Sustainable Birth Care in Disaster Zones and During Pandemics: Low-Tech, Skilled Touch

This chapter examines effective care in the immediate and long-term aftermaths of disasters that render the technocratic model of birth inapplicable in the absence of the technologies on which it relies. The “risks” normatively associated with childbirth under that model are subsumed by the risks generated by disasters. The chapter is based on written accounts of what actually works for pregnant and birthing women and their babies, namely, skilled midwifery care with basic, low-tech equipment, collaboration with local midwives, and, in rare cases, the ability to transfer care to obstetricians. The authors of these accounts are midwife Vicki Penwell, founder of the NGO Mercy in Action, and midwife Robin Lim, founder of the Bumi Sehat maternity care clinics in Indonesia, the Philippines, Nepal, and Haiti. The outcome statistics they provide for their disaster zone care clearly demonstrate the effectiveness and sustainability of their flexible, portable models of care. We also draw on written accounts of the experiences of Japanese women who gave birth immediately after the 3/11/2011 Great Japanese Earthquake by Tsipy Ivry, Rika Takaki-Einy, and Jun Murotsuki. Davis-Floyd describes some of the rapid changes in global maternity care as a result of the coronavirus pandemic and their effects on both practitioners and childbearers. This balance between a focus on providers and a focus on women helps us to clearly see what works from both perspectives. The most essential lesson learned from these accounts of birth in disaster zones is that maternity care should be decentralized, everywhere, both for disaster and epidemic preparedness and under normal conditions. Women want, and need to receive, care in their communities.