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Behind the Scenes

The Honduras trip is coming up soon.  I’ve been quietly preparing for it as I finished the semester, completed my clinical hours and returned to Michigan for a much needed rest with family.  In fact, as I write this I have been in the midst of studying Spanish phrases relevant to maternal health.

When people find out what I do, they often comment about how they want to work in international midwifery.  I wonder if they are thinking they would like to tour the world with a focus on maternity systems, or if they truly understand what international/global midwifery is all about.

For example, I am not going to Honduras to assist at births or to do prenatal visits.  I may participate in this if given the opportunity to observe local practice, but will not be seeking this as an opportunity. Why? Because I am only in Honduras for six weeks which means that any gap in care I fill will return the moment I leave.  International midwifery is not about temporary gap filling.  Instead, I am about resource strengthening.

You may be wondering what resource strengthening actually looks like.  It has many faces.

  • I will be training 2 or 3 health care workers to teach a neonatal resuscitation program called Helping Babies Breathe.  I will provide the organization with two training kits and 20 sets of materials so they can train 20 TBAs in this important skill before I leave.  They can then order the materials themselves to continue training.  If I did the training of the 20 TBAs, that would be all that could be trained until another trainer came.
  • I will be speaking to nurses at a few hospitals about interventions that promote maternal-infant bonding so they will be equipped to make policy changes at their hospitals.  If I attempted to promote bonding by acting as a doula at a few labors the result would be a handful of labors rather than policy change at the hospital.
  • I will be working to create a culturally appropriate childbirth education curriculum and training local volunteers to teach the curriculum.  As with the other tasks, the effect then reaches far beyond my six weeks in the country.

Actually, as much of my work is done before the trip as during.  I have to spend lots of time making sure I am ready to adapt to speaking Spanish 24 hours a day (I’m not doing very well with this one).  I have to order materials and ensure they reach the right places at the right time.  I have to collect as many resources as possible to alter and adjust when in Honduras so as I talk to women and learn about the culture I can quickly adapt what already exists and identify gaps in available resources.  I need to be able to assess what already exists within each community and identify ways to strengthen the resources – which means I have spent many hours reviewing available literature and health statistics. I need to be familiar with many programs, theories, ideas and methods – I need to be able to use them in an instant.   I also need to be able to communicate effectively to allow the local women to make the decisions about what is and is not going to become part of these new programs.  All of this has taken years of learning and months of preparation.

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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