This story exemplifies what we do here at our Bumi Sehat center. We are not simply a birth center; we are a group of concerned and committed people supporting women in their spiritual, physical, and economic needs, focusing on, but not limited to, safe motherhood and infant survival. We also advocate for and practice the most gentle, evidenced-based model of childbirth. We employ sound medical science with respect for nature, using holistic methods of healing and advocating for natural childbirth as a first choice. We practice with a deep respect for Indonesiaâs diverse cultures, considering each patient as a soul.
Describing Bali and Balinese birth
Before I tell the story of our center, let me tell you about the country in which we live. Bali, 8° south of the equator, is an island culture. It was once an independent kingdom, later absorbed into the nation of Indonesia, the fourth-largest country in the world. Bali is predominantly home to Hindu Dharma people, who comprise 84.5% of the population of 4.22 million. Other nationally acknowledged religions include Islam, Buddhism, Catholicism, Christian Protestantism, and Confucianism. Indonesia has many diverse cultures, and people migrate to Bali for work and avail themselves of Bumi Sehatâs health servicesâthe Asmat of Papua, Toraja of South Sulawesi, Dayak of Kalimantan (Borneo), Sasak of Lombok, to name a few. Whereas agriculture and fishing were historically the main industries, today tourism is the primary source of revenue for the island of Bali, yet the majority poor still live agrarian lives. Tens of thousands of hopeful people migrate to Bali each year from many Indonesian islands, attempting to build a better life. Often they find themselves displaced and destitute.
Bali suffered two major eruptions of the beloved holy mountain Mount Agung (Gunung Agung) in 1963. The rice crop failed that year due to the volcanic fallout, and hunger plagued the Balinese. Historians write that the famine that followed the eruptions claimed about 50,000 lives. In fall 2017, Mount Agung came back to life. During the first seven weeks of eruption alert, evacuee women in advanced pregnancy were welcomed, along with their families, at the Bumi Sehat clinic in Nyuh Kuning village, safely 30 kilometers from the summit of the volcano. A total of 138 people lived on site at Bumi Sehat through the next seven-week evacuation phase, and again for 13 weeks, when eruptions continued. At Bumi Sehat, with the help of the skilled midwifery team, the evacueesâ babies were born and blessed (see Chapter 9). Small earthquakes and steam with ash eruptions are a continuing reminder of Baliâs vulnerability.
Between December 1965 and early 1966, Bali suffered widespread unrest; an estimated 80,000 to 100,000 Balinese were killed in conflicts between the Indonesian Nationalist Party and the Indonesian Communist Party, which constituted roughly 5% of the islandâs population at the time (Friend 2003; Taylor 2003; Vickers 2005).
Earthquakes, enormous sinkholes, storms, eruptions, landslides, violent conflicts ⊠indeed, the seemingly peaceful island of Bali is always on the edge of disaster. Bali is also the epicenter of creative/artistic expression in Asia, with our area, Ubud, being the eye of the innovative storm of dance, drama, gamelan music, painting, weaving, woodcarving, stone sculpture, batik, and beautiful temples.
The Bali Hindu Dharma religion is an intricate display of daily offerings and frequent ceremonies aimed at appeasing the gods and the demons, placing a distinct demand on the time and energy of the women here. Rural women rise before dawn to cook on fires made from wood that they must scavenge. Mothers hand wash the family laundry, harvest the rice, and hold down demanding jobs. Balinese women often spend hours in the night and daytime making religious offerings, once an enjoyable sharing among women, now exhausting, as modern times require women to work outside of the home.
Almost 30 years ago, when my family moved to Nyuh Kuning, Ubud, in the foothills of Baliâs central mountain range, roads in this small village were made of dirt and broken coral. There were no automobiles and only a few families had motorbikes. Trying to get to the main city, Denpasar, 1.5 hours away by car, or even Ubud, 10â15 minutes away by motorbike (accessible on foot via the Monkey Forest), was difficult. Consider that to find a midwife, clinic, or hospital where one might give birth, most families needed to borrow a vehicle, or walk. If it were night and/or raining, the husbands often pleaded with their laboring wives, âPlease hold the baby until morning!â Dozens of people relayed to me stories of women they loved giving birth unattended, and sometimes bleeding to death. Many families had buried one or more babies.
There were the often-told lighter stories of women birthing successfully along the roadside, trying to walk long distances to the midwifeâs practice. The bidan di desa (midwives of the village) were trained in Department of Health programs. They worked in small government or privately owned birthing units, no more than tiny cement enclosures, often built beside the village graveyards. The bidanbidan (plural for âmidwivesâ in Bahasa Indonesia) fought off death from post-partum hemorrhage by injecting pitocin, and the people were grateful. The flip side of the fast-track midwifery training, designed and implemented by NGOs from Western countries, was the fact that many bidan-bidan cut large episiotomies and sutured without local anesthetic. (I have seen episiotomy wounds left to heal wide open when suture was not available.) Many bidan-bidan used harsh fundal pressure to hasten the births. All babiesâ umbilical cords were immediately clamped and cut; the instruments used were sometimes unsanitary. Gloves and injection syringes were in short supply and often reused. The bidan-bidan would quickly and roughly bathe the babies in caustic soap, scraping the newbornsâ skin with a hard plastic hair comb to remove all the vernix caseosa and any traces of the mothersâ kotor (âvaginal filthâ). The Western protocols for birth, especially immediate clamping and cutting of babiesâ umbilical cords, represented a harsh departure for the birth culture of Bali.
By the 1970s, infant formula companies began to market artificial milk via the drastically underpaid network of bidan di desa throughout Indonesia, who partnered with infant formula companies to supplement their incomes. Tens of thousands of these health care providers, enlisted by Indonesian businesses and supplied by NestlĂ©/Gerber, Danone, and other conglomerate corporations, distributed free samples of infant formula and endorsed the bottle-feeding of infants. According to the World Alliance for Breastfeeding Action (WABA), the number of reported deaths due to the effects of infant formula, compounded by water and sanitation issues, is around 300,000 babies per year. WABA Indonesia warns that a baby fed infant formula in Indonesia is 300 times more likely to die in the first months of life than a breastfed baby. The bidan-bidan received âgiftsâ of gas stoves, television sets, motorbikes, and so on. Trips to the Hajj, something every Muslim must achieve at least once in a lifetime, were favorite incentives to push infant formula as the first feeding of newborns. The marketing of milk sabotaged breastfeeding and contributed greatly to Indonesiaâs rising infant mortality rate (Al Jazeera 2005; Dong 2009; Williams 2013).
Such was the situation I encountered when I arrived in Bali in 1992. Since then, unsanitary and unkind practices have been replaced by skills training in quality colleges of midwifery throughout Indonesia. Currently Indonesiaâs midwife association, Ikatan Bidan Indonesia, absolutely endorses exclusive breast-feeding for the first six months of infant life. Bumi Sehatâs childbirth centers are International Childbirth Initiative (ICI) (see Chapter 9) network sites (called MBnetsâMotherBaby networks), and follow all 12 Steps of the ICI, including its 12th, which incorporates the 10 steps of the international Baby-Friendly Hospital Initiative (BFHI); our mothers achieve 100% success in breastfeeding before post-birth discharge. Because of our health care âfor free or by donationâ system, mothers feel comfortable staying at Bumi Sehat until breastfeeding is well established and easy, where they have the supp...
