Cars and bikes everywhere, horning all the time! The taxi driver had to swerve because there was a cow in the middle of the street, lounging in the sun, in the midle of urban chaos of Kathmandu, Nepal. The cow is a sacred animal in Nepal. Kathmandu is the capital and most populous city.

We visited many temples and got to know about the culture, religion and customs. The agriculture-based economy. The main religions are Hinduism (80%) and Buddhism (10%).

Home birth assisted by traditional midwives is still very common, especially in the remote villages where the access is limited, with the total of 82% home birth in the country, in urban areas is about 50% (2006), but the conditions are not very favorable, with lack of access to hospital if necessary, lack of training and materials.

There is a great incentive for mother give birth in institutions, the care is free and the mothers receive 1000 rupi ($ 10) for the birth, but they only receive after birth. This is a way they found to increase births in hospital and achieve the Millennium Development Goal number 5 of the UN, which is three-quarters of decreasing maternal mortality by 2015. The maternal mortality rate went down from 539 (1996) to 281 (2006) per 100,000 live births (2006), neonatal mortality is 33 per 1000 live births. The c-section rate is very low, about 2.9% (2006), which shows a lack of access to hospitals. Moreover the rate in urban areas is higher, and some are elective c-section.

I went to hospital in central Kathmandu where the nurse took me for a visit at the Birth rooms, postpartum rooms and also to see the Kangaroo careroom.

I took off my shoes and put a specific one and walked into the Birth room. There were several women in labor with a companion, separated by plastic partitions. I attended two births in a period of 40 minutes. The midwives attend all deliveries. But I felt the saw a mechanic interventionist care. Then they invited me for a tea and I could talk a little more with them. They knew nothing of humanized birth, natural methods of pain relief, different positions for birth. One of the nurses even made an elective caesarean of her daughter, who is now 1 year, so I don’t need to “suffer,” she said. I spoke to them about humanized childbirth that they could adopt, that happens in developed countries and brings many benefits to mother, babies and greater satisfaction for the professional as well! They were interested with this idea.

In the middle of traffic, the cab, I interviewed the president of Midwives Society of of Nepal (Midson). It is a new organization and they are planning on  courses for direct entry midwives. Another goal is to humanize birth assistance during birth which is still a very new idea in the hospitals. They also want to replace the lay midwives by professionals midwives in rural areas.

I visited the only birth center of Nepal Aadharbhut Prasuti Sewa (APS), a non-profit NGO established in July 2007. I was very well received by the local midwife, who is one of the founders, and also by a volunteer midwife from England.

They provide care to women and children, including prenatal, birth, postpartum and family planning. It is also a training center for midwives and students, because education is very limited. The major goal is the reduction of maternal and neonatal mortality in Nepal.

They told me that women do not usually get naked during labor, they just lift the skirt when the baby is born. Childbirth happens with the woman lying in bed, but are learning about humanization of childbirth. The water birth is not an option due to lack of water, but also women do not like to be naked. After a few hours the mothers go home and almost all breastfeed their babies.

There are many rituals involved during childbirth, which is the one of the most important rites of passage. Among the Newars, the ethnic group that lives in the Kathmandu valley, the mother gives birth in a dark and quiet room. After birth mother and baby are in retreat in the room for few days. The midwife, Aji, also makes prayers and invokes the protective influence of the Goddess. The placenta is called ‘bush-co-satthi’ which means friend of the baby, she is usually buried. Between four and twelve days after the birth happens a ritual where the baby is formally presented to his family and gets its name. Mothers learn to massage their babies from their mothers.

I hope that Nepal achieves the Millennium Development Goal of the United Nations, and more women have access to healthy food, clean water, and also to health facilities and c-section when they are necessary, but that humanized care can be provided and traditions are preserved, because this is the richness of each culture.