Here’s a taste our “the midwife said…” blog. See more stories like this at

Five little breaths. That was all it took. (July 11, 2014)

I’ve been thinking a lot about the story that we want to share with people. So many people are like, “Why are you doing this?” “Are you crazy?” “Why on earth would you want to leave America to live in the desert?” The story is so big and so small, all at the same time, that I find it difficult to choose what to share. The fabric of this tale is intricate and many-colored. The short story is that we want to serve God and are choosing to do so by using our God-given gifts and talents and skills to help the Galmi hospital and the people of Niger.

The long story
… not so easy to tell …
especially since it’s not just my story to tell.
But I do know that the midwifery piece of the story is fairly easy for people to grasp onto in answering the “Why are you doing this?” questions.

This week, I was impressed to share a “here’s why” experience that I’ve had.

Take me back to last summer. I’m attending a beautiful, although challenging, homebirth. It’s been a long haul for all of us … many many hours of hard labor and a lost night of sleep resulted in a VERY FAST birth of a beautiful little girl. Her mama was in a sitting position (we usually use a birth stool or something similar) for the birth and I lifted the baby up into her arms. The actual birth was so quick that the daddy almost missed it because he had taken a quick break and was in the other room. My student midwife snapped a few pictures right after the birth and the absolute joy and surprise and pride in the mama’s face is so beautiful. Baby was ok right at birth. She squawked a little and then calmed down. Because of our position with the mama sitting, I was waiting for the placenta (it would be easy in this position) before moving her to the bed. After a few minutes. Maybe five? Her cervix began to prolapse (I could see it outside of the vaginal canal). While not common, this is definitely a risk of a rapid expulsion of the baby in combination with the sitting position. Gravity just pulls everything down. Seeing the cervix is, in general, not a good thing. I quickly repositioned it and made the decision to get the mom into a prone position on the bed, about 12 feet away.

With mama still holding baby, we helped her into a standing position. As my eyes moved upward toward her face to begin giving her instructions about warning signs of fainting, my gaze passed over the baby in her arms. The baby who was not pink and not breathing, but who was blue and still.

This could have been a tragic story. If this baby had been born in Niger (or anywhere) with an untrained birth assistant (or no assistant), she might have been deemed dead and set aside while the mother was tended to. Remember, this baby had followed the normal pattern of breathing initiation (not exuberantly, but she had made at least some initial efforts — enough that after my initial assessment I was comfortable handing her care over to my assistant in those minutes after birth). Her color was initially good. Her initial efforts at breathing were present. But now. now. now she was limp and not breathing.

My training paid off that day.

I gently took the baby from the mama (remember, we are standing in the middle of the room) positioned the back of her head in the palm of my hand so that her airway was open, while holding her bottom and back with my other forearm, and gave her five inflation breaths. These are breaths meant to fill the lungs and push out the fluid with which the lungs are filled at birth. In situations such as this one where the baby has made initial efforts at breathing but then is struggling to breathe (or not breathing, as in this case), inflation breaths are often ‘all it takes’. For whatever reason, the baby’s initial efforts were not sufficient to clear the fluid-filled lungs and make the transition from living in water to living in air. Normally, I would use my bag and mask to do this. However, due to the situation at this birth (and the position in which we were standing!), I simply did mouth-to-mouth. Five puffs of air. Just the amount of air that fills my cheeks. and the baby revived. She let out a mad scream and quickly regulated her breathing and heart rate to normal. I handed the baby back to her mama and we continued our journey to the bed.

Five little breaths. That was all it took.

Without them, this baby likely would have died.

I don’t tell you this story to try to make myself out to be a hero (trust me, I am still frustrated at myself for being so busy with the cervical issue that I didn’t catch the baby’s struggle sooner). I tell you this story to illustrate how SIMPLE life saving techniques related to birth can be. If every traditional birth attendant were taught how to properly resuscitate a baby (no special tools required, as I illustrated in this story), how many babies do you think would be saved?

The World Bank shows a neonatal mortality of 31 per 1000 in Niger. This is not the “worst” in the world, but it’s up there. There are an estimated 43,000 FORTY THREE THOUSAND! infant deaths per year in Niger. (the population is only 16.9 million) [Note that I am switching between “infant” versus “neonatal” and “perinatal” for this section. Infant is the first year. Neonatal is the first 28 days. Perinatal is the first week. Generally.] Let me bring it home a little. Infant mortality in Niger is 70 per 1000. Infant mortality in the USA is 6 per 1000. Neonatal mortality is 31 per 1000 in Niger. Neonatal mortality is 4 per 1000 in the USA (as a side note, the USA ranks pretty dang low in the line-up of industrialized countries … but that is not a battle I am called to fight). If infant mortality is 70 and neonatal mortality accounts for almost 1/2 of those deaths, then that means that 20,000 babies are dying in the first month of life. That means that 2% {DID YOU GET THAT?!? TWO PERCENT} of BABIES ARE DYING IN THE FIRST MONTH OF LIFE in Niger! Maybe half of those are dying at birth or very shortly thereafter simply because they are not adequately clearing the fluid from their lungs. Maybe it’s only 1/2 of a percent. That would mean that over 4000 babies per year could be saved with simple resuscitation techniques.

These types of statistics and the fact that God has blessed me with the opportunities to learn life-saving skills in an out-of-hospital setting (which, if you never thought about it, is extremely useful in the developing world 🙂 ) and He is now setting up opportunities for me to share those skills with others in developing countries are one piece of the “Why are you doing this?” puzzle. If I can serve God and help people save their own people’s lives, I’m in.


Special Note: This journey that our family is on is not solely about “Carrie’s Midwifery”. There are things that each of us will be doing in Niger. Sean’s work is pretty amazing and has great promise in providing skills to the people of Niger that can rock their world in a positive way. Our children will have their own impacts and we’ll share those as they happen once we’re there. I tend to share the midwifery “stuff” because it is very tangible to people and in some ways easy to relate. Please don’t ever think that this is just about me (Carrie) because it’s anything but. We just keep showing up day after day and doing our best to honor our God.


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