“Maternal Instinct,” with Alissa Shattenberg
Alissa Shattenberg is the founder of the Sarobidy Maternity Center in Madagascar. She got her nursing degree in 2000 from SPU, then went on to receive a master's degree in nursing and a degree in midwifery. When she and her husband moved to Madagascar, where they have only one doctor for every 8,500 people and the highest teen pregnancy rate in Africa, Alissa responded to that need. The maternity center provides a yearlong program for women and children, including prenatal, labor and birth, and postpartum care.
Amanda Stubbert: So let’s start by just talking about what is this place. Tell us about this maternity center that is saving lives every day.
Alissa Shattenberg: The Sarobidy Maternity Center opened in May of 2013 and it was really in response to the need that there’s not quality and dignified medical care for women during pregnancy. Sarobidy is the Malagasy word for precious, and our premise is that this is a really precious time in life and that women are precious in the sight of the Lord. And the babies and families are precious in the sight of the Lord. And so as such, we want to surround women and we want them to know, we want them to experience compassionate medical care, and dignified medical care and competent medical care during this really precious time in their lives.
Amanda: I have some children myself and I know you do, as well, and it is such a beautiful, magical time, but it’s also a nerve-wracking time and can be a very scary time. And that’s where we have a lot of help and a lot of resources. So I can imagine in a place where that is not the case, there’s just a lot more feelings that go on there.
Alissa: Yeah. So during my time at Seattle Pacific, when I was a nursing student, there was … one of my professors was a professor at Seattle Pacific as well, a clinical professor. But she also, during the summer times, she worked in Vietnam and she would take students to Vietnam. And I just remember when I came back from Madagascar after that first visit in 1999, and I came back and I just told her about what I saw and what I did. And she just took such a vested interest, and when she knew I was going back to Madagascar later, we met up in Seattle and she took me to the University of Washington Bookstore and said, “You’re going to need this book, and you’re going to need this book, and you’re going to need this book.”
And she bought all of those books for me, and she gave me all of these resources and just kind of poured into me all of her knowledge that she had attained through years of working in Vietnam. And really her heart for God’s global kingdom and that these lives matter and, Alissa, the lives in Madagascar matter. And so, it was this beautiful time. And those books still sit on our shelves at the Sarobidy Maternity Center in Madagascar, and we reference them from time to time for some of our pediatric patients. And, yeah, it’s good.
Amanda: It’s good. There’s nothing like a mentor, right?
Amanda: … that sees your heart and says, “I know where you’re going to go, even if you don’t see it yet yourself.”
Alissa: Absolutely. And, one of the things, and we spoke about this a little bit yesterday, is that midwives in Madagascar, they often go into midwifery because they want to help. They love women, they love babies. And yet as they go through their educational system and they begin working, midwives in Madagascar are known for being really mean. And so, somewhere along the line that changes. And Ruth, who’s our national midwife or a national director for the maternity center, and she’s been with us from the very beginning. She loves the Lord. She loves women and babies. And that’s why she went into midwifery. And then through those years of her education, she shifted and she realized that she was becoming one of those mean, abusive midwives.
When we first started talking about this, the vision for the maternity center, I wanted to see something completely different. I want to see women loved and cared for and with competent and respectful and dignified care. And Ruth, I was telling her some of the practices, and she kind of looked at me like I had a third eye.
Like, what are you talking about? And over the years Ruth has gone from seeing it or from hearing about it to now she is this loving midwife who comes alongside these ladies who is just so gentle and tender and vibrant and compassionate with them during their appointments, during their delivery, after their babies are born. And she came back, and she’s a few years after the fact, and she said, “Alissa, thank you so much, because I’m not that mean midwife.” The Lord has just taken this work and this is how he wants us to treat these women because these women are precious. And so, it’s neat to be in that role now where we can see these midwives coming out of a broken medical system and really treating the ladies and babies within our care in a dignified and respectful way.
“I want to see women loved and cared for and with competent and respectful and dignified care.”
The women that come to the Sarobidy Maternity Center really come from all walks of life. As I mentioned, some are illiterate, some are educated. We have Muslim women, we have women who maybe are completely unchurched or who are nominal Christians. And really, our ultimate goal is that as they spend 12 to 14 months with us in our program, that they would sense the love of Christ. And as we have Bible studies with them, because we do a Bible study each week and as we ask them, “May we pray with you?” After each and every visit and during delivery and when we take them home in our ambulance and all of those things, our ultimate goal is that is not just good and improved medical care for them, but that they would really come to this place of knowing Christ and experiencing Christ through the hands and the feet and the work of the maternity center.
And that they would say, “Huh, what is this?” Christ has been present in Madagascar. It’s not an unreached people group. And yet our goal is that these women would just really come to know Christ as their savior.
Amanda: Really full, holistic care.
Amanda: Because medical, physical, that’s obviously number one, because if you aren’t alive tomorrow, that’s the end of the story. But then two is the emotional, like we’ve talked about like medical care that leaves you traumatized is not good care. So mental has to get, but to make sure that the spiritual is in there as well because we are holistic human beings and you want to make sure that you’re caring for them on all levels, which is fantastic.
Alissa: Yeah, absolutely.
Amanda: So when you first got to Madagascar, did you go to Madagascar with the goal of opening this center?
Alissa: I didn’t. I went with the goal of seeing what the Lord was going to do. And I knew that I had women and children on my heart. And even when I was at Seattle Pacific University and I was in the nursing program working as a labor and delivery student nurse, I was like, “Oh, this is not for me. This is way too messy. I don’t care for this.” So then, years later, after I’ve been working as a nurse practitioner and the Lord calls me to go back to school to become a midwife, I was like, “What’s going on?” But I didn’t know. I didn’t know what that was going to look like. I just knew that I had a heart for women and babies. And that they needed some different kinds of medical care. The same kind of care that we experience here in the States and that I received with my midwives when I was pregnant.
“When I was at Seattle Pacific University and I was in the nursing program working as a labor and delivery student nurse, I was like, ‘Oh, this is not for me. This is way too messy. I don’t care for this.'”
And so it was a year and a half, two years, into our time in Madagascar that I really, all of a sudden, I knew. I knew this is what we needed to do. I knew this was what that God was calling us to do in terms of opening up the Sarobidy Maternity Center. Before that, it was just lots of ideas.
Amanda: So how do you start something like this? Now that you have this fabulous clinic that’s helping women every day, and I’m sure there’s still a lot of very highs and very lows that are a part of that, but how do you get started?
Alissa: One step at a time. So cliche. I worked alongside my mentor, and she has been a trained midwife for 35 plus years in the Philippines and they’ve been doing this in the Philippines. And then we also reached out to a maternity center down in Haiti; I had met the founder and director of that maternity center, as well. And so I really picked these ladies’ brains and we visited their maternity centers and we collaborated with their resources and kind of built up our own program. But using some of the foundations that these two amazing women have put in place in the developing world.
Amanda: That’s awesome. So tell me, what does that look like? What is a typical week in the maternity center?
Alissa: Women come to the maternity center early in their pregnancy. And currently it’s just a hundred percent word of mouth. And they come to us and they apply to be in our program. And we look at various risk factors, and we look at how many women are due that month and whatnot. But they apply and they sign a contract with us. Because we say, “Hey, we’re committing to you and to your pregnancy and to the duration that you’re in the program, but we need you to also commit to us.” And they pay a 10,000 Ariary inscription fee and they can do that up through the time of delivery. So 10,000 Ariary is less than $3. And that is to really that they have buy into the program.
And once they’re … after they’ve applied, we do a whole slew of testing. We do laboratory testing and we do HIV and syphilis and gonorrhea and chlamydia and all of those things. And we also perform an ultrasound for dating purposes. Then they begin our program and every Monday is our prenatal program and the ladies, all the pregnant mamas, come with these big growing bellies and we do vital signs and we do education. It might be education regarding what to expect when labor starts or about high blood pressure in pregnancy or about sexually transmitted diseases. Any of those topics.
And we see women based upon an American prenatal schedule. So in Madagascar, the government wants the women four prenatal appointments throughout the course of their pregnancy. Most women get one, maybe two. Our maternity center provides an average of 11. So, a huge difference as we’re following these ladies really closely. And then as the women get close to term, we provide a labor support class where women can bring either their husband or their auntie or their sister or their mom or whomever they want as a labor support. And so it’s a childbirth education class, because the women have heard about all of these things, like you don’t need to lay down, we don’t want you on your back during labor and delivery. We want to moving around, we want you doing all of these things, different positions. You can be in the birth tub, all of these things.
But then whomever their labor support person is, this is completely a foreign concept to them. Because in Madagascar, women lay flat on their back, they’re given medication, and sometimes the midwives push the baby out.
Amanda: That does not sound like a good experience.
Alissa: No, it’s not. And it’s incredibly dangerous for mom and for baby. And so we need also this buy-in from the support person. And so we also provide a childbirth education class. And then as the ladies come in once they’re close to delivery and their labor starts, then they come to the maternity center and that’s where they stay until their babies are 12 to 24 hours old, longer if necessary. And we have just a team of midwives of really fabulous Malagasy and foreign midwives that just come alongside these ladies, and they provide a hundred percent surveillance of mom and baby during labor, as well as the massage and the relaxation and this really calm environment, which is not common in Madagascar.
In Madagascar, there’s lots of talking, there’s lots of voices, there’s “Come on, just get this baby out.” There’s timeframes you have to have; you can only be pushing for so long. You can only do this for so long. And at the maternity center, we just allow this natural process that God has given ladies, this natural process of birth to occur.
Amanda: I remember you telling me that before about the time limit, because I think most women have experienced a time limit in the hospital. Like, okay, these medical things have happened. So the timer starts and we have to get the baby out. But we’re talking usually like hours and hours and hours. But when you say time limits in a Madagasy hospital, you’re talking 20 minutes, right?
Amanda: Like a ridiculous amount of time to-
Alissa: Absolutely. And it will vary depending on schools of thought, but for the most part they want these moms pushing for 20 minutes, for 30 minutes. And that is it. And that could be a first-time mom, which sets up a mom for absolute failure because it’s a lot of hard work, as we know.
Amanda: Yes, it is. It absolutely is. And so you’re a mom yourself, and I believe you started this center when you had very young children at home. Can you talk about doing this work every day and then coming home to your own babies? Like how just emotionally, much less physically, how did you get through those years?
Alissa: Yeah, that was tough. That was really tough. When we went to Madagascar, our babies were 4 1/2, 2 1/2, and 6 months old.
Amanda: Oh, my goodness.
Alissa: And I was continuing with my midwifery training while we were in Madagascar with a 6-month-old, as well as the toddler and the preschooler. And so it was tough and doing that in a completely different cultural context and different language and everything else. But Jamie, my husband, was fantastic. And we really worked as a team throughout the process, and there were a lot of late nights and not a lot of sleep, like all young moms. And then, developing a program from scratch.
Amanda: Has running a maternity center that is so hands on and so high touch changed you as a mom? How you mother your own children?
Alissa: Mm-hmm (affirmative). Well, first of all, the fact that our maternity center is so hands on, we really want to know the women and we want to know their stories and we want to sit with them and hear about the struggles of their lives. And that’s only possible because we have this incredible team of Malagasy midwives and foreign midwives who are doing that. And in terms of how it’s touched my own life, I remember those early days of motherhood when we had our babies and just the absolute times that you’re just falling more in love and more in love with your children in those early, early middle-of-the-night nursing sessions and as they get older, our kids are now 9, and 11, and 13, and it’s different. It’s a different motherhood.
And yet, when I see these ladies after they’ve had their babies, or when they’re at our postpartum program on Thursdays, and I see them and I see how they’re just gently taking in every little detail of their baby, I’m like, “Oh yeah, that’s right.” Like, we can’t, I can’t stop now that my kids are older. I can’t stop and miss out on all these little, just really precious details of their lives and their characters and who God’s developing them into. So it’s really a reminder for me to just take a step back and to slow down and to just watch and love our kids exactly where they are and take in all those moments.
Amanda: Yeah, I think that’s good advice for all of us, right? All of us parents out there.
Alissa: I need to remind myself of that frequently.
Amanda: Every day, every day.
Alissa: Every day.
Amanda: So we talk about story: your story and your children’s story and being involved in the story of all these women. And I know that part of the goal of this maternity center is to let these women and children have a story, to be able to live into their own story. Do you have a couple stories that you can share with us to bring back to us?
Alissa: Absolutely. Absolutely. There’s so many stories, as you can imagine. So premising it on, Madagascar is consistently one of the top 10 poorest countries of the world. You can imagine that the medical system is incredibly broken and that goes along with being one of the top 10 poorest countries of the world. And so many, many women experience abuse on every level during pregnancy or during delivery in the medical system. And that could be physical, it could be emotional, it could be mental, it could be spiritual. And it’s really these just horrible human rights violations that we see on a daily basis. And it’s incredible the number of women that come through our program who have experienced the loss, the death of a child. It’s astonishing. And sometimes they’ve lost one baby, or sometimes they’ve lost two or three babies after birth and it could be within hours after birth, it could be two years after birth.
It’s just really dependent. And some of it’s birth trauma and some of it’s infections and disease. It’s yet-to-be accidents. It’s mostly preventable things. If women knew, if there was the education, if the medical system was a more equipped medical system. So, for example, there is one woman, and she was one of the very big first women in our program and she already had, she’d had three pregnancies and her first son, he’s now in his 20s and he’s still in our community, but when he was a few years old, he got sick with a really high, high, high fever and she didn’t take him to the medical, to the hospital, to the clinic. And as a result of this high fever for multiple days, he experienced brain damage, and he’s this wonderfully sweet boy, but he’s got brain damage.
And then she had her second child, a little girl, and she’s strong and healthy and thriving and running around the community. And then her third baby, she’s a single mom and the baby was breech, and she went to the hospital to have this baby and she had a normal delivery. She did not have a C-section. And within a few days, that baby died because of birth trauma. And she came to the maternity center for the first time early in her fourth pregnancy. And she was so nervous and she was so fearful because she had just lost a baby two years prior. And the moment that we put on that Doppler and we could hear her baby’s heartbeat, she just melted and just got tears in her eyes.
And this is a very stoic woman and the Malagasy are incredibly stoic people. And she just cried as she just was filled with joy and hope that this here’s another baby. And so she carried that baby to term. She had a beautiful delivery. That baby is now 6 years old and running around our community. And so it’s neat to see these ladies and that they get to experience something completely different than what they’ve experienced in the past.
Amanda: And I can imagine that there’s a bit of a snowball effect here as most women, childbirth and child rearing is a bit of a community act, right, with your family and your neighbors and those around you. And as you show women and children a different way, a way to do things with care and concern and love, a way to do things safely and preventing infection and just things like that that has to have a snowball effect in the community when women begin to help other women be treated differently.
Alissa: Yes, absolutely. And one of the things that we do is we provide this really educationally rich program where every week, either Monday during our prenatal day, or Thursday during our postpartum day, where we provide education for these ladies. We have a number of women who are completely illiterate, others who maybe have a fourth grade education or a sixth grade education, every once in a while, ladies with a high school or college diploma.
But there is one woman, one of our artisans in our artisan program, who is completely illiterate. And she’s had two of her three babies with the maternity center. She said, “Now I know what learned people know. I know how to prevent worms.” Like intestinal worms, intestinal parasites. “Now I know how to prevent intestinal parasites. So my kids and my family don’t get those.” And so there is definitely that snowball effect of women as they experience a different kind of care as they get these educational lessons like what to do if your baby’s sick. You don’t want to wrap up your baby when it’s 100 degrees and 90% humidity. You don’t want to wrap up your baby in five extra layers of clothes, right? So that’s some of those things that caused problems.
And so it’s neat to see these ladies then communicate with other women in their community. We had, about a year ago, a mom who had just delivered and she had delivered on a Sunday night, early Monday morning. And so all the pregnant ladies came, were coming for prenatal day. And so several of the moms came into see their friend who had just delivered. And it was so neat to just sit in the back and watch the interactions between the ladies and this new mom as she’s nursing her baby and she’s like, “See, look, it’s that liquid gold that they were talking about, that colostrum. It’s so important.” And historically, in certain parts of Madagascar, they would throw that away and they would give the baby tea water with sugar instead of this wonderfully nutrient-dense, God-given colostrum. And so, it’s neat to see these ladies in their excitement share their knowledge with other women in the program, as well as within the community.
Amanda: And I, I’m just so struck by that. And it’s just fascinating to me that here you come with Western scientific medicine that’s lifesaving and helpful, but so much of it is just a return to the natural way that we were all created to have this cycle of life.
Alissa: Absolutely. There’s a hotel in the capital city of Antananarivo, and it’s also a museum and a restaurant. And so there’s … I know, we love this place. But I love going and walking through the halls and seeing the old history of Madagascar and there’s this beautiful black-and-white picture, and it’s a mama and she’s on this like a small wooden birthing stool and there’s a traditional midwife or a traditional birth attendant in front of her and this mom is upright and she has the support of another woman by her side.
And that’s what the Malagasy experience used to be … that’s what birth was a hundred years ago, 200 years ago, 300. And then as foreigners have come in and as the French medical system, because the system is very Frenchified, it’s completely opposite. It’s completely on your back and all of those things. And so, to come back to the roots, to come back to best practices, it’s a joy.
Amanda: I just want to help. I just want to help. I’m sitting here in gorgeous sunny Santa Barbara, California, and it makes me want to get on a plane to Madagascar. And so if I feel that way, there could possibly be others listening to us that feel that way. What’s next for the center? How can those of us in Santa Barbara or Seattle or France, how can we help in this process of returning women to who they were created to be as moms and with babies?
Alissa: Yeah, it’s a big question. First and foremost, these moms and their stories need to be shared. And I really feel that their stories need to be shared and that the work that the Lord is doing in Madagascar needs to be shared. It can only strengthen as more people know about it and as more people are praying and more people are getting involved. And so that would be the first thing, to really be praying for these ladies, to be praying for our midwives for wisdom and continued compassion and as our Malagasy team of midwives is continuing to learn more and more best practices, because they’ve also come out of a really broken medical system and educational system.
“I really feel that their stories need to be shared and that the work that the Lord is doing in Madagascar needs to be shared. It can only strengthen as more people know about it and as more people are praying and more people are getting involved.”
The second, one of the things that we … now that we’ve been doing maternal healthcare in Madagascar for 6+ years, we realize, in order to do safe maternal healthcare, we have to have an operating room on site. It’s absolutely essential. And nearly a thousand women a day, globally, die in pregnancy or in childbirth. And 99% of those deaths occur in the developing world. And most of those are preventable with quick action and with operative services available and trained midwives and all of those global health agencies say, in order to reduce maternal mortality, we have to train more midwives.
All of that, that is like the number one thing, but it’s also being able to have operative services when life-threatening complications arise. And so our dream is to expand the maternity center so that we can provide care to more women while keeping the balance of this really personalized care and yet also being able to provide operative deliveries when that emergency situation arrives, which of course also means a surgeon or a physician with surgical skills and an anesthesiologist and a blood bank and a recovery room and a larger facility.
And so, that’s the first long-term goal for our maternity center. The second is when the moms and babies, when they graduate at 6 months old, we see moms during our Thursday postpartum program until they’re six to eight weeks postpartum. And then continuing if they have things that come up. And then we see the babies until they’re 6 months just to continue to make sure that they’re growing and developing appropriately. And then they graduate at 6 months old and that 10,000 Ariary price tag that I was telling you about, that’s less than $3, when they graduate, they get that back.
Amanda: Oh, that’s wonderful.
Alissa: They get that back and they are so thrilled, along with a diploma, and we do a foot-washing ceremony. And when they do graduate, they go back into the broken medical system. That’s Madagascar. And so, another goal would be to start this large family practice medical clinic that would be open to anybody in the community, to those moms and babies that have graduated from the maternity center up to the old grannies that are walking around the community. And so that would be the second large medical dream. The operating room, and then a family practice clinic, to just continue to meet the needs of the community around us.
Amanda: And to just give people a snapshot of the scope. So in the first six years from ground up from nothing. And how we’ll just take one patient and see where it goes to today. How many women have been served by the center?
Alissa: Yeah. So we started with six women in 2013, and to date we’ve served over 1,000 women, plus their babies.
Amanda: That’s phenomenal.
Alissa: Yeah, throughout our prenatal program and postpartum program, as well as a family planning program that’s open to anybody in the community.
Amanda: Well, Alissa, you have our prayers for yourself, for your family, for Madagascar, for your women, and we hope that you will continue to share their stories with us.
Alissa: Thank you.
Amanda: And the world.
Alissa: Thanks for this invitation. It’s been great, guys.
Amanda: Thank you.