Politicized Birth... and yes, the Ocean.

So I've traded the lulling sounds of the ocean waves, breezes and the chiming of wooden carvings for the barking dogs of "home" at the birth center again. I spent some time in Lovina and swam in the hot spings, then to Amed where I went a smidge crispy on the beach and finally to Tirta Gangga a hillside village on Mount Agung with misty rice paddies out my front door and nighttime fireflies! I had a gorgeous time, but was looking forward to coming back.

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Birthing in Bali is just as political as anywhere else in the world I suppose.

Medical care is not available or subsidized by the government, it's all out of pocket. To the point where cars speed up and pass someone on the street who has just been hit and is now in a bad motorbike accident. People won't stop and help, no one comes to take the injured to the hospital because then they would be expected to pay for the hospital bill! 

For births, there are many small clinics around the island that offer "low-cost" maternity care, which is an option for those who cannot afford the hospital. In hospital, a cesarean birth may cost 5 million rupiah, or roughly $500. This is a ridiculously high price for the majority of the Balinese. Here's the catch: If you cannot pay your medical bill after birthing in hospital, you do not get to bring your baby home until you do settle that debt. 

The birth center here is free, and safe and good. But you know, after a few days away, I've been really thinking about the births here. And they are not so gentle sometimes. Maybe they are still better than a hospital where they can keep your baby for ransom, but there are so many things that could be made gentler here. There are a lot of postpartum bleeds--near hemorrhage--and part of it may be the aggressiveness in which the bidans anticipate and worry about the potential for a bleed and therefore are overzealous with the oxytocin injections, cord tugging, and manual extractions. I've seen things here that I have never seen at home. My first bleeds, my first atonic babies, my first fainting in labor, my first neonatal resuscitation. I don't see this in the hospital, at homebirths or at birth centers back home. It makes it really hard and scary to think about families telling the midwives to do anything they can to keep them here at the clinic when things are going badly, because they would rather bring a baby kept alive only by epinephrine to the hospital where it will be allowed to die rather than cope with the debt that befalls the whole village if they transferred for a cesar. This of course is not the case for everyone, not even close, but apparently it does happen. The family who had the one cesarean we've had here in the past 5 weeks told me that their neighbor, an ex-pat from New Zealand, paid their hospital charges. 

Maybe this post should be titled: How being a doula in Bali cannot change the political atmosphere of birthing and health care administration, or even ease the fear-based practices of the midwives who work under pressure of policy and protocol.