Midwives face hard choices in periphery

Roosmany Leolang, a midwife from Bima, West Nusa Tenggara (NTB), had to brake the rules during a difficult delivery in the 1970s. It might have saved her patient’s life.

The midwife chose to conduct a risky procedure on a pregnant woman who was bleeding profusely because her placenta was too close to her cervix.

“It seemed that she had no more than a 5 percent chance of living, as she had lost a large amount of blood quickly due to complications,” Roosmany, now 61, recently told reporters.

The woman’s condition, called placenta previa, caused her to bleed excessively while in labor and might have killed her, Roosmany said.

Roosmany, one of only two midwives then working at Bima Hospital, said she had been determined to penetrate the placenta that covered part of the opening of her patient’s cervix, no matter what.

“The placenta grew in the lowest part of her uterus, covering the cervix. I couldn’t do anything else than try to penetrate the placenta and put my hand inside her womb. After finding its legs, I then pulled out the baby.”

Performing a caesarean section is the only medical intervention allowed to help a patient with placenta previa.

“I knew that the medical intervention I did was prohibited. But I didn’t care, as a surgical procedure could not take place due to the poor condition of the operating rooms, and no doctor was on duty at that time.”

Uterine inversions were other rare but potentially life-threatening complications that Roosmary faced over her long career.

“I helped a woman who was lying in a dark, quiet room where there was only an oil lamp. She had just given birth to her child. I saw something was sticking out from her vagina. I first thought it was the umbilical cord; but, I was really shocked when I discovered that it was actually her uterus.”

Roosmany was one of several midwives given a Srikandi Award, an annual award, scheduled to presented by the Indonesian Midwives Association (IBI) and PT Sari Husada on Dec. 20.

She was voted an “inspiring midwife” by a panel comprised of distinguished members of the Indonesian medical community, who acknowledged her efforts to improve education for midwives in Bima.

Health Ministry regulations stipulate that midwives must complete a three-year diploma (D3) program in midwife education at the minimum.

Up to 2008, however, most midwives in Bima had only one-year diplomas (D1). Due to her relentless efforts, 50 senior midwives in Bima, including Roosmary herself, have obtained three-year diplomas.

Midwives play an important role in reducing the nation’s high maternal and infant mortality rates.

According to the Indonesian Midwives Association (IBI), 60 percent of all childbirths in the nation were facilitated by midwives.

“Many women give birth to their children with help from traditional midwives with poor obstetric skills, although they seek antenatal care from midwives,” Kartono Mohamad, a public health expert, said.

This year’s Srikandi Awards will honor nine midwives from candidates nominated by 33 provinces throughout the nation.

— JP/Elly Burhaini Faizal