Heads Up! Breech Conference

Robin Lim: Birth on the edge

November 9, 2012

Robin Lim was last year's recipient of the CNN Hero of the Year Award. Her presentation was a moving series of stories from her work in Indonesia and other countries. I've tried to type up as many as I can.

Women in Russia are coming to Bumi Sehat, the birth center in Bali Robin helped found, to have their babies. Hospitals in Russia separate women from their babies for 5 full days and nights before they are allowed contact. She spoke of a mother whose daughter was born in Russia with the 5-day routine separation, then who had her son at Bumi Sehat.

Robin started a SE Asia Waterbirth Association. She's seen women traumatized by the tsunami get into a birth tub-their first voluntary contact with water since the tsunami. Balinese OBs have recently decided they will not do water births. The Bumi Sehat midwives have decided to make a stronger informed consent process and keep doing it, rather than cave to OB's pressure. Private hospitals have 80-90% cesarean rates; public hospitals (for the poor) are up to 40% in many areas. Because of this, Bumi Sehat does VBACs every week, sometimes 2 per day.

She's a citizen of the US and former resident of the state of Iowa, where it's a felony to be a direct-entry midwife. There are 3 main groups in Iowa who choose home birth: Amish, Mennonite, and some transcendental meditation groups. These groups have had fatalities because they've chosen home birth but could not find a midwife, thus leading them to birth unassisted.

981 women die every day worldwide of complications of pregnancy and childbirth. Most die, ultimately, from poor nutrition. The leading cause of death in her island has become PPH, which she ties to the dietary change from brown rice to while rice. The main source of protein in Indonesia is tempeh (from soy, which is now all genetically modified). She's seeing an increase in retained placentas and abnormal placental situations which she attributes to the GM soy. 

Do they do breech birth at Bumi Sehat? The official answer is "Are you kidding? It's against the law." In reality...well, they do quite a number of breeches. The midwives at Bumi Sehat believe that the family should make the decision of what happens, not the care providers. But they also have to walk the line so they can keep the clinic open.

Her sister died as a complication of her third pregnancy. No midwife would take her because of her large size. She was feeling very unwell, and her OB said to wait until her next visit. She died in her sleep. Her sister is on Ina May's quilt.

We midwives know that love is a nutrient. How else could we take care of undernourished women and help them do so well? How did we in Bali get away with what we do? (Very delayed cord cutting or lotus birth, etc.) How did the Dept. of Health allow this? Her friend Mary Kroger taught her to speak to doctors and the health department with love, not anger. She spoke about an OB who used to be hostile to her, but now who is a "reborn gentle birth guy." He's head of obstetrics at a big teaching hospital and has become a revolutionary in the birth world.

Her favorite breech story: 14 years ago, Robin was a new midwife. She had just fled to the Philippines after the political changeover in Indonesia. A woman randomly walked up to her door with a limp cord hanging out from her. The baby was transverse, and she could hear no heartbeat. Robin tried to turn the baby, and it flipped to footling breech. It was born pretty quickly, the flattest baby she's ever seen. Robin started doing neonatal resuscitation. There was no heartbeat, no respiration, but she felt the baby was close by. 

The woman's grandmother had told the pregnant mother that if she didn't allow this baby to be born vaginally, the baby would not make it. (The woman had had a cesarean section for her first baby due to breech, then 2 home births, then this one.) Robin continued to pray and do CPR. The mother was still standing; Robin finally had someone get the mother a stool so she could sit down. She said to the mother, "Joy, talk to your baby." She reached down and stroked the baby's cheek and says "Natsuki, even if you have to die, I love you." Robin's husband took the baby's little foot and blew on them and gently, saying "Come be with us." Right after this, the baby girl let out the biggest scream. This girl is now so smart that she's fast-tracking through her science classes. The grandmother came in an hour after the birth. She held her granddaughter and adjusted something in the baby's jaw. All of a sudden this baby, who wouldn't nurse, latched on right away. This was Robin's first breech birth.

About 4 years ago, a mom came in for prenatal care. She was carrying a breech baby. They tried ECV, but quickly abandoned it because the heart tones went really crazy. The parents were adamantly against a cesarean; the father had had many dreams that if his wife had a cesarean, she'd die. The baby was born footling breech. The baby came out easily, but died 9 hours later. He had only 2 vessels in his cord. The mother came back 18 months later for her next birth and wanted her baby born in the same room with the same midwives.

Almost all of the 6 million voters for the CNN Hero of the Year finalists voted for Robin Lim. She got lots of votes from Russia, Japan, Australia, and of course Indonesia. Her son-in-law is a big grunge rocker in Indonesia and would promote her contest and breastfeeding before his concerts.

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