One Birth at a Time: ONE H.E.A.R.T.

By Jennifer Street Hyvonen

Utahn Arlene Samen helps Tibetan mothers and infants survive childbirth.
by Jennifer Street Hyvonen

I had a choice: panic or stay calm. I was scared and every instinct said, "Choose panic!" But I knew this choice would make my heart beat faster and cause the blood to pour out quicker, giving my midwife, Diana, less time to work her time-honored skills to save my life. I could hear my new baby boy crying for his mother, and my powerless husband trying to comfort him. So I did what I had done for years on the yoga mat: slowed down my heart rate by breathing slow, deep, life-giving breaths. Hopefully, Diana had enough time.

The next day, I asked Diana what would have happened if I hadn’t delivered in the hospital. She said, "Ninety-five percent of the time everything goes great. Three percent of the time, there are troubles but they can be fixed. But 2% of deliveries are life-threatening and require emergency intervention."

Worldwide, 500,000 women die giving life each year-mostly from preventable and treatable complications. Hemorrhaging is the most common cause. Tibetan mothers are at particular risk of dying from complications because of their poor nutrition, isolation, lack of transport and very little knowledge of childbirth. One in 33 women die in labor. One in 10 babies do not live beyond their first month.

Arlene Samen, a Salt Lake City-based nurse practitioner specializing in high-risk pregnancies, was shocked when she began her original health assessment of maternal and infant mortality in Tibet. She heard story after story of women dying during childbirth from bleeding too much. She was determined to alter this heartbreaking reality.

Samen first went to Tibet at the request of her spiritual teacher. She was doing volunteer medical work in northern India when she learned that many women in Tibet deliver alone and lack basic information on childbirth. Her teacher asked her to help save these women and children, preserving the future of the Tibetan culture. "They are dying," he said to Samen. "Without our women and children we have no future." Samen, a convert to Buddhism, heard her teacher’s terrible stories and came back to Salt Lake City determined to bring skills and medicines to these mothers. "This is my life’s calling," she says, "It is what I was meant to do."

Samen’s initial step was to fly to Tibet with several other medical advisors to assess Tibetan birthing practices, beliefs, cultural structure, and environment. "I interviewed dozens and dozens of mothers," says Samen. "You cannot meet a woman who doesn’t grieve for a lost child. It affects the whole community." Some women have lost two or three children. "Tibet is primarily rural and impoverished, with deeply ingrained traditionals. It has a rich cultural and religious history, but no tradition of midwifery or birthing skills. Tibetans, however, do have myriad cultural beliefs and practices surrounding childbirth. For instance, if a woman wears her traditional dress backwards during labor she may have an easier childbirth. Pregnant women do not carry water because they believe it may cause the umbilical cord to wrap around the baby’s neck.

More harmful is the belief that the blood of childbirth is polluting to the home, so women quietly slip outside and deliver alone so as not to bring harm to their families. "I’ve seen women just appear in their kitchen with a new baby strapped to them," says Samen. "They told no one they were in labor and then resumed their work, holding a nursing baby, without complaint or comment. I have never seen such strength or will."

Infections also claim many lives because birthing takes place in open fields or in barns on dung-covered hay. Umbilical cords are cut with whatever is available, such as used knives or dirty sheep shears. It is impossible to protect babies from the cold in such exposed conditions. Mal_nutrition is rampant. "We sent samples of the typical Tibetan diet, which consists of yak, yak butter, and tsampa (roasted barley), to a lab in Beijing," says Samen. "The report confirmed that this diet is devoid of micronutrients, raising rates of anemia and making hemorrhaging more deadly."

Worst of all, Samen found absolutely no resources aimed at education, awareness or birthing training. Villages are isolated and remote, with few roads and little access to electricity, water, heat, or medical facilities. Tractors are the most common means of motorized transportation, making disseminating information even more difficult.

On one assessment trip to Lhasa, Samen flew a group of OB-GYN doctors from the University of Utah to tour one of the country’s few birthing hospitals. While there, a laboring mother came in with severe high blood pressure, anemia, and shock. The hospital workers told her they could not help and that she would probably die, so she should go home. But the woman had nowhere to go, so the University of Utah doctors were asked to consult. After hours of difficult labor, both baby and mother survived. "I cannot believe she and the baby made it," remembers Samen. "It was one of the most complicated births I have ever attended, and they made it because she had help."

The end result of Samen’s assessment is the Salt Lake City- and Lhasa-based nonprofit organization, One H.E.A.R.T (Health, Education And Research in Tibet). One H.E.A.R.T.  provides training for skilled birth attendants, community outreach to increase home-based lifesaving skills, and basic birthing kits consisting of sterile birthing sheets and gloves, a razor blade, anti-hemorrhaging medication and a warm hat to insulate the baby.

What is beautiful about One H.E.A.R.T is its simplicity. One H.E.A.R.T. outreach workers educate Tibetans on essential matters such as how to suck mucus from a baby’s nose. They urge that two people attend the birthing mother-one to go for help if needed and the other to stay with the mother.

"We are not teaching advanced medicine," says Samen. "These are simple, basic skills that can be learned easily and spread quickly. Often, they are the most powerful." One H.E.A.R.T. also uses culturally-sensitive teaching techniques such as incorporating Tibetan terminology in their trainings. For example, rather than explaining bacterial infections, they say the dirty sheep shears have pollution which can be harmful to the baby, so they need to be cleansed before cutting the cord.

Ann Down, a One H.E.A.R.T. Board member, says, "In most countries, particularly in the West, there is some organization, some government entity that people can turn to. In Tibet, these women are alone and have no one. There is nobody to help them separate superstition and tradition from medical fact." One H.E.A.R.T. works within cultural norms to reduce maternal and newborn deaths, one birth at a time. And the organization’s methods have caught the attention of the Chinese government. China has signed a three-year contract allowing One H.E.A.R.T. to double its efforts and expand.

Of course, as with most nonprofits, One H.E.A.R.T. relies on charitable contributions to do its work. An argument that I often hear for not supporting One H.E.A.R.T is that women and children are dying right here in Salt Lake City, so why should we send money and resources to save lives halfway around the world? And, I must admit, sometimes I can relate to this way of thinking, especially considering that I work for a local nonprofit whose services also depend on private fundraising.

In the end, it all comes down to what you choose to do when life calls. So, again I choose to do what the mat has taught me: to breathe into life. And, we don’t always get to choose where life calls from, whether it be the yoga mat, the delivery room, the streets of Salt Lake City, or the mothers of Tibet. But when it calls, just breathe.

Log onto to sponsor a birthing kit, medicine bag or training program. Tickets to the September 18 One H.E.A.R.T. Gala may also be purchased online.

This article was originally published on September 1, 2008.