By Ansie van Teijlingen, Midwife
This story was originally published in Australian Midwifery News - Summer Issue 2025.
In Australia we have access to one of the best healthcare systems in the world. A system that prides itself on safety, accessibility, excellence and where commitment to overall health and patient care is key.
With over three decades experience as a midwife, my journey has woven through diverse cultures, different countries and varying settings in healthcare, ranging from busy teaching hospitals to regional communities. Yet amidst this varied experience, I've come to realise that the promise of safe, accessible and excellent care can sometimes be elusive.
You simply have to attend a baby shower, or a playgroup and you hear harrowing birth stories, not to mention the anxiety when booking in a client for her birth journey. Nearly all women come with stories they've heard or personally experienced. Birthing, as it was intended, is a sacred, beautiful, joyful ability to give life, seems transformed into a stressful, anxious journey fraught with risk factors, coercion, intervention and trauma.
In Australia the issue appears to stem from excessive care and intervention, whereas in other regions, it often arises from insufficient care and delayed intervention when needed.
It seems that women all over the world face challenges and trauma in birthing.
Imagine having to walk for several hours in poor road conditions, through rising rivers and over mountains to the nearest health centre, carrying your loved ones on a makeshift stretcher and hope of helping and healing, providing your own food and linen for your admission, and not having access to specialist help or a referral pathway. Imagine a place where women and children still die in childbirth due to preventable and treatable conditions. A place that is less than three hours flight from Australia. This is the reality in rural and remote PNG, as Norma shared:
"My first pregnancy," Norma told me, "Did not end up happy. My labour lasted five days. I live five hours walk away from this health centre. After three days of hard labour, my family brought me here and it took two more days before my baby boy was born, but he did not live." Sadly, during story time that hot, humid afternoon in May 2024, I learned that Norma’s story is not unique. My heart broken, I continued to listen to the unimaginable and overwhelming challenges these women face.
Norma and 85 other women walked for hours along muddy roads, amidst constant rain and through the Noban river to attend a five day village birth attendance course at Anguganak Health Centre.
The program focuses on enhancing maternal healthcare in the Nuku district of Sanduan province, specifically targeting Village Birth Attendants (VBAs) and health workers. Its primary goal is to reduce maternal and infant mortality rates by collaborating with the local health service team. Additionally, the program provides gift bags to encourage mothers to give birth at the Anguganak health centre and distributes clean birth kits for safer emergency deliveries in villages. Over time, the teams have played a crucial role in establishing a reliable clean water supply for the health service and are currently involved in upgrading the maternity ward. They also promote antenatal care and family planning. Moreover, the program regularly engages with schools, supplying hundreds of Days for Girls washable menstrual kits to support girls and staying confidently in school. Deb, who started and has been running this program since 2015, with the support of Australian charities HealthServe and Sendhope.org, has diligently returned annually to continue building relationships, partnering with Christian Brethren Health Service and providing much-needed resources and training.
In May 2004, the team, now with me in tow, returned for two weeks and we provided two workshops, one for the VBAs and one for the healthcare workers.
The training methods were a combination of presentations, group work, practical skills, stations and video content via a solar powered projector. The VBAs participated in activities and frantically copied and drew as much information as possible into their little notebooks. They answered questions with insight and asked for training relevant to their practice. Thirty-three women were attending for the first time, while 53 have attended previously or even several times.
Some came with experience but little knowledge to inform their practice, some came only to learn about women's health and well-being, some arrived with small babies even as little as two weeks old.
Regardless of age and background, they all came expected and hopeful for new information and skills to take back to their communities.
During the training sessions it was hardening to witness the supportive interaction between the Health Centre Staff and the Village Birth Attendants (VBAs). The staff recognised the VBAs as crucial links between the villages and the local health service contributing to the program success by not only endorsing it but also providing essential support such as accommodation and meals for the participants.
Over the past nine years, more than 200 VBAs have participated in this program. They demonstrate a remarkable dedication and thirst for knowledge to better themselves and empower the women in their villages. They understand that healthier women lead to stronger, more resilient communities.
During the second week, 19 health workers underwent in-service training, which included realistic emergency drills with birth simulators in their own environment. My earlier involvement in supporting during a complex birth, provided me with profound insights into the formidable challenges confronting local women and healthcare staff. This experience ensured that the training content and emergency drills were tailored to be relevant and effective, with the active participation and buying of all the healthcare staff, rather than being imposed from a position of authority.
These healthcare workers are not midwives. While capable of facilitating births, running antenatal clinics, suturing perineums, managing postpartum haemorrhage and retained placenta parentheses albeit differently from an Australian guidelines), they are constrained by their scope of practice, skills, limited resources, limited access to medications or expert support.
Out the front of the Health Centre the signboard reads:
"Welcome to the Anguganak Haus Laip, we treat, God Heals.”
The usual Tok Pisin word for such a place is Haus Sik, however here in Anguganak it is called Haus Laip which means house of life!
Here at the Anguganak Haus Laip, Norma's story did not end with her tragic loss. Her experience led her to seek more education on how to help herself and others to have safe births and better outcomes and she is now, proudly, one of two VBAs in her village who have helped five women to safely birth their babies and brought two others into the health centre. She has also given birth to a healthy baby girl since becoming a VBA.
Seeing the impact of the training and education these women receive and share in their communities is all inspiring. Over the two weeks relationships were established and rekindled, knowledge was shared, skills were owned and acquired, memories were refreshed and new memories were made. Empowered through learning, educated with new skills and knowledge and equipped to serve, these VBAs and healthcare workers are the heroes of their own stories.
From my position of privilege, I initially believed I would make a difference in their lives. Instead, I was deeply moved by their warmth, vibrancy, and joy.I have returned humbled and enriched, contemplating how I can make a more significant impact with my life.