The Midwives of Angkor Watt

The Midwives at Angkor Watt

Ramyana and I sit on the porch of a health center in rural Cambodia with a group of midwives, nurses and women from the village.   It is warm and is shoes are scattered in a pile by the steps where we have, according to custom, left them.  They have put down brightly colored woven mats for us to sit on.  It is afternoon and everyone has returned after the usual two-hour midday break for lunch and a rest.

I have brought with me plastic babies that Ramyana fills with water; one is brown and one is white.  They think one is Khmer and one is Chinese.   The company that makes these does not have one to represent the many shades of in between that exists within Cambodia and the world.  They can see that they are not the same as either baby I have brought but somewhere in between.  The lungs and heart that can be simulated with a small hand held pump amuse them. 

I have come to teach “Helping Babies Breathe”; a global initiative to teach basic skills to help babies breathe in the first minute of life.  I also have brought, with the help of many people, a new bag and mask and suction to each health center and hospital I visit. 

But first I must sit with them, in a circle and say their names.  I ask them to tell me when they became a midwife and for how long.  I ask if their mothers or grandmothers were midwives and how they learned.  We talk about the hardest thing and the funniest thing and the scariest things.  We talk about midwifery before and during and after the Khmer Rogue.  We talk about the customs they love and the ones they are losing.  Slowly they inch closer to squeeze my arms or legs and touch my hair and ask me questions about my life, my children and being a midwife where I have come from.

In this way, we pass many happy hours sharing stories as well as practicing the art and science of helping new babies to breathe and to get off to a good start in their mothers arms.  

My translator is a young woman who went to a Korean nursing school in Kaput Province near the border of Vietnam.  She knows English well and cries when the older midwives tell the stories of how they came to be “called” to be a midwife.  She becomes skilled at getting air into the babies and becomes a much-appreciated co-teacher.  I am sorry when we have to part ways when I return to the city.

These stories hope to capture the rich history of Cambodia as seen through the eyes of mothers, babies, families and their midwives.

The Midwife at Angkor Watt

The women in the health centers here, as well in most colonized countries, give birth flat on their backs on small, metal tables.   They are free to walk around until they are ready to give birth and can often be seen outside or on porches with family and friends.  The delivery rooms are often very small and may lack privacy.  They climb on the table.  If they are ten and not pushing they are given some Pitocin and perhaps am episiotomy.   This is not very different from my own country’s hospitals except that the bed can go up and down and let the woman sit and she more than likely has a epidural as well and certainly is not allowed to walk around outside in labor. 

Once a woman has Pitocin in labor, both her and her baby are at increased risk for complications that have been well researched and documented.   Women bleed more, after the birth.  Babies do not come out breathing as well. They have more jaundice and thus more problems with breast-feeding.  Midwives, from experience, know that if a woman lies flat on her back the baby’s heart rate goes down.  In my country’s hospitals women are put on fetal heart monitors and can be given a C-section, more Pitocin or have a vacuums put on the baby to get him out quicker.

In Cambodia, the heart tones are rarely taken and yet the woman is laid flat on her back with Pitocin.   I am here to help babies survive in this country; not just at birth but also for the first year of life.  I am here for such a short time so what can we tall about that might make a difference.

They say all Cambodians give birth flat on their back and always have.   A woman from Australia says, “Women is Cambodia always gave birth on their backs.”   And yet the midwives tell me they are terrified of babies getting stuck and dying; either as a breech or shoulder dystocia. 

After several days I consider all this and then I remember the carving of midwives at Angkor Watt.  The woman is squatting; being held up by two women on either side while the midwife kneels to catch the baby.  I bring a print of this ancient carving to the trainings.

Angkor Watt is an ancient kingdom in northern Cambodia that existed in the twelfth century.  It is a wonder of the world with exquisite architecture, pools and carvings.  Thousands of tourists visit it and it is the national pride of Cambodia. 

Most Cambodians have not and cannot go there.  It is free, for them but it is far away from where I am.  But they know they word and are quiet when I show them that there were midwives, like them, carved on the great wall so Angkor Watt.  They stare and consider this.  An older midwife says, “So squatting came from Cambodia and not the west.”   I tell her that all women, everywhere in the world, most likely were in some upright position for some part of pushing, all over the world. Or that at least it was a tool midwives used when they needed to get a baby out.  

I show them hands on knees, rolling on their side and bringing the legs way back when a woman I son her back.  Everyone laughs as we practice delivering babies. 

I offer them the wisdom that was not mine but was their birthright and history all along.  I offer that if the babies are ever stuck they can think perhaps of moving the mother or if she can’t push to get her up.  

There is no memory, even amongst the TBA’s of giving birth upright.  It is hard to know when it was lost or shamed out of them or became out of style.  In other countries the old midwives had women up and about for birth but here even the oldest midwife says they always delivered the babies with the woman flat on her back.  

I do not really know.  Did the French bring this to Cambodia’s royalty and then it became the custom from there?  

How did it become the custom in my country? 

A young midwife asks me if women in my country have C-sections and give bottles o they look cute?  I consider this and say no doctor is supposed to do this but I suppose some do. They look for a medical reason, I say.  She says if you have enough money a doctor will do that there. I explain that this is dangerous and no one should be doing it anywhere for that reason. 

 I show her again the picture of the carving at Angkor Watt and say, “this is the wise way.”   She smiles and we all tell more stories and laugh and wave good-bye.