Ensure Safe Motherhood for Women in Rural Nepal

It was half past noon in Tumlingtar, Sankhuwasabha, as 23-year-old skilled birth attendant Romila sat in a meeting with health staff and local authorities. As they discussed ideas to improve coordination and efficiency at the facility recently renovated by One Heart World-Wide, screams brought the conversation to a halt. 

Romila rushed outside to find a cluster of people carrying a young woman in a stretcher high above their shoulders. After directing them towards the delivery room, Romila spoke to the woman’s husband who told her that the woman had given birth just over an hour ago at their home but the placenta had failed to deliver. She was only eighteen and although her newborn was healthy, the hour-long journey from her home in neighboring Bhojpur left her weak and short of blood. 

“She showed a lot of determination to be fighting against the pain,” admitted Romila. Nevertheless, her vital signs were worrying and Romila knew they had to act immediately to reduce the risk of further complication.  

Soon after their arrival, preparations began to remove the placenta manually. The young woman received several treatments in order to begin the procedure. IVs were inserted into both of her hands where she was injected with pain medicine and Ampicillin for prophylaxis. Her bladder was manually emptied using a catheter and several blood tests conducted to check her hemoglobin levels. 

Once the procedure began, it did not take much time to remove the placenta. The young woman was then taken out of the operating room where she was given hot soup and reunited with her newborn child. By the end of the day, she was back to her normal self, and after staying overnight for precautionary measures, released the next morning. 

“It was disheartening to know that the young woman did not have any Antenatal check-ups,” lamented Romila. This was the first time during her pregnancy she sought medical attention and Romila feared had it not been for the complication, the young woman would have continued to deliver at home and carry her pregnancies without seeking medical aid. But now Romila plans to use this example to show other women the importance of delivering their children under the supervision of trained professionals. “We will show her case to educate and inspire women from her village to come to the birthing center to have a safe and hygienic birth,” declared Romila.  

She continued by thanking One Heart World-Wide for the renovations on the local birthing center. “Had it not been for the renovations and new equipment,” admitted Romila, “I would not have been confident in my abilities to manage the case. Things have changed for the good, the birthing center now resembles an actual hospital.” 

She continued to assert, “We are hopeful that we will be able to inspire women to come to our new birthing center for ANC check-ups and deliveries. We are grateful to One Heart World-Wide for giving us the ability to expand our services and increase the quality of healthcare we provide to save more lives.”  

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It’s 8:45 am in the Puldung village of Terhathum, a hilly region in eastern Nepal best known for its wealth of rhododendrons, Nepal’s national flower. The high altitudes and sparse population make it an ideal habitat for the rhododendron, but also make it nearly impossible for people to traverse. Manmaya has lived in Puldung her entire life and spends each morning chopping wood to fuel the fire she uses to heat her home and cook breakfast for her family. Manmaya cares for a crowded household consisting of her husband, in-laws and three children from her husband’s previous marriage. Only four months earlier, a pregnancy complication nearly took Manmaya’s life and that of her first child. 

 From the local village where Manmaya lives, the nearest hospital is an eight-hour drive over rock-strewn and mud-slicked roads that switchback through the region’s vast valleys. Since most people who live in the village do not own cars, taking the reliably unreliable public bus – whose rear seating section is dedicated to livestock – is the only option for navigating the treacherous journey. 

 On the verge of her due date, Manmaya wasn’t able to sleep. Several times throughout the night she awoke with a parched throat and painful sensations around her abdomen. After a night of pain and anxiety-induced insomnia, she asked her husband to take her to the nearest birthing center. Since there was no hospital within a day’s journey, they chose to go to the Poklabong Birthing Center, which One Heart World-Wide (OHW) had recently renovated, supplied, equipped, and staffed with government-certified skilled birth attendants (SBAs). 

 When Manmaya arrived at the birthing center she was met by Sindhu, one of the certified SBAs sponsored by OHW. Sindhu was shocked by Manmaya’s condition; she was weak, pale and the leg of her baby had already breeched the womb. Fearing she would need a cesarean section, Sindhu rushed Manmaya into the delivery room. She knew that under the present time and travel constraints, the procedure would not be possible. A conventional vaginal delivery would be their only option. 

 Sindhu quickly performed an ultrasound to confirm Manmaya’s baby was full-term and without signs of distress. She took both of their vitals and estimated it would take nearly an hour to manually maneuver the baby out of the birth canal. Throughout the painstaking procedure, Sindhu constantly monitored the baby’s heartbeat and ensured the umbilical cord did not come out before the baby, a potentially fatal condition known as cord prolapse.

 The procedure wore on for nearly two hours. Finally, the deafening silence was broken by the sound of cries from a healthy baby girl. Sindhu breathed a sigh of relief and handed the newborn to her mother. Manmaya broke into tears as she held her  child for the first time. 

Sindhu credits OHW for providing her the necessary training and equipment to perform the procedure. “Had I not completed the SBA certification course, I am not sure I would have been able to handle the case successfully. We had all of the equipment at our disposal [thanks to OHW] and will be able to save many more lives in the years to come.” 

 “Now, I realize that anything could have happened with me or my child had I delivered at home,” lamented Manmaya. “I am grateful to the Poklabang Birthing Center staff for helping me have a safe delivery.” 

 One Heart World-Wide works to provide all women like Manmaya, who live in the most rural, remote parts of the world, with access to quality maternal and neonatal healthcare services. To ensure geography does not prevent mothers from having a safe birth, OHW helps train health workers like Sindhu and build birthing centers in remote areas without access to hospitals, like in Poklabang.

 Since we began our work in Nepal, OHW has reached over 100,000 pregnancies and this year alone plans to reach an additional 45,000 pregnancies. If you would like to know more about our work and how you can get involved visit our website at https://www.oneheartworld-wide.org.