The Casa Materna is a home for pregnant women within the city of Puerto Cabezas. It is part of a strategy used in developing nations to reduce maternal mortality. Women, who often come from far away communities in order to have their birth at a facility attended by skilled birth attendants, stay at this home to await the swells and surges of labor. The Casa Materna provides medical attention 24hours a day and is a safe space for mothers to be home-away-from-home. The Casa Materna for me is a bit of a home-base where I can check in with nurses that I know, and also is the site of my weekly meetings with obstetric and maternal-infant health nurses to create the radio program Mairin Karnakira-Mujer Poderosa. On a recent visit to the Casa Materna I spoke with two pregnant women who had made the journey from their communities to have their births at Hospital Nuevo Amanecer. Both of them had delivered babies before in their homes. I asked them what made them decide to come here to Puerto Cabezas. One woman answered that previously she lived in Las Minas. There was a health clinic in the town and an obstetric nurse present. She felt safe in her community that if something went awry that she had medical attention quickly available. She explained that since then she had moved to a new community distant from any health center. It took her 3 hours walking to reach the road, and then an additional 8 hours in vehicle to get to the city. She came to the Casa Materna so that she would have medical care at her fingertips. The other woman said that she had been told that it was 'better' to have her baby in the hospital. That it is cleaner, and that there are physicians present if she were to need one if an emergency arose. I was glad to hear that these women made this type of informed choice for themselves and their birth. The rhetoric that NGOs and the Ministry of Health have been disseminating for some time was evident in the words that these women chose and in their desire to protect their health and pregnancy.
Today I provided a Birth Preparation class to the women present at the Casa Materna. There were a total of 34 women currently staying at the home. Of 34 women 3 were pregnant for the first time. Of the 31 remaining 31 had a previous home birth and only 1 woman had experienced a hospital delivery. We discussed the changes that happen to the cervix, its softening and opening, and how each pain of contraction is related to more opening. I used a hand sewn model that I made two years earlier to show the changes of the uterus, the birth of a milky white babydoll, and the burgundy-chiffon umbilical cord and placenta. I acted out a laboring woman and we all closed our eyes, laid our hands upon our bellies, and deep breathed together to alleviate the intensity of our labor pains. I decided to spend some time asking women what their expectations were for birthing in the hospital, and also sharing with them what would be different here versus at home. Women shared that they thought it would be cleaner, and that if there was an emergency there would be someone present to manage it. One woman shared how she heard that many maternal deaths were due to retained placenta and that she believed that if that happened at the hospital that they would have a way to resolve this problem. I asked the one woman who had birthed in the hospital what her experience was like. She said that she thought it was cleaner [a resounding theme!] and that she liked the birth table...she felt like it gave her strength. I explained to the group, watching them lay their hands gently across their swelling bellies, how they would be brought to L&D when they have 4-5cms of dilation, about the delivery bed and the obstetric position, about the manual exploration of their uterus postpartum, and how the nurses will dress their baby and the puerperal mother uniting them on a bed at the back of the room. One mother from the group thanked me for preparing her for the differences she could expect in the hospital.
I had a major revelation as I walked out of this Preparacion de Parto class: 1) these women want cleaner births 2) they wanted access to emergency medical services and 3) when you don't know what you are missing [water birth, low-lights with guided mediation, doulas, empowered homebirth, etc.] your birth experience can be good.
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