by Rachel Zaslow, Mother Health International (2nd in a two part blog)
I believe that when we remove midwifery from community, we risk losing midwifery altogether.
One day while we were acting out a birth scenario where a baby was extremely distressed at birth, we talked about how helpful it would be for the midwives to be able to count fetal heart tones. If a traditional midwife could determine in advance if a baby was in distress, she may be able to resolve the situation or have time to make a transfer. Without knowing how to count, how would a midwife learn to count heart tones? For those of us who learned to count diligently in elementary school, it is hard to imagine a world that is not ordered by numbers that correlate to days and times. The midwives shared that they track their menstrual cycles with a string of beads that is cycled to the moon. This way of knowing makes sense in an area where there is no electricity and women still bleed with the moon.
My partner midwife Olivia was with us at that meeting and she thought of the abacus. This is how the Heart String was dreamed up. We made a string of color-coded beads that midwives could use to assess fetal heart tones. For every heartbeat, the midwife ticks off a bead and then after 15 seconds (we use sand timers), look at what color bead they have landed on. White beads mean the FHT is too low. Green beads, FHT is in a range of normal. Red beads, the FHT is too high. We then developed protocols for what to do in instances where heart tones are too low or too high. The strings were almost immediately understood and used with great accuracy, because it is a way of understanding that correlates to traditional systems of knowledge. Over the last several years, we have used the Heart Strings with traditional midwives in several countries and have been overwhelmed with their success. Midwives who previously could not tell the difference between a high-risk mother and a low risk mother were able to make appropriate medical decisions prior to a bad outcome, thereby avoiding catastrophe and saving lives.
I still wonder if there is a way to honor ‘different ways of knowing’ when we think about education, especially in a community that is not our own? When we think critically about barriers to maternal and child health, we must understand the history and context of the places in which we stand and we must question methods that ‘bestow’ knowledge upon others. There is no one answer to the crisis that faces women around the world, but one thing I know for sure is that one on one care and support is not only achievable, it is imperative to good outcomes. We don’t need tons of money or fancy equipment. To stand with women, we must be ‘with women’. We need good old-fashioned, ‘hands on’ care. The kind that women give to other women. The kind that mothers give to their babies. The kind that nurtures and sustains. The kind that thrives on and in community.knowledge upon others. There is no one answer to the crisis that faces women around the world, but one thing I know for sure is that one on one care and support is not only achievable, it is imperative to good outcomes. We don’t need tons of money or fancy equipment. To stand with women, we must be ‘with women’. We need good old-fashioned, ‘hands on’ care. The kind that women give to other women. The kind that mothers give to their babies. The kind that nurtures and sustains. The kind that thrives on and in community.
Endnote: Dear reader, if you cite the HeartStrings, please give credit to the inventors at Mother Health International and to this page where you first read about it, Maternova. Remember that the HeartStrings are patented, and that this page, like every page on the web, has terms and conditions associated with its content and proper citation!
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.