Balancing life and death in Nepal

It was a night that Rita Ale Magar says she will never forget. Bhavana, 17, from remote Dumre Dara village walked 2.5 hours to reach a birthing centre of Udaypur.

The underage mother was already 16 days overdue, her blood pressure was alarmingly high and she was going through prolonged labour. She was having difficulty pushing out the baby and was in severe pain.

This was the most complicated case the centre had received, and the nurses were understandably nervous. But Nurse Rita had to lead the team and take the decision to try to save both the mother and her baby who were at high risk.

“This was the moment when I had to use all the knowledge that I was taught by my mentors,” recalls Rita, who is a beneficiary of the Simulation-Based Mentorship Program (SBMP) of the group, One Heart Worldwide.

After nearly two hours, the baby was born but that was only the beginning of the ordeal. The baby was not breathing and had no heart rate or muscle tone.

“All of us thought the baby was dead, but we had to try our hardest to save him. I had less than a minute to give my best,” adds Rita, still shaken as she narrates her experience.

It was at that point she remembered the ‘Golden Minute’ session she had learned about at the mentorship program -- the time needed for newborn resuscitation of babies born with asphyxia and deprived of oxygen.

Nurse Rita quickly cut off the umbilical cord, put the baby on the resuscitation table and gave him electric suction which allowed it to start breathing. But the baby still looked pale, and was having difficulty crying.

At the same time, the mother’s condition was worsening, she was bleeding profusely. The nurse sought help from a paramedic team to ventilate the baby with an Ambu bag while she tended to the mother.

The baby's condition started to improve, but since there was no neonatal intensive care unit at the birthing centre, Rita referred the baby to a hospital in Biratnagar. The baby boy has since recovered and is now healthy.

“I was panicking but I benefited from my mentorship, and I will always be grateful to the clinical team from One Heart Worldwide who had trained me,” she adds.

One would think that health professionals would not want to work in villages with minimal resources, but the opposite is true for Rita for whom being stationed in the far-off government birthing centre has been a challenge, but fulfilling when she can save lives like this recent case.

Nurse Rita has delivered over 200 babies in the last three years. The birthing centre was initially under-equipped and she was the only Skilled Birth Attendants. This is where the One Heart came in to provide hands-on simulation exercises to nurses to get them ready for real-life birthing complications.

Two nurses who received that simulated training were instrumental in saving the underage mother and her baby. They also counseled family members.

Read also: Who will save Nepal’s poor new mothers? Rojita Adhikari

The patient, Bhavana did not know about the risks associated with pregnancies and was adamant about giving birth at home because she herself was born at home. Additionally, she had not seen anyone going to the birthing centre for delivery.

Even after she was long past her due date Baavana was still not convinced about institutional delivery. It was only when she realised she was putting herself and her baby at risk did she relent.

“Ultimately, she made the right decision but it was almost too late. Luckily, she survived. Saving her was so rewarding also because this could set an example to other villagers,” adds the nurse.

But it is not easy for the villagers to get to the birthing centre due to the rugged terrain which further discourages them from accessing institutional delivery. There is no proper transport or ambulance service either. Most people have to walk over four hours to get to the centre which is especially inconvenient for pregnant women and girls.

Says Rita Ale Magar: “But no matter how hard the journey, it is worth the effort because us nurses are here at the birthing centre to help mothers like Bhavana and their newborns.”

Read more: No conceivable reason for unwanted pregnancies, Rojita Adhikari