Compulsory.

I've recently been thinking about where I will do my overseas placement. This is a non-compulsory element of the SMS program for senior students, and one which is often marketed as a way to get numbers, to cultivate the muscle memory which is so important in the hands-on skills of midwifery, and also to serve alongside sister midwives in developing countries. It's hard in the US to get adequate experience suturing, or managing complicated births, breeches, twins and the like. While it's not compulsory, it most definitely is for me. I want to practice in the developing world not only for a rotation as a student but I hope for a few months of every year from this point forward.

I often think that we inhabit a different planet from most everyone else on this great green world.

American women who chose midwifery care and out of hospital birth do so because they are privileged enough to have a choice and privileged enough that we as maternity caregivers can dub them "healthy, low risk women", the perfect self- selected population who chose to enjoy perfect, safe births in the comfort of their well appointed centrally heated, homes in their warm, clean birthtubs. In some ways, this is the home of the easiest brand of midwifery of anywhere in the world. Midwifery in the developing world often doesn't look anything like this.

Working in the developing world you get a chance to see what devastating maternal and infant mortality looks like, smells like, tastes like. When you walk alongside the midwives and doctors who fight with minimal resources to save women from what we in the developed world might see as the most basic of complications, and yet still lose countless mothers and babies to hemorrhage, infection, hypertension, seizure, malaria, dehydration...

When would you use gloves if you had just one pair for a delivery? Would you allow a baby to drop on the floor rather than reach out and catch with bare hands, knowing that the Mama has HIV?

My fascination and desire to work abroad in the poorest parts of the world is driven in large part by my sense of good fortune. I was lucky enough to be born in a country where I have taken clean water, nutritious food, excellent education, vaccinations against disease, antibiotics, hospitals all for granted. It sometimes strikes me as exceedingly unfair that I am fortunate enough to get to question the quality of my own birth experiences (fancy, well resourced hospitals, the choice between midwife or doctor, two healthy liveborn sons) when most of the world's women simply shoot for survival for themselves, and then, if they're lucky, their babies. They're struggling to find the 60 cents it takes to purchase an emergency delivery kit, so they can deliver their newborn themselves onto a plastic sheet, rather than the clay floor; so they can use a sterile razorblade to cut the cord, rather than a piece of razor grass, or a piece of old tin. While I am debating the relative merits of which kindergarten to send my son to, or if I want him to receive the chickenpox vaccine, women all over the world are simply trying to help their babies survive their first year without succumbing to diarrhea, malaria or parasites.

For me, overseas service is not about numbers, catches or time suturing. It's about getting to know and love the people I work with and around. I want to relieve my sister midwife for a month so she might be able to return home to see her family and take a break. I want to share the joy of a happy, safe birth and a fat healthy baby, but I also want to shoulder some of the burden of the sadness, and help work towards being part of the solution to maternal and infant mortality. Is it daunting contemplating going to a part of the world where poverty, political/military instability, hunger, HIV/AIDS, Malaria/dysentery/typhoid/whatever is the rule, rather than the exception? Yep. Does it have my parents/husband/in-laws a little wiggy at the prospect? Yep.

I could stay here in the States forever, getting ever more pissy at the various state legislatures who restrict or prohibit midwives from practicing and ever more comfortable with the privileged status quo of the North American system (hospital transports, lovely spa-like birth centers) and the (comparatively) perfect homebirthing clientele which are LM's bread and butter. I could do that, and I probably will for large chunks of time, while I educate my boys. But intermittently I will practice in the developing world: in Africa, in India, Pakistan, Afghanistan, in Latin America. Because unless some of us make those women and their babies and their outcomes important, then nothing will change. My bleeding liberal heart wonders what change might be effected if every midwifery student from the US (Australia, NZ, the Netherlands and so on) did an overseas placement in a developing country...

If that were a compulsory rotation, rather than an optional one.

For me this is part of being a midwife. It's about acknowledging our privilege and our moral obligation to serve those women and babies for whom few ever speak, except perhaps the WHO maternal mortality reports. Remember won't you that every digit on that page of mortality statistics was a mother, a wife, a sister, a daughter. It behooves us all not to forget that one simple thing.

I read Babycatcher's blog (midwife working in Malawi) regularly, and her stories humble and inspire me. Her last post on Water was particularly poignant.