NEPAL PART II

In my last post, I wrote about leaving the city and traveling into a rural district in Nepal. I wrote about health posts, about limited resources, and about how much birth care here depends on where a woman lives. This is the birth story I mentioned there. When she started telling me her story, she said she had felt something days before the birth, but at the time she thought it was too early. She couldn’t remember exactly how far along she was according to her calculated due date, but she assumed it must have been around 36 weeks. The sensations were unfamiliar and irregular, easy to ignore at first.

Then the pain changed. She described how the contractions started to come in like waves, rolling over her body and leaving her breathless. When they became more regular and stronger, she told her husband that she wanted to go to the city hospital. They already knew she was carrying twins, and she had been advised to give birth there, because the health facilities close to her village could not ensure a safe birth because a pregnancy with twins comes with a higher risk of complications.

So they packed their bags and their journey to the city began with a two hour walk to the nearest bus stop. Walking while having small contractions, pregnant with twins, she had to stop repeatedly. When the bus finally arrived, it was another three-hour ride out of the mountains. The road was rough and bumpy, and every movement of the bus intensified the contractions. By the time they reached the city, she was exhausted.

They arrived at the apartment where they were supposed to stay before going to the hospital. Her husband carried their belongings, and at tried to support her as well.

The plan was to rest briefly and then go to the hospital birthing unit.

But when they tried to leave the apartment, she realized she couldn’t move anymore. The pain had become overwhelming. She felt an intense pressure and sensed that the baby was moving down. Instinctively, she reached between her legs with her hands and told them she could feel something. The baby’s head.

The owner of the apartment and his wife came immediately to help. There was no time to go anywhere, no medical equipment and no prepared space. She went down onto her knees, and within moments the first baby was born.

She told me that everything happened very fast. The baby came out pink and screaming, breathing well, looking perfectly fine. About ten minutes later, the second baby was born. She was still on her knees when the second twin arrived.

The second baby was healthy too, but much smaller, very small actually.

The wife of the apartment owner stayed with her throughout the birth. She supported her, and helped in the ways she could. She cut the umbilical cords with a razor blade and tied them with thread. Both babies survived. Both babies are doing well. She told me that after she gave birth and the Babies were fine, there was no point in going to the hospital, so they stayed their for the nicht and then went back home.

She is 24 years old and these were her first kids. A midwife in the hospital told me, that if she would've made it to the hospital, they most likely would've given her e cesarean. Most of the hospitals in Kathmandu have a cesarean rate of around 60%. As a reference, the World Health Organization (WHO) suggestes a 10 - 15 % cesarean rate.

What stayed with me was how calmly she told the story. There was no drama in her voice, no sense that this was something extraordinary. It was simply what had happened.

She did not frame it as something frightening or unfair, she told it as casually as anything else. Giving birth meant walking for hours, leaving home, and hoping to arrive somewhere in time, this is just the way it is.

After hearing the birth story of the woman with the twins, I kept thinking about how much of her experience came down to one thing: access. Not courage, not strength just access to care, to infrastructure, to people who are trained and allowed to stay with women during birth. Let me introduce to you Prof. Kiran Bajracharya the probably most important women in Nepals young Midwifery History .

I feel incredibly lucky that I got to meet Kiran. Before coming to Nepal, I didn’t fully understand that midwifery, as an autonomous profession, is still very new here. For a long time, births in Nepal were mainly attended by doctors, nurses or health workers with additional Skilled Birth Attendant (SBA) training. This training is essential and lifesaving, especially in rural areas, but it is not the same as having midwives who are educated to provide continuous, woman-centered care throughout pregnancy, birth, and the postpartum period. Kiran saw that gap very early on.

She saw that not all women were surviving childbirth, often not being truly cared for. Birth was treated as an medical event to manage, not a process to accompany. And she understood that this was not because people didn’t care, but because the system had never made space for midwifery as its own profession.

So she started pushing.

She advocated for academic midwifery education in a country where the profession had no long institutional history. She worked within political systems, universities, and health structures that were not designed with midwives in mind. Again and again, she had to explain why midwives were not “just nurses with extra skills,” but professionals with a distinct role, knowledge base, and philosophy of care.

What struck me most when listening to her was her passion, her persistence and her determination. Because it wasn’t dramatic it was just consistent.

Nepal only started educating midwives academically in recent years. And yet, since then, maternal health indicators have improved.

Advocating for midwives means advocating for women and advocating for women means challenging deeply rooted patriachal structures, they anchored cultural, medical, and political. If you want to listen to Kirans Interview - you will find that on my Youtube channel.

During my time here, I also had the opportunity to speak at a university and share how midwifery education looks in Germany. We compared curricula, subjects, and learning goals. On paper, we are not that different anymore. We study anatomy, physiology, obstetrics, complications, evidence-based care.

But the way this knowledge is translated into practice is still worlds apart.

In Germany, midwives often struggle with time pressure, medicalization, and systemic constraints and fair pay, but the profession itself is established. In Nepal, midwives are still fighting for space, recognition, and the right to practice what they are trained for.

Sitting in that classroom with Nepali midwifery students, listening to their questions and reflections, I kept thinking about the woman with the twins, how she had to walk for hours in labor, hoping to arrive somewhere in time. Kiran’s work is about changing exactly that.

Not through grand gestures, but through education, persistence, and the belief that women deserve more than the bare minimum, no matter where they live.

This is why her story matters and why midwifery is never just about birth. Thank you Kiran.