Building on Uncertain Ground
This blog post was contributed by Anna Dion, one of the fifteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.
This week, we launched our Birth Companion Program in a semi-rural town north of Buenos Aires, Argentina. The program is based on a longstanding program that I was involved with in Canada through Mothercraft Ottawa, but has been adapted to suit the specific needs of the population that the staff at the small health centers see every day.
Our first two classes have been beyond my greatest expectations. The first focused on building trust within the group of women that will become Birth Companions. Each of us told a personal birth story—either of our own birth or that of one of our children—to our immediate neighbor who then introduced us to the group. Just as birth itself is unpredictable, people’s experiences ranged from extreme heartbreak, fear and loss to beautiful stories of immediate bonding and joy. Our second class was more technical, focusing on female anatomy, the milestones of pregnancy, the importance of pre-natal care and common danger signs during pregnancy. Through all of our classes, we are also trying to blur the lines between students and teachers, emphasizing that we all have plenty to learn from each other through this process.
While I am genuinely thrilled that we have been able to bring this program from an idea to an implementation stage in 4 months, there are still many uncertainties that keep us planning during the day and my mind spinning at night.
One is the accessibility that these companions will have to accompany their matches during birth. There is an Argentine law (Ley del Parto Humanizado) that explicitly states that every woman has the right to be accompanied by someone of her choice during labor and delivery. However, the reality is that the main maternity hospital here is not designed for women to be accompanied by anyone without jeopardizing the health safety of other patients. The maternity ward is an open room with beds, side by side, sometimes separated by a curtain, with a door connecting at one end for women coming in from the waiting room and another at the other end leading directly into the operating room. If each woman were to be accompanied during labor, it would not only fill the already overcrowded room, but also increase the risk of infection to the women on the other side of the operating room doors. In parallel to delivering our training course, we are working with the hospital administration to see how we can work together to improve the outcomes of laboring women, without jeopardizing patient safety or disrupting the hospital staff doing their best to ensure every mother and child are discharged from the hospital in the best possible health. This has also made me re-think where accountability lies with respect to making national laws an attainable standard.
While the Birth Companion’s role goes well-beyond just supporting her companion during labor and delivery, birth is a transformative process for all involved. Our hope is that, eventually for some of the program’s most high-risk patients, our companions will be able to accompany them through the entire process.
We are also continually facing the challenge of sustainability. This program was intentionally designed to be the child of SAHDES and of the Municipal Secretariat of Health in Pilar, with SAHDES providing the core funding for this first year of activities. But as the program expands with a greater demand for resources, and programming issues become more complicated, this program will need dedicated staff and resources, something both organizations are chronically trying to preserve.
Despite the perpetual questions and doubts that come up every day, I am still convinced that we are doing the right thing by building this pilot program on slightly unsteady ground. As long as we keep learning along way and trying to catch our mistakes early, as my fellow Young Champion Sara Al-Lamki says in her blog this month, it is better to try and fail than to fail to try.