Tsunami Deaths of Midwives Causing Obstetric Care Crisis

Some women have been forced to deliver their newborns in dark tents without even a bar of soap, using shards of bamboo to cut the umbilical cords. Others have had to walk through miles of jungle for prenatal help.

After surviving the tsunami, many women are facing the danger of giving birth alone — a grim legacy of the loss of hundreds of midwives (search) among the disaster's dead.

"It breaks my heart to see mothers forced to cut the cord by themselves," said Fitriana, a volunteer from Solidaritas Perempuan (search), a women's aid group. "It's very dangerous for the mother and baby because all of the things used are not sterile."

The Indonesian Midwives Association (search) says 30 percent — some 1,650 — of its members on the northern tip of Sumatra island died in the Dec. 26 catastrophe. Many who survived are too traumatized to resume work or lack equipment to safely deliver babies.

Those still working are overwhelmed. Revita and her sister, Syukriah, have set up a makeshift clinic in a refugee camp in a clearing tucked in the lush green hills above the provincial capital, Banda Aceh (search).

Revita says the two plan to stay in the camp, despite endless problems, including a scare Thursday when Indonesian soldiers attacked suspected separatist rebels in a nearby forest. Bursts of gunfire sent camp residents, pregnant women among them, diving to the ground in fear.

"I cannot leave them, I have to stay here and help," said Revita, who like many Indonesians uses one name. "There are so many pregnant women."

Revita knows the problems firsthand. Two weeks ago, she gave birth to her own child in a dark tent without even a piece of soap — to say nothing of basic obstetric care.

Syukriah used scissors to cut the umbilical cord of her sister's newborn. Other mothers have used bamboo shards.

The newborn, Zakira, — which means tent in Arabic — wriggled in her mother's arms. A thin prayer book was tucked under her small pillow.

"For the moment, she is healthy," Syukriah said. "But, the nights are cold and there are so many mosquitoes. We have only thin tents."

The U.N. Population Fund (search) estimates there are nearly 15,000 pregnant women among the survivors in Indonesia, many of whom lost husbands and other relatives in the tsunami. More than 800 are due to give birth within a month.

The lack of midwives is compounded by the scarcity of doctors in the region. Some 2,000 health workers have been sent to Aceh, including nine midwives who are struggling to keep up with the demand.

Revita and Syukriah set up their clinic with no medicine, improvising by crushing medicinal roots to make ointment for babies with skin rashes or fevers.

"I fear for Zakira's future and my own 2-month-old baby," Syukriah said, rocking the infants in makeshift cradles made of sarongs, metal springs and rope hung from tree branches.

Because of the sisters' presence, the 20-tent camp has become a magnet for pregnant women and nursing mothers, among the long list of other needy.

Some 50 people lined up Thursday as Revita checked for fevers, headaches, stomach pains and other illness. They lay on straw mats, waiting for her to pull out pills from two instant noodle boxes, which serve as the clinic's medicine cabinet.

The troubles have made a joyous time difficult to bear. In Acehnese culture, the delivery of a baby is traditionally celebrated with feasts, prayers and the slaughtering of goats at a name-giving ceremony.

"It breaks an Acehnese mother's heart not to be able to do or give these things," Revita sobbed. "I can't even give them the most essential thing — a clean and safe home."

Acehnese culture also instructs women to stay at home for 60 days after giving birth, to recover from labor and because of beliefs that women are impure from the bleeding of childbirth. But Revita and Syukriah, whose husbands both survived the disaster, know their services are needed.

Henia Dakkak, a public health specialist for the U.N. Population Fund, said the group plans to distribute nearly 20 tons of hygiene and prenatal care products — including razor blades, soap and sanitary napkins.

Aid groups will also hand out head scarves to Muslim women who lost them as they ran for their lives. Without the coverings, some women will not go out to get aid.

"Men are more likely to be aggressive in getting aid while women are left behind," Dakkak said. "We need to give more help to the women. The Acehnese can't afford to lose any more women now."