_Situated in one of the largest Internally Displaced Persons camps in Northern Uganda, not only does the Earth Birth birthing clinic provide maternity care to local women, it's also become a safe space for those displaced by war to gather and work on projects. Founded in 2008 by Brooklynite Rachel Zaslow, the clinic is home to around five births a day and sees up to 50 women daily for pre-natal care. A large part of Earth Birth's staffing consists of traditional birth attendants, women who practice midwifery as it has been handed down to them from generation to generation; the World Health Organization (WHO) estimates that 80 percent of Uganda's population has passed through the hands of a traditional midwife. How did someone from Oregon by way of Brooklyn end up delivering babies in Uganda?
It's a long and twisty narrative, but the short version is that I was invited to come to Uganda by a fellow New York birth worker in 2007 to volunteer in a government-funded hospital. What I witnessed there was devastating. The hospital was functioning at what the WHO estimated to be over ten times its capacity. Women were turned away in labor or sent to walk home minutes after giving birth, often bleeding to death on the road home. Women who were admitted to the hospital were often treated violently by the hospital staff for not pushing fast enough or failing to bring their own piece of plastic to give birth on. These conditions made for a traumatic and dangerous place to give birth in an area that has been ravaged by war. I founded Earth Birth with my partner, midwife Olivia Kimball, the next year.

What kind of services does Earth Birth provide?
We provide prenatal care, labor and delivery; post partum, family planning and HIV/STD treatment. Women do not need to pay to receive services, but rather, they must involve themselves in a project that sustains the clinic. For example, they can choose to work in our community garden. The food that is grown there goes back to the women and the excess is sold in the market to pay for supplies at the clinic. We also have the only ambulance in the region so we are able to transport women to the closest hospital (50km away!) when a situation occurs that we cannot handle in-house.

Uganda, particularly in the north, has been devastated by civil war over the last two decades. Would you say war is exponentially harder on women?
Yes. Absolutely yes. Women are often used as tools of war. In Northern Uganda for two generations women have been used either as sex slaves for the rebel army or as reproductive machines, abducted and forced to give birth to as many babies as possible to build up the army with child soldiers. Women giving birth in captivity are faced with lack of prenatal and obstetrical care, severe starvation, untreated STDs, physical mutilation and extreme emotional trauma, among other issues. Not surprisingly, Northern Uganda has one of the highest birth rates in the world, and also one of the highest maternal and perinatal mortality rates.

__ How is the most basic human act—giving birth—also a political act?
Well, it has to do with vaginas, and I find that almost anything related to the vagina tends to become politicized. But on a serious level, childbirth is completely embedded in issues of class, race, education and privilege. Women without money or education or community support networks don't tend to have a lot of options and as such, have higher rates of complications and mortality. That's true in Uganda and it's true in New York.

Have you ever felt in danger as you worked?
Sometimes I am in the middle of a situation and I think “I really shouldn't tell my mother about this”— like the time I had to transport a woman with a stuck second twin to the hospital in the middle of the night. We were driving down the road that was the pathway for the rebel army to abduct people—and had to pull over because the feet of the baby started coming out. My partner midwife Olivia and I had to stick our butts out the window of the car so that we could reach the woman, catch and resuscitate the baby, and the thought did cross my mind, “this is really 
dangerous.” For the most part though, our clinic site is really peaceful and safe. My daughter runs around naked and chases chickens.

What lessons from Uganda have you been able to apply to your midwifery back here in New York?
My focus in NY right now is academic. I am finishing a PhD in Women's and Gender Studies. I am writing about childbirth, displacement and the problem of humanitarian aid. I don't think enough midwives write about the importance of what we do in a way that the academic community can hear. This ultimately affects the way we work together with the medical community, which ultimately affects the options that women have— so it's all just one big political act.



Also posted at The L Magazine

_Alice arrived in the Eleventh hour. Literally, translated from the Acholi language, 5 am is called the Eleventh hour, with 6 am being the Twelfth and 7 am being the First hour; the first hour of light and a new day. She arrived in what she believed would be her Ninth and final labor. Having walked about 6 miles to reach help, she was ready to push shortly after arrival. Her body was tired, she had barely eaten the previous day, and was encouraged to drink sweet tea to give her energy for the push.


The baby's tiny head emerged, quickly followed by the rest of her, and yet the mountain of Alice’s belly still loomed before us, undiminished. As her body called her to push again, she believed the placenta would be born, yet instead, tiny feet made their appearance, then disappeared again to be replaced by another, tinier head. Then the second little girl was born, followed immediately by those persistent, delicate little feet that had tried to cut the line. And then there were three. Three tiny, beautiful little girls, instead of the last, single child that Alice had been expecting.

_Needless to say it was a bit of a shock, to all involved. Earlier in the pregnancy, Alice's husband had divorced her, after bearing him 5 live children. He maintained that because he had used condoms with Alice when they had intimate relations, he had nothing to do with this new pregnancy, and sent her back to her fathers village with all of her children. She found herself suddenly single, now with 8 children all under the age of 12.

The first days were challenging, but the babies, named in Acholi tradition: Apiyo (first born), Acen (second born) and Adoch (born breech) were strong spirits, all able to latch and nurse well. Apiyo was 2 kg/ 4.4 lbs, Acen 1.8 kg/ 3.9 lbs, and tiny Adoch was only .9 kg/ 1.9 lbs. Alice was very despondent at first, overwhelmed with the reality before her. She was reluctant to hold them or nurse them, believing that at least one or more would surely die, afraid to love them. Her tired body refused to cooperate, and two, three, four days passed and still her milk failed to come in. We fed her, gave her teas, vitamins, homeopathics and loving support... yet still her milk did not come.

__And she thrived, sleeping on my chest at night and spending the day curled up with her sisters, by a week old she was starting to gain on them.

It took 6 long days for Alice's milk to come, but thankfully it did, as we knew it must. She was able to fully nurse Apiyo, but we had to continue helping her with Acen, who developed reflux, and needed to be fed small quantities in an upright position and then burped and held upright for 10 minutes after each frequent feeding. As for Adoch, more and more Alice asked that she remain with us midwives. She expressed her belief that she might be unable to care for all of her many children, collect firewood, cook, wash, find food for so many with three small babies. Who would carry the other two while she worked with one on her back? How would she manage while they were still so small and unable to be worn on the back? Several days later, her milk supply was still not adequate for three, not even quite enough for two, no matter how much we fed and hydrated her.

One afternoon, as I sat bathing the babies with her, Alice looked me in the eye, told me about her concerns and asked if I would like to have Adoch. I asked her if she was serious. She said she knew now that she could not take care of these babies alone. Could I, or someone else take one or even two of them?

With Adoch bound to my chest, and my own one-year-old daughter on my hip, I went to my co-midwife Rachel, to cry the pain in my heart because I knew I could not take this baby, yet I knew if I did not, she would surely die. And as she often does, Rachel inspired me... what if we could find an adoptive family? And as soon as we put the word out to the universe, a miracle was provided! A wonderful couple who had been trying to have their own child for years without success would like to adopt two of the babies!

Two weeks postpartum, a grateful and stronger Alice returned to her village with Apiyo, the first and strongest of the baby girls. Acen and Adoch grew steadily with us, and just a couple of days later met their new mother. Although the legal process in Uganda is lengthy, the new parents are committed to give their daughters the very best and are sticking with it through thick and thin.

At 2 1/2 months old, all the girls are now over 4 kg/ 8 1/2 lbs , healthy, strong and beautiful.
Olivia Kimball, Traditional Midwife