Ensure Safe Motherhood for Women in Rural Nepal

A few days before the delivery of Saraswoti K.’s youngest daughter, she was having fits of abrupt pain, sharp and intense, around her pelvic region. Saraswoti had been alone for few weeks now—her husband works in politics and is bound to travel often, her middle daughter was pursuing her Bachelor’s degree in Kathmandu, and her eldest was working in Bhojpur Bazaar.   

The morning of Saraswoti’s third birth, she was cutting grass for cattle, in a field near her home. She explained that she felt as if her bones were coming out of their sockets. Limping home, she pulled a thatched-mat over to her, and laid on her back.  Her pain was intensifying, weakening her from inside out. Through this pain, she realized that her baby was about to arrive whether she was ready or not. Several times she shouted for help but there was only silence.

“A few times I begged and prayed and hoped someone would appear to find and save me in this moment. My clothes around my abdomen, were soaked a deep red and my vision had become hazy. I heard my baby cry and I submerged into darkness. I felt like life was leaving my body,” Saraswoti recalls.

She regained consciousness at the Bhojpur District Hospital while a bottle of saline ran through her veins. Her eldest daughter was sitting beside on the bed and rocking her new baby sister in her lap. 

Saraswoti’s neighbor found her unconscious with the newborn child on her chest. A pool of blood surrounded her. Unlike today, they only had one telephone connection in her village and mobile phones were nonexistent.

Her neighbor ran uphill for what felt like hours but in reality, was probably more like 15 minutes. She knew exactly where she was heading and worried about the shop’s queue for the one functioning phone. Arriving at the shop, the Khatri’s neighbor immediately called Saraswoti’s youngest daughter at the Bhojpur Bazaar and asked for the shopkeeper fetch her daughter to explain the emergency situation. She waited for ten minutes and phoned again. By this time, the shopkeeper had already sent his helper to deliver the message to my daughter.

Her daughter had already arranged an ambulance and drove straight home from Bhojpur while the Khatri’s neighbors and friends carried her on a stretcher, for a whole day, to reach to a point where an ambulance could finally reach Saraswoti.

Saraswoti stayed in the hospital for almost 10 days recovering from the Post-Partum Hemorrhage that almost claimed her life. “I was extremely lucky to have defied all odds to survive a fatal childbirth complication. I contemplate that incident frequently and feel nothing but grateful for my life. That incident gives me courage and determination to do the best I can in all aspects of my life. I have been working as a Female Community Health Volunteer (FCHV) for over two decades now. I feel happy that I am dedicating my time to my community, working with mothers and children, and saving lives in the process. My own experience is the source of inspiration for my work,” Saraswoti explains.

“In our time, health facilities were scarce, never mind the birthing centers we have now. I delivered all of my children at home. There are many women in my village who have delivered more than five children at home. Some gave birth in the jungle, some in fields or farms. Women dying during childbirth was a common thing. We were not sure how many of our children would make it past infancy, because infant and child mortality was also high. So, we hoped at least few of our kids survived. Having a big family was also a necessity for farm work. The concept of birthing centers, antenatal and postnatal check-ups, and access to iron and calcium tablets were never heard of at our time.

But times have changed for good. There has been some amazing progress in maternal and neonatal health all over Nepal. We now have ‘a good looking’ birthing center in our own village, trained nurses, a local ultrasound service, antenatal check-ups, and delivery at the birthing centers. We rarely report home deliveries and there have been no maternal deaths in my village in the past five years. I think we will declare our village a zero-home-delivery village in next two years. And I will always keep on working as long as I can.”

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Saraswoti K. lives in Arumba village of Yangpang rural Municipality in Khotang district in east Nepal. FCHVs are a major foundation of OHW’s program objectives. We renovate birthing centers, supply birthing center equipment, train the nurses working in the remote villages to become certified Skilled Birth Attendants, train Health Facility Operation and Management Committee towards providing quality services and managing health facilities, operate the remote ultrasound and solar suitcase projects and work closely with the communities to prevent childbirth related deaths.  

FCHVs are an integral part of our Network of Safety, help us achieve our objectives at the ground level. FCHVs, like Saraswoti, are the ones who register new pregnancies in their villages, provide health education to mothers, keep track of deliveries that take place in the home, and encourage pregnant women to attend their antenatal care (ANC) appointments and deliver at the local health facilities.OHW also train FCHVs to use lifesaving medicine like Misoprostol.