News Home

How midwives guide babies into the world, in Kenya, Washington and Jerusalem

Correspondents Report By Africa correspondent Sally Sara, Middle East correspondent Sophie McNeill and North America correspondent Stephanie March
A newborn Kenyan baby, Simaloi, cries shortly after her birth.

Salune Laton Koikai helped to deliver baby Simaloi.

ABC News: Sally Sara

This moment happens every minute of every day, an ancient and seemingly universal experience.

In Kenya, in Washington, and in Jerusalem, the rhythms are the same. A room, a mother, and a safe pair of hands to guide the child into the world. And yet, so much is different.

If the newborn could look around and understand what she saw, she could immediately learn so much about her corner of the world.

Kenya has an infant mortality rate 10 times higher than Australia.

The situation is improving, thanks to increased education, health services and sanitation. But many women in remote areas don't have easy access to a clinic or hospital.

As a result, traditional midwives play a vital role in delivering newborns.

Salune Laton Koikai is a midwife from the Maasai tribe in Kenya. She began delivering babies when she was only a teenager.

"There was an expectant woman in our village," Salune says. "I was very young. The other girls in the village were young too. The baby was coming out and none of us had ever done this before.

"Everyone else was running away but I found some courage and I delivered that baby. I started that way."

The nearest hospital is a long walk, so most of the local women prefer to give birth with the help of a local midwife, rather than travelling a long distance to see a doctor.

"We are limited, because we don't have these facilities. The doctors are not here, the machines are not here. We only have our hands and our knowledge. So, when there are complications, we have a problem.

"We have to help, because we don't have a hospital here."

The Rift Valley is home to many members of Kenya's Maasai tribe.

Salune has seven children of her own and is surrounded by her grandchildren.

More than one-third of women in Kenya give birth without any skilled help, often because clinics and hospitals are too far away.

"There are two big challenges when I am helping women deliver. One is when there is a lot of blood coming out. I cannot stop that. So, this woman will have to seek help. The other problem is when the placenta doesn't come out. This is when I get a challenge, because I can't go beyond my knowledge."

The gap between infant mortality rates in urban and rural areas in Kenya has decreased. More children are surviving to their fifth birthday and beyond, because of improved education and sanitation.

Some Maasai men don't see their own newborn child for several days after the birth. They prefer to leave the baby in the care of its mother.

"The Maasai men, they fear the baby. They don't want to see the baby until after a few days. They fear that colour of the baby. They don't want to come close or hold it. But the mother is happy, happy, happy."

Two weeks ago, Salune helped to deliver baby girl Simaloi.

"The moment that makes me happy is when the baby starts crying," Salune says. "We all get happy, because that means the baby is healthy."

Training traditional midwives is an important part of improving the odds of survival for babies in Kenya. Salune is 62 years old but has no plans to retire from her work as a midwife.

"I want to encourage the other midwives around the world. What we are doing is good and God likes it. God is helping us. I say to the midwives, just have courage and continue the good work, because without us, we will have no people in the world."

In Washington DC, it's been more than a decade since Claudia Booker gave up her career as a lawyer to become a midwife.

As a solo practitioner she is always on call. "I haven't turned my phone off in 12 years," she says.

She drives around with a car full of birthing gear so she can rush to her clients when they go into labour.

"Our schedules are not our own, it becomes very difficult to plan what you are going to do."

Less than 2 per cent of births in America are home births - and that rate is much lower for African Americans.

"It is very much on the rise for white women, it is not on the rise for women of colours in America," Claudia says.

One of her clients is 34-year-old Binahkaye Joy.

She's planning to have her third child at home. It's really important to her she have an African-American midwife.

"I come from generations of women who were denied their right to their own fertility," she says.

"For black women to birth in freedom is a political act and to be supported by another black woman who is a part of that tradition of liberation is extremely profound," she says.

Claudia puts the low rate of home births - particularly among African-American women - down largely to health insurance.

"There are very few states in America where public insurance pays for home birth," she says.

She says more insurance companies are willing to pay the $9,000 to $50,000 for a hospital birth than they are for a $4,000 to $6,000 home birth with a midwife.

"Why won't they pay for the $6,000? Because the $6,000 only benefits the midwife," she says.

"Everybody gets to divide up the hospital money and that keeps capitalism going as opposed to 6 thousand dollars going to one person," she says.

That means people like Binahkaye have to pay for it out of pocket.

"I'm also not affluent, not wealthy," she says. "I've had to defend myself and my birthing needs to aunts and uncles and parents, they don't see how much I value my humanity."

Claudia visits her clients more than a dozen times during and after their pregnancy. She checks in on new parents Haben and Michael, who are at home adjusting to life with their seven-week-old daughter Aroura in Virginia.

They wanted to have Aroura at home, but the baby was weeks overdue and they ended up having her at the hospital. Never the less, for Haben having a midwife there was vital.

"I feel midwifes, [like] Claudia are like expert mothers, so with everything it is more relaxing in those situations," she said.

For Claudia the post-partum visits, are among the most important.

"Post-partum depression, post-partum psychosis, the baby blues, that whole sliding scale of critical mental and emotional issues are really something that we need to pay more attention to," she says.

"We need to treat it just like diabetes and just like any other condition we have it has no more shame to it than a bad cold, it should not have any more shame to it than a bad cold."

As she nears 70, Claudia finds the constant driving and middle of the night phone calls tiring. She keeps promising herself she will slow down but is finding it hard to give up.

"You have to be really careful as a birth worker because there is a hormonal addiction that comes with it.

"People go to a birth, they like the smell for the birth and the rush of the adrenalin, the rush of endorphins, you get carried away with that part of it."

In Jerusalem, it's 10am and midwife Daphna Strassberg is a few hours into her shift at the Hadassah Ein Kerem government hospital.

Israel's birth rate is among the highest in the developed world and Daphna's ward is doing its fair share of the load.

"We have over 700 deliveries every month here in our hospital," she says. "Yesterday morning we had 16 deliveries in the morning shift."

The average Israeli woman has three babies in her lifetime.

"Jerusalem has a lot of religious people. I think that has to do with it," Daphna says. "We believe that babies are a blessing."

This morning, Daphna already has three women in labour.

"What we tell women when we prepare for delivery is we tell them to keep an open mind," Daphna says. "You can have a beautiful natural birth and everything will be fine. And you can have an epidural and everything will be fine."

Many Israelis follow a unique tradition where they don't purchase anything at all for their first baby until it is brought safely home from the hospital.

"It's a superstitious thing that people believe before the baby comes. You can think what you want for him, you can even make an order in the store but you don't bring the things home until you see the baby is healthy."

Waiting outside in the corridors for a check-up is Yafit,30, and her husband Yoav, 39.

They followed the Israeli tradition of not buying anything when their first child was born five years ago.

"It's part of our faith," Yoav explains. "It's bad luck to buy before the first one is born."

Hospitals are one of the few places in this divided city where you see Israeli and Palestinian colleagues working closely together, side by side.

The patients are mixed too. Hadassah's birthing ward receives nearly as many Palestinian mothers as it does Israelis.

As I follow Daphna in the halls, I can hear screams of pain coming from one room in Arabic, and from the other in Hebrew.

"I don't know Arabic but I can deliver in Arabic," she says proudly. "I know how to tell a woman when to push, when not to push, when to breathe. I can tell her how to get up. Little things, but I can manage."

Mohammad, 35, is here for the birth of his fourth child. He is from an Arab village in the north of Israel but he and his wife drove here especially because this is where they wanted to give birth.

"Here in this hospital, it feels like its own country," he says happily. "We get full rights here. There is no discrimination."

Many of Daphna's patients are ultra-orthodox Jews. She says sometimes Rabbis give instructions on how the father should behave during birth.

"Some men just wait behind the curtain and some men wait completely outside the room. Some stay next to their wives. It depends on their beliefs," she says.

It's not surprising that here in the holy land there is often a lot of praying during labour in these wards.

"You can see it with Arab women, you can see it with Jewish women, with non-religious women. You can see it with everyone."

Daphna says blessings for her Jewish patients straight after the moment of birth, with a different prayer said for girls and one for boys.

In Jewish tradition, boys are not named until they are circumcised eight days after birth.

Just before Daphna's shift is about to end, one of her women gives birth. Daphna is there next to her guiding her through her last few contractions as she pushes a little girl into the world.

"She has three boys in the house at home and now she has a girl after three boys," Daphna says, beaming and holding the newborn.

"It's great. It's a miracle. I think it's always a miracle."

Daphna says she believes being a midwife is one of the most incredible things to do in the world.

"I believe it's a privilege to help life come into the world. It's more than just work."

Daphna does a handover with colleagues starting night shift who will take over the care of the women who are still in labour.

She has to race home to look after her own small son.

So how was her labour? Daphna laughs. "I had a C section," she says, chuckling. "I'm not a good example."

More Stories