Story #100 - Ibu Robin Lim, Ubud, Gianyar, Bali (INDONESIA) - Midwifery, Maternal Mortality, Birth Worker, Living Abroad, Activism & Healing from Trauma
Robin Lim is a Filipino–American midwife, mother and grandmother, and founder of Yayasan Bumi Sehat, a non-profit organization in Indonesia established in 2005 that provides a safe place for mothers to give birth. She has been an early responder to many disasters. In 2006 the Alexander Langer Foundation honored Ibu Robin as the Premier Alexander Langer. In 2011 Ibu Robin was chosen CNN Hero of the Year. This gave Midwife–to–Mother care a broader popular platform, worldwide. In 2012 APPPAH, The Association for Pre and Perinatal Psychology and Health, gave Ibu Robin the Jeannine Parvati BirthKeeper award, and in 2016 she became Earth Company’s Impact Hero.
PART 1
"Dilating now. Oh yeah. She's going to have her baby today."
I'm sitting at Ibu Robin's kitchen table as she responds to an incoming call from her birthing center Yayasan Bumi Sehat, where a mother is laboring. The center is down the street, and we can hear the future mom's guttural scream from where we sit. The kitchen is wide open — open as in there are no walls. Children and women are running around the different sections of the home, brewing tea and playing with the branch of a frangipani tree.
A young man sleepily enters the room and sits down next to us.
"That's my son," Lim says. "One of them. All my children and grandchildren live in houses surrounding us."
She stands and speaks in a mix of Balinese and Bahasa Indonesia to a woman who hands her teacups after washing them. "I will email you the Center's mission statement and statistics about our patients," she tells me. "I know you've just arrived, but I might have to leave soon. The mom's progression is fast."
I spent more than six hours with Lim that day, constantly interrupted by the flow of work, housekeeping, birth, and hugs to visitors. Ibu Robin — "Ibu" for "mother" and an indication of respect and social standing — is nothing short but a celebrity here. Old patients stop by unannounced to say hi and show how grown their children are. "I was at your birth!" she says to one of them, ruffling his hair. She greets everyone with the same warmth and bustling hospitality: "Come in! Have some tea" and swiftly disappears if she needs to tend to something more pressing: a vitamin K shot, singing ancient chants, paperwork, a call from the Italian embassy.
Lifestory
I guess my story begins when I was a teenager and became a mother, 38 years ago. I came back from traveling in Europe pregnant with my first child. In a way, it was a blessing. We were poor — we lived in a trailer house that was less than two and a half meters by six, in a trailer park at the end of a road in California, where old people lived. It was near my college, and I would ride my bicycle pregnant to school.
Instead of panicking about not having money or insurance, I found midwives. We were at the beginning of midwifery as a career, and they were basically junior nurses trained by doctors, trying to get experience in hospitals. Very young, fledgling midwives. I said to them, "I'm not going to the hospital." How many times mothers would stand there, looking at their babies behind glass, in plastic boxes, crying as she stood outside in her robe, bleeding while her child screamed for her. This seemed completely unnatural to me.
My grandmother was a traditional birth attendant in the Philippines mountains, where there were no hospitals. She had ten children of her own, and everyone I knew was born that way, tended by skilled birth attendants who passed the knowledge from generation to generation.
My grandmother had told me not to trust modern medicine. She said to me one day, "They'll cut you open and they'll kill you." I was 11.
My father was military, and my mother, Filipino. I don't think I realized the worlds I lived in; two very different worlds, really. I'd spend most of my time with my grandmother in the mountains, searching for healing herbs, hiking, and swimming all day. Then there was my dad's world, as American as can be. One day, I remember having a massive kidney infection, and the military wanted to fly me via helicopter to Minnesota. Can you imagine a little girl separated from her parents to go to a completely different world? My Lola [grandmother] wouldn't have it, so she kidnapped me. My parents didn't know where I was. She took me and hid me in a shack in the mountains. Fed me buckets of corn and tea because every herbalist knows that corn silk tea is one of the best things to destroy kidney stones. She told me, "Corn is a woman. You take her hair and boil them. She'll take care of you and will dissolve your stones." I healed in a couple of days.
There is a saying in the Philippines about discomfort that compares it to sand under your skin: you can either be irritated by it or transformed it into a pearl, like the oyster in the sea. My Lola taught me that it was the same with your heart. She said to me, "Life will bring you many challenges. But you will never be comfortable if you don't dedicate it entirely to build peace."
My sister died of complications after childbirth. She was high risk, and 36 hours before she died, she told her OB something was wrong with her body. She knew it was not like her other pregnancies and asked for help during her follow up checkup. But her doctor said to her, "I don't have time to deal with this right now. I'll talk to you in two weeks." And she died.
After she passed, I found myself in this very strange and painful place. Two of my closest friends had also died, and I felt lost but found incredible comfort in the presence of my friend's husband, who later became my life-partner. We were both two damaged humans who found each other through grief. Eventually, it became the two of us with a lot of children. We decided to move to Bali because we'd heard this was a place where they respected children and elders and honored them like the infinity that they are.
My husband and I threw our lives together like a couple of crazy people and just made it work here.
We moved to Bali before it became popular. It was another world then, with far less inhibition. It was normal for old women to walk in the streets with no tops on. When we built our house, you'd see old people working in the rice fields, and they would come in for lunchtime, eat or sleep there on our floor. Houses belonged to everyone. When my son was born in the nineties, he would go into any kitchen, and they would feed him. He'd toddle around the village — there was no car here, just a dirt road with broken coral — breastfeeding on 13 women. You'd think these things happened 100 years ago, but it was only 20 years ago. Every child belonged to every mother.
Midwifery
I believe that all of us midwives and those trying to sit together and find solutions for human rights in childbirth are witches. We are from a lineage of earth. The birth keepers are the earth keepers.
I also believe that the solution today for reproductive health is to combine advanced science, medicine, and midwifery. We can't rely on science alone, or we'll end up with a high-tech model of childbirth, much like the one we find in the US. It supposedly saves lives, but that's bullshit — pardon my French. It's bullshit because America, which spends more on childbirth technology and reproductive health than any other country in the world, has moved from the shameful place of being number 50 on the list of countries by maternal mortality ratio to the even more shameful place of number 60 [it was 56 at the time of publication.] It's safer to give birth in Croatia than in the US. Knowing that these numbers are under-reported, it's incredibly scary.
The high technology medical model of childbirth is a male model. And it's not working. We have good science, which is wonderful, but the model is terrible. My dream is to build a Research Institute here to provide care with one foot in nature and another in science and teach women to respect that little voice inside their heads that tells us something is wrong.
The other day I was in Italy to promote this job and our birth model when I received a call from a mom about to die from placental abruption. I was having lunch with a Senator and left to go to the bathroom and arranged transportation for her to the hospital. In 22 minutes, she was in surgery. We need hospitals. We need to have respect for doctors, labs, and blood tests. Cutting science would be like cutting off your own arm. Education is important, and data and statistics are key.
But as I tell my students when I teach sex ed: "You damn well better wear a condom... but it's not going to protect your heart."
We need that intuitive and spiritual sense in healthcare. People here are not scared to use to word "spirit" because everyone believes in it. That's why we sing when babies are born: we acknowledge them as a miracle.
Birth is not just a medical event. Of course, if there's an emergency, the hospital will be ready for the moms, but we still have to sing. What chant will depend on their religion or faith, but we always sing amazing grace. I think it goes with the idea of bringing more love into this world. Birth is driven by oxytocin, which is the hormone of love, and oxytocin is incredibly shy. It cannot bear the cold — cold temperature, cold treatment, or cold emotions. Oxytocin needs hugs.
Birthers need someone to help build trust. Not just trust in their midwife or birth keeper, not just trust in their doctor, but trust within themselves. We need to teach women that their bodies are not broken. I just had this group of over a thousand students the other day, and every one of them is standing there, asking questions, and saying, "You know, natural childbirth is good in theory, but in Singapore where I live, nobody has a natural childbirth." And I can't believe it. I mean, nobody's broken here! Their womb and uterus are not broken; why are they all trying to "fix" that? Thousands and thousands of girls have been told they needed "help" with their uterus. Guys don't have that. You never hear someone say, "My penis is broken!"
Women are taught from a very young age that something is wrong with their bodies. They get this message that they need to hide periods, and when they get pregnant, we give them prenatal scares. It's not prenatal care; it's scares.
It makes you terrified. And then, you have to pay thousands and thousands of dollars to have a medicalized birth. Something's wrong with that picture. It damages the mothers, and it damages the babies. If we cared so much about them, we wouldn't do that.
In my opinion, the biggest human rights issue that we face on the planet right now is medically abusing the smallest citizens that have no way of saying, "No. That hurts me." Think only about the placenta and the baby: they share about 450 milliliters, less than half a liter of blood. The moment you clap and cut that cord at birth, over a third of that baby's blood is still trying to be delivered by the placenta through the cord. They call it "cord blood," and some countries will use it for research and donate it to others.
In Italy right now, they're trying to force girls in high school to agree to give away the cord blood of their future children. But that's doublespeak: it's not cord blood, it's the baby's blood! No mother will agree to give the third of her baby's blood to science or for someone who had a motorcycle accident. They need that blood! If I'd take the third of your blood from your body, I'd go to prison. So why are we doing this to newborns? Children cannot donate blood legally. You have to be 17. But in Italy, 33% of newborns are giving away their blood to science in private cord blood banks. It's huge. They're selling their supply all over the world, and it's corruption. The government is passing laws right now to prevent that from happening.
But even without the menace from private corporations, we're still preventing babies from the third of their blood volume. How would you feel without that blood in your body? Pretty bad, right? Add that to not being allowed to go to the breast, nuzzle, or bond with your mother who's in stirrups. I want to see a man put his feet up in stirrups and open himself in front of strangers in a medical institution. It won't happen, right? Right. So give mothers a quiet, warm, secure place to give birth, and her oxytocin will do the work. Let's stop monetizing on something that happens naturally and, most of the time, without the need for any intervention.
The fact that women, intelligent and college-educated women, do whatever doctors ask says a lot about the power of these institutions. We know better. But we are hardwired to believe that it makes sense.
Pharmaceutical companies and other corporations have made billions on the back of women by selling us stuff to hide our menstruations or our postpartum bodies. And it's not just men; this system has been built with the collaboration of women. I believe we have generation after generation of mothers who are victims of this system and then victimized their own daughters.
I'm not having it.
“Patient First”
Disaster Zones
Our family does everything together, even when there's a disaster. The children did body recovery during earthquakes, and we're usually there before the Red Cross. We are known in the non-profit world to have a quick response when it comes to reproductive health. After an earthquake, for example, all the infrastructures are gone. There's no hospital, no clinic, no doctors, no electricity, running water, food, or shelter for the people. Nothing. And guess what: babies are still being born.
We started a clinic back in 2009 when the earthquake struck in Haiti. We went to Jacmel and arrived through the Dominican Republic on a military boat lent by the Chamber of Commerce. They sent us a boat every week after that with food and medicine, and we were able to feed people and work in hospitals to establish a more gentle way to bring life.
What was going on in the hospital was hideous. People having limbs amputated by a fucking organization [that shall remain nameless] and someone laid them in the sun on the hot sidewalk with a paper bag on their chest blowing away, and that bag contains their antibiotics! They'll die without them! And I'm like, "Why the hell did I just give this hospital $600 000 worth of essential medicines from direct relief?
Somebody has to stand up to these assholes in the world. So, in the end, I kept the medicine and warehoused it in a big old house made of an old pirate ship. We redistributed the medicine, and we sang. We sang in French Creole when the babies were born. Because in the hospital, women were being forced to be in stirrups on filthy tables. I've seen babies being held upside down, the clamp banging on their faces as they are weighed. Guess what? Babies don't care how much they weigh or what the circumference of their head is at birth. They just want their mothers.
Babies don't have a concept of time. So when you separate them from their mom and her womb, they go from this warm, tight, and safe place to this big, horrible, noisy, and bright environment where strangers are banging metal stuff on their head. They don't know their misery will end in two or three minutes.
All they feel is trauma. And then have to learn to love and trust. How are they supposed to do that?
We have proven with the work we're doing there that women's bodies are not broken. Even in the lowest resource and highest risk setting, hungry or homeless, mothers can make it if they have love and food.
I'm constantly asking for food and resources for those women in disaster zones. Constantly. I don't feel bad for asking, nor am I tired. I feel entitled in the most amazing sense of the word: I'm entitled, my God, to want to feed people. It's amazing to think that so many people feel entitled, and what do they want? They want designer watches and diamond earrings. If it's the world we live in, I'm entitled to ask for more money and food for pregnant and postpartum women so their babies can breastfeed.
Lim stands before the mockup of the future Bumi Sehat Center
The Center
Everything here I have to provide. We have one main center and three clinics. We are trying to build a new, bigger center*, but land is not cheap here. Not anymore.
The goal is to have everything in one place: first, a peace institute to put the advisory board for human rights in childbirth and a research institute. Right now, I'm working with a botanist who's trying to create an antivenom from a plant because people get killed by snake bites. If you go to the hospital, most antivenoms haven't been stored properly, or they're simply not available. We're trying to figure out what to do with it: do you dry it? Make it injectable? How about in cases of emergency?
We also need a bigger center for when a single mom shows up in my kitchen, for example, because she comes from a village in Java and tells me she will be stoned to death by her father because she was raped. It has happened many times. I let them stay in my house, and they give birth at the clinic. I give them jobs and try to restore their humanity; I give them a place to live and learn skills to turn into a livelihood. Because what else will a single mother do in this part of the world? Who will hire her if not a pimp who will make her give her baby away? There's a huge prostitution issue happening right now, and the work that needs to be done is grassroots.
So we built a row of little rooms. They share the space, their children play together, and they babysit for each other. They have jobs, an income, food, security, and support from each other. Some of them already have HIV, so we try to provide testing and free, confidential counseling. Where else can they go otherwise? Who will get an ambulance if they're sick, no matter how poor they are? Our work goes beyond birth because we try to look at any problem of humanity and sustain it.
We have a volunteer at our clinic who's been with us for decades. She's American, but her husband was Balinese. Her children were born and raised here. They're gone now, and she's a widow, but she helps us translate and does acupuncture. Yesterday, a friend of hers came to us to give birth. She'd be beaten badly and had bruises everywhere. She was ready to walk away from that abusive marriage, but she had nowhere to go.
So we need a place not just for birth but also as a women's shelter, for growing herbs, to do seminars where women come from all over the world to learn about essential life-saving skills, doula, and mothering mothers. We did this thing called "Journey into Midwifery" to teach advanced skills to midwives. People came here from other countries saying they couldn't find education at a reasonable price in their hometown because their cities became so touristy the people started charging enormous prices for training. It makes it impossible for the people at the grassroots level. So we opened my house to them, and we try to find money to host here.
There's no other place really that I know of in the world that does community health as a human right — and for free. For example, people may make a donation that will go into midwifery, mother care, or recycling. We've recently been named the cleanest village in Indonesia (not just Bali) because we've started that 20 years ago. We're also cleaning other villages in the country and motivating an entire community.
You know what they say: it's 11:59. We don't have any more time.
I don't do it alone, of course. We have a big association of people who work together. We have support. But the clock is ticking. How can we build peace and make it sustainable if we're not even protecting our youngest citizens? All the research shows that your capacity to love and trust is set at birth. Not just for the first 18 months of your life. How your mother is treated in pregnancy and at birth matters. Was she honored? Is she nourished? Not just good food, which is very scarce on the planet now, especially for the poor, but love is also a nutrient; support is a nutrient. I believe that a baby born gently has more capacity to love and trust later in life. I deeply believe that.
Now, if you'll excuse me, I have to go to the clinic. Meet with the patient; she's about to have her baby.
You can come with me if you want. If you're lucky, you might even hear his first cry.
*TBC*
*The construction of the new Bumi Sehat – Bali Community Health Clinic was finished in 2016. They now have three dedicated birth rooms and four recovery rooms, as well as an acupuncture clinic and doctors rooms. They provide a variety of weekly clinics, ongoing birth services, and 24-hour a day emergency health services.