Expectations for pregnant women living in the Yukon Kuskokwim Delta are above and beyond anything I have ever come across in the lower 48. But that shouldn't surprise anybody who has been reading this blog and has even the slightest understanding of how different medical care out here can be. Most pregnant women anywhere have their ideal birth plan. For some it's a scheduled induction with an epidural surrounded by their closest family. For others it's a natural birth, dad holding her hand speaking words of encouragement, and family and friends waiting close by for news of when they can see mom and meet baby. Most women fall somewhere in between the above two scenarios. Never though, have I met a pregnant woman (although I'm sure a few are out there) who said her ideal birth plan is to be alone in a strange town miles away from family and friends, with a doctor and staff they have never met. But that's the reality for pregnant women living in one of our 58 villages. As Bethel is the only hospital within a 58,000 square mile area, it is the safest place to deliver a baby. Now I know some of you are thinking, why not use midwives? Believe me, I am all for midwives. Having had my second child delivered in a birthing center by a midwife, I think the profession is very valuable. However, I was only minutes away from a hospital. If, God forbid, something had started to go wrong with my labor and delivery I would have been whisked away to the hospital and the more advanced medical care I was in need of. But out here, for most of the villages, Bethel (the nearest hospital) is hours away, days if the weather is bad and the planes aren't flying; when minutes can sometimes mean the difference between life and death of mom and baby, it's just not worth taking the chance. So every pregnant woman at her first prenatal appointment is asked to sign the "Be in Bethel" paperwork. This is an agreement between the hospital and mom that she will leave her home, other children, husband and support system, travel to Bethel at 36 weeks and remain here till she delivers her baby. Wow! I couldn't imagine if my doctor told me that a month before my baby was even due I had to leave my entire comfort zone and support system, and live in a hotel in a strange city until I had my baby. On top of that, I couldn't imagine my husband not being there to witness the birth of his child. But that's how it is out here, and for good reason. Moms and babies who tried to stay home and deliver in their village have suffered terrible consequences. In fact, the "Be in Bethel" agreement came into effect some 40 years ago when a mom started having complications during delivery in a village. The health aide (who was trained in child birth) needed more advanced medical help. A medevac team with a labor and delivery nurse was sent to bring mom to Bethel. Sadly the plane crashed and all on board were killed.
The hospital here is set up to act more like a birthing center. Perhaps the main difference is that epidurals are NOT offered. That's right, unless an emergency c-section is needed, all our women deliver their babies naturally. Women who strongly desire an epidural must pay their own way to Anchorage and deliver there. As a result, our nurses are excellent in helping women work through the pain of labor, rather than so many other labor and delivery nurses I have met who are quick to offer epidurals or other pain medications.
You may be wondering where all this talk of babies is coming from. Why write about this now? Although I will thankfully not have to experience leaving my family and traveling to another city; I will get to experience having a baby in Bethel. We are expecting our third little bundle of joy March 30th 2014.
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