The word “care” can mean many things. At Maison de Naissance (MN), it means that women receive counseling, education, medicines, lab tests, and loving attention every day, from expertly trained and dedicated members of our staff. It means that these elements of caring are provided without charge, and without discrimination, to all women who come to us. This is particularly important for women infected with HIV, the virus which can cause AIDS if left untreated.
In Haiti, as is true all over the world, there is a stigma attached to having a HIV positive test, and it can be difficult for a woman to accept the news. The counseling that accompanies this testing, both before and after, sets the stage for our mothers to understand that there is hope - that they can receive medications to help keep the virus under control, and to prevent their baby from becoming infected. Collaboration with the PEPFAR program at MN helps provide medication and the staff necessary to expertly complete the record keeping that insures all of our patients are tested, and all of the HIV positive mothers are given medicine in labor to keep their babies safe.
This is just one element of the care received at MN, but it’s a vital part of Berneice’s story:
Berneice’s husband was HIV positive when they met and married, but he did not share this news with her. She was thrilled when she became pregnant right away, and went to Maison de Naissance for an early prenatal visit. HIV/AIDS testing is a routine part of every pregnancy's first prenatal consultation. Berneice was devastated to learn that she tested positive for the virus, having had no other partners besides her husband. She felt very alone, never having known anyone who survived with HIV. Her treatment, including nutrition counseling and a referral to the Mother's Club, began right away.
After several visits to MN, she overcame the stigma of testing positive, and began connecting with the MN Mothers’ Club, where she met other women living with HIV and their healthy babies. They told her of their own experiences, and how the treatment worked to prevent transmission of the virus to their children. Berneice was able to complete her course of daily medication, kept her nutrition up, pulled herself out of depression, and delivered a healthy baby boy with the help of MN's dedicated midwifery staff.
When Berneice brought her baby boy back for a well baby checkup, she proudly showed him off to the staff who turned her life around.
What follows is a recurring theme when working in an impoverished, rural Haitian community, where maternal health professionals are everyday heroes.
Four days before Madeleine took her baby boy home from the hospital, she didn’t know if either of them would be alive by morning. Madeleine was eight months pregnant when she came to Maison de Naissance feeling very sick. Her head hurt, her hands and feet were swollen, she was seeing spots, and she had pain by her rib cage. She had been previously warned by her midwife and her community health worker to watch out for these symptoms of preeclampsia, a severe complication which can cause seizures, bleeding from a torn placenta, and even death of the mother and baby.
Though this was her first baby and she had been seen at MN only once, Madeleine knew her due date was a month off, and she was sure it wasn't time for her baby to come. As she rode the back of her neighbor’s motorbike along the bumpy dirt roads to MN, she became extremely worried. She wasn’t feeling the baby move as much today, and her head was hurting worse. By the time she arrived at MN, her blood pressure was very high and she was bleeding. The midwife who was seeing her recognized the symptoms, and provided medication to keep Madeleine from having a seizure, while an IV was started.
Grabbing a pack of supplies for a cesarean section, she accompanied Madeleine in the MN ambulance for drive into Les Cayes to the General Hospital, where a cesarean section could be performed. Thanks to the education that Madeleine received at her prenatal appointment with an MN midwife, she recognized the warning signs of preeclampsia. The quick work of her midwife ensured that she made it to the hospital in time to save the mother and her baby. Just another day of midwifery in rural Haiti, providing life saving maternal health care services!
Late in 2013, we heard from our local partner, the Haitian Ministry of Health (MSPP), that they were completing the construction of a new deliver ward at the local public hospital in Les Cayes, the town closest to MN. This was excellent news, as we occasionally had to refer a laboring mother to that facility if the delivery required surgical intervention. The only problem, we were informed, was that they were unable to staff it. This was in fact the perfect opportunity for MN. For some time, we had been looking at ways to expand our patient capacity, but also needed to maintain costs. We have always worked closely with MSPP, and one of our goals has always been to strengthen the local public health system by working with them as closely as possible. As a result, we offered the services of our highly trained and experienced midwives to the public hospital, in return for salary sponsorships from MSPP.
The process is underway, and two of our midwives are already helping out in the new delivery ward, providing professional attended birthing services to a mostly new segment of the population that did not previously have ready access to them. Another double win for MN - healthy mothers and healthy babies!
Just this past August, there was a surge in the number of mothers coming to MN to deliver their babies. While there are always month to month fluctuations, and even seasonal highs and lows for new births, August was an unofficial record setter, with over 90 healthy babies brought into the world by our dedicated and hard working midwifery staff in that one month. It seems that the public hospital in the nearby town of Les Cayes had reinstated previously waived fees for deliveries, and MN's reputation for exceptional care and no fees, ever, drew a significant portion of their patients to our facility.
People often ask why we continue to offer free services, when it appears that at least some percentage of the population in our zone of service could afford to pay at least a minimal fee? The answer is twofold: there is no way to easily distinguish someone with a little extra money from someone who has none, and in many cases, the little bit they might pay for our services would be better spent on food, cooking fuel, a child's school tuition, or any number of other important expenses.
When you consider that our average cost for an uncomplicated delivery, US $115, is only one percent of the average cost of a hospital delivery in the USA, all of the babies born at MN in August were delivered for less than the cost of one in this country! This is not simply a reflection of the economic differences that exist between the USA and Haiti, but more importantly, the result of the efficiency, competence, and above all, dedication of our staff to our mission, to significantly reduce maternal and infant mortality rates in communities like the one that they live and work in.
Amidst the highest infant and maternal mortality rates in the western hemisphere, $115 is a small price to pay for the midwifery services to deliver a healthy baby to a healthy mother and potentially save a life!
Every day at Maison de Naissance (MN), our midwives deliver on average 2 - 3 babies. Professionally attended births are significantly less likely to result in the death of the mother or baby, and so every healthy baby delivered to a healthy mother is a life saved.
Relatively simple complications in unattended births (eclampsia, hemorraging) can lead to the death of the mother, baby, or both, if the mother or others present do not recognize the signs or have no knowledge of basic treatment for the conditions. Even a healthy birth can end tragically if proper hygiene and/or sanitation are not understood or practiced during and after delivery.
Our midwives are professionally trained and certified; they know how to treat most complications, and when to call for a hospital referal if surgical intervention is required. In eight years of operation and over 4300 deliveries, there has not been a single maternal mortality our birthing center. The lion's share of credit for this statistic goes to our dedicated midwifery staff.
Another amazing fact is that our midwives have always kept the center open, 24 hours per day, through hurricanes and floods, when the power and water were out, no matter the circumstances or difficulties. They have delivered babies by candlelight, flashlight, kerosene lamp, and under car headlights. They are truly unstoppable when it comes to delivering healthy babies to healthy mothers!
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