at 3

months postpartum, she was still desperately trying to get Putu to

breastfeed.

    As Wayan labored we got a call from Benny and Sylvie, a devout Muslim

couple expecting their third child.  Sylvie¹s first birth experience at a

large hospital was quite traumatic.  Fundal pressure was applied so

intensely that during the second stage that, her symphsis pubis (pubic bone)

separated.  In the initial x-ray there was an 8 centimeter gap.  This caused

her so much pain that she was not able to walk for 4 1/2 months.   Sylvie¹s

second child was born by cesarean section, as the doctors they consulted

offered her no chance of an injury free vaginal delivery.  Aside from the

normal challenges of recovering from surgical birth, Sylvie was traumatized

by the fact that in surgery she was exposed to strangers, who could not

appreciate her cultural need to keep her body private.  Then there was the

additional financial burden, of paying for the surgery.  Having not yet

finished paying off that load, Sylvie and Benny came to us, expecting a

third baby ( in 4 years) and praying for a safe, normal birth.

    Every month at the yayasan we midwives have one or two women who we know

need special attention.  Perhaps we worry more over these women and their

babies.  However, more accurately it should be said that we pray more for

them, as they are facing special challenges.  In September it was Nyoman

Jasmini, who had had two cesarean births.  She was told her babies were too

big for her pelvis.  Jasmini delivered her biggest baby ever, vaginally and

peacefully at the yayasan, into our waiting hands.  Afterward she was

triumphant, she felt invincible.

    For the month of October it was definitely Wayan and Sylvie who were

most cradled in our hearts and for who we felt the most concern.  So here it

is, they both come to us, on the same morning.

    As Wayan¹s labor heated up Sylvie and Benny arrived by cab.  We had been

filling the birth tub for her.  Brenda helped her out of her traditional

Muslim dress and jilbab (veil).  She came to me concerned about the amount

of bleeding Sylvie had.  I came in and saw that Sylvie had two enormous

clots totaling about 400 cc in her underpants, and more in the toilet.

    About then Shirley rounded the corner, I pointed to the blood. "Right,"

She said, "Let¹s just pray she¹s fully dilated and we get this baby born."

Well, Sylvie was fully dilated, none of us were comfortable with the amount

of blood she¹d lost, but we could not risk a transport and possible delivery

in a vehicle, into the birth tub she went.  Sylvie teased her baby out,

gently, gently.  A beautiful 3.5 kilo girl. "Ahum Delila!" and a teary

Muslim prayer for the thankful parents.  This was still Ramadan, and the

time of fasting, and remembering the poor, and God-within.  This was for

Sylvie her first gentle, birth, after which she could walk and sit up.  She

was beaming. 

    As I awaited the placenta, and said a special prayer over that nasty

cesarean scar, asking it to not hold tight to the placentaŠ Wayan began to

push in the next room.   Sylvie¹s placenta released nicely.  And her baby

went straight to the breast.  Benny cried tears of joy and gratitude.

    About 1/2 hour after Sylvie¹s baby was born, Wayan pushed a beautiful 3

kilo 100 gram baby boy into the light.  He went right to the breast, and has

been fully breastfed ever since.  Wayan and her husband Gede, could not help

but notice how like Putu, their deceased  daughter this new baby was.  His

wide set eyes, the way his third and forth toes on the right foot crossed,

he was utterly himself, and yet a reminder of their beautiful lost girl.

This was a truly a day of healing.  Later as the midwives cleaned up, they

played soft folk music, and smiled at each other.  Some days are just

wonderful. 

The next day two of the yayasan board members attempted to force the rest of

us to allow them to turn the yayaysan midwifery practice into a clinic for

profit.  What followed was a legal chess game.  These two men had already

resigned in writing, now they were attempting to liquidate the foundation

that they were no longer a part of.  Due to the hard work of Ibu Komang, Ibu

Brenda, Ibu Budi, Sandyasa, our lawyer Pak Agus and our village leaders, Pak

Made Weno and Pak Baguio.  The "Healthy Mother Earth Foundation‹Yayasan Bumi

Sehat" has emerged from a time of intense growing pains, to be stronger that

ever. 

    After thwarting this attempt at corrupting our precious dream, we were

all exhausted, physically mentally and spiritually.  In addition to the

legal, political stress, the midwives were up every night that week, with

one or more births.

    Just when the smoke cleared I had a call, it was 1:30 a.m. "Get to Ibu

Budi¹s house, she¹s hemorrhaging!"  As I threw on clothing and called Brenda

to bring a car around, I went over the possibilities in my mind.  We all

were aware of the fact that Budi had a total placenta previa.  But there had

been no spotting, no warning. She was 28 weeks pregnant, too soon, too soon.

We found Budi to have bled so much that it was shocking.  She had dreamed

that her waters released, asked her husband, Pak Tunjung, to turn on the

light, to find they were both soaked in blood, from chin to toes. We went

quickly to the hospital in nearby Mas, where we normally transport, and we

know a good surgical team can quickly be assembled.  The doctors were not

willing to do the needed cesarean, because the baby was 12 weeks early and

would need neonatal intensive care, available only at Sangla hospital.  The

problem was that Sangla was another 1.5 to 2 hours away, depending upon

traffic.  The midwives at Mas were helpful and fast, we put and IV in each

of Budi¹s arms and flew, knowing this second transport would compromise the

baby and further endanger Budi¹s life.

    By 2 a.m. we were preping Budi for surgery, and buying all the Type A

blood the bank had, nine pints!

    Baby Putu was 1 kilo 400 grams, big enough, but her apgars were low, due

to the fact that the placental blood was all but gone.  Budi was not so well

either.  She convulsed dangerously after surgery.  Her placenta bed bled

terribly.  She remained in a coma for the next 19 hours.

    Sometime in the late morning, Brenda and I went home to get clothing for

the family members, food, and more money to pay for the medical expenses.

Also to report to the rest of the yayasan on the status of our dear Budi and

Baby Putu. 

    Later that afternoon Ibu Nyoman took over the yayasan birth place, we

had admitted a young couple, Putu and Ketut.  They had seen us only a couple

of times, and now were in good labor at term. I went back to the hospital

with my husband, Wil, my third trip that day, leaving the birthing couple in

the capable hands of Ibu Nyoman.

    As I sat in the infant ICU, my hand in Putu¹s incubator, praying, doing

Reiki.  I marveled at eventsŠ.  Earlier that same night a couple I had

diagnosed with twins came in.  The Ultra sound doctor said, one baby, but

complete placenta previa.  When Kadek spotted badly we advised them by phone

to get immediately to Sangla Hospital, which they lived nearby.  As turned

out, it was twins, boys.  Both smaller than Budi¹s baby girl, 1 kilo 100

grams and 1 kilo 200 grams.  Since there was much less blood loss and these

baby¹s 9 weeks early (instead of 12) they were doing much better.  They

would survive. I found myself in ICU praying over three babies.   I made

plans to bring Kadek, their mother a breast pump, as the twins were still to

fragile to suck.  My heart sank as hour by hour Baby Putu¹s breathing became

more labored.  My hand phone rang, it was around 10 p.m., it was Ibu Nyoman.

"The heart tones here are not good.  I¹ve tried position change, now oxygen.

They are not that bad either, around 100 to 110, but the mom is only 3

centimeters dilated, my feeling is we should transport."  I encourage Nyoman

in her decision. 

    An hour later she called from the hospital at Mas, I was still in Sangla

hospital, Budi still unconscious. "Ibu (mother)" Nyoman cried, "this baby is

gone, heart tones are gone.  We did an ultra sound, it¹s a short, short cord

around her neck, she didn¹t make it.  We both cried.

    Around 3 a.m. after Budi had emerged from her coma and was stable,

sleeping normally, we made it home, leaving Budi¹s family from Lombok to

care for her along with her husband..  The hospital at Mas called to ask

what to do with my patient with infant demise.  I asked them to let her

sleep, she had cried herself to sleep an hour earlier.

    At 5:30 a.m. my hand phone rings.  It¹s Ketut the young father of the

baby who had died.  He is crying out of control. "The doctor says that since

we are too poor to pay for a cesarean, he wants to remove the baby in

pieces."  "What?" I say, wondering if this is a sick phone call of some

kind.  "Ketut, is this really you?"  "Yes." He cries. "The doctor says he¹ll

first take the head, then one arm at a time."  "Stop!" I yell, "I¹ll be

there in a few minutes."  I wake up Wil, who takes me through the drizzling

dawn by motorbike to the hospital.

    There I find Putu fully dilated, very beat up emotionally and begging to

let her baby be left whole.  In Bali Hindu Dharma the body must be intact to

have the proper offerings done for burial.  Outside I had been greeted by

nine elders of this family, all of them wearing clothing that was in

tatters, clearly they did not have the resources between them to pay for a

cesarean birth.  Dr. Wegagama gave me two choices, he would remove the baby

vaginally, in pieces, or I would pay for a cesarean.  I examined Putu, she

was fully dilated, baby¹s head at plus 1 station.  I asked him for a chance

to help Putu birth vaginally. He did not agree.  I signed, and we went into

surgery. 

    Cesarean birth is birth, a miracle, even if it was not the mother¹s

dream birth.  But a cesarean birth in which a beautiful 3.5 kilo term baby

girl is lifeless and blue, is much different. The cord was no longer than 30

centimeters, wrapped once, tightly around her neck.  I stayed with Putu as

she was expertly closed. She was asleep by now.  The elders of the family

could be heard crying just beyond the surgery doors.  When I came out, they

were hugging their granddaughter/grandniece, They had dressed her in

beautiful newborn clothing that I had brought along that morning.  They were

kissing her beautiful lifeless face.  It was the best money I ever spent.  I

said a little prayer that the rest of the yayaysan would agree, as I don¹t

ever normally make unilateral decisions concerning money.

    After Putu briefly saw her child, and the baby was taken off for burial

and Balinese offerings, I went home, showered and returned to Sangla

Hospital.  Budi was out of the coma. Her baby¹s condition had deteriorated.

Dr. Mo met Brenda and I.   We spent most of the day in the neonatal ICU,

amazed at the dedication of the staff there, reporting back to Budi on her

baby¹s status, every couple of hours.

    By around 6 p.m. it became clear that Baby Putu was not breathing on her

own.  Her little heart could not take much more.  We gathered Pak Tunjung,

the baby¹s weeping father, and Pak Mangku, Budi¹s father who had come by

ferry from Lombok island.  They sang Giyatri mantra to Putu as the ICU staff

tried to save her.  Finally, painfully first her breathing then her heart

stopped.  It took four hours of negotiations to get permission to bring the

baby to Budi, so she could say goodbye.  Some of her family was against her

seeing the child.  But Budi was quietly determined to see her deceased baby,

to kiss her hello, and goodbye.

    Pak Tunjung took the baby home, it poured rain as the villagers gathered

in the dark to put this tiny perfect body to rest.   After Budi slept Brenda

drove us home, slowly in the dark.

    The next day we received two healthy baby boys at the yayasan.  Our

appreciation for these new lives was more than double the usual.  We had had

far too much of death. A few days later Budi was released and moved into the

yayasan, where she feels most safe and comfortable to heal.  Send her the

light of healing.

 For those of you who help us financiallyŠ I pray you won¹t mind that we

spent so much money on these births/deaths (paying the hospital bills).  Our

plans to buy a transport vehicle are still in place, it will just take a

little more time.  When we face loss of life, finances fade into the

distance, and we know our responsibility is to something deeper and more

from the heart.  Thank you, each of you who help.  Each of you have

contributed to Budi¹s survival, and to a proper goodbye for two small babies

who did not make it on Earth.

Om ShantiŠ Ibu Robin, Banjar Nyuh Kuning, Bali