Hard start for Bangladesh baby

Most women in Bangladesh give birth without the help of modern medicine. Cassie Farrell, producer and director of the BBC's Survival - A Healthy Start programme, followed the fortunes of one baby in the north-east of the country.

Baby Shomona went for five days without breast milk

In a small corrugated iron hut, a young woman, Morjina, is in labour. She squats next to her bed, groaning as women rush in and out. It is dark, smoky and forbidding. There is an air of panic.

The traditional birth attendant, known as a dhai, calls for garlic and burning chillies. She wants Morjina to retch, in a desperate attempt to strengthen her contractions.

Once the baby, a little girl, has arrived, the dhai starts pushing on Morjina's tummy, first with her hands, then with her feet. She was trying to deliver the placenta as quickly as possible.

This is the reality for more than 90% of women in Bangladesh, who give birth at home with little of no modern trained medical help.

Most are accompanied by a dhai, whose knowledge and birth practices have been handed down to them little changed, through the generations. They bear little resemblance to midwives in the developed world.

The dhai's have little or no medical back-up. If anything goes badly wrong during the birth, the mother probably won't survive.

Exhausted

A common problem, such as an obstructed labour will probably have to run its course and will almost certainly kill both mother and child. In the West that could be easily treated by an emergency Caesarean but that's much harder to come by here.

A haemorrhage can be a death sentence - which can happen if the dhai is too aggressive in trying to get the baby or placenta out.

The dhai pushes hair into the mother's mouth to make her retch

In this case, the dhai, Musammat Sobura, started to force Morjina's hair down her throat, causing her to retch and sweat. Eventually the placenta came away and was buried next to her bed, deep in the mud floor.

Morjina, who had been forced to stay upright on her knees until this point, could now finally collapse on the floor, utterly exhausted. She was one of the lucky ones - she and her daughter, Shomona, had survived the most dangerous time in their lives. One in 50 women in Bangladesh die in childbirth.

Surviving birth turned out to be just the first obstacle for little Shomona.

Minutes after she was born, the dhai shook the baby and dangled her by each of her limbs. Her limbs were then pulled sharply. The dhais believe this will make the child grow up to be tall and beautiful.

Then the dhai smeared mucous from the umbilical cord onto the baby's miniscule gums. The reason for this wasn't clear but apparently it was intended to ward off infection. Since the dhai hadn't washed her hands, it seemed to me that this could cause more problems than it solved.

Then it was time for a bath, outside in the courtyard, under the slow monsoon drizzle, followed by a good dousing in mustard oil.

After that the baby was wrapped up and taken inside - time for its first breast feed, I assumed. But I was wrong. Instead, she was fed on honey, again from the dhai's finger. All the bonding that is now prized so highly between mother and child in Western medicine was entirely bypassed.

Baby Shomona was making obvious sucking attempts but all she was getting was thin air. Surely it was now time for her first feed? But we were told that the "milk had not come in" and that Shomona would have to be fed on honey and cow's milk for at least three days.

Opposite

This was not an isolated case. During filming, we discovered that lots of new mothers and babies in the area were going through the same process.

Dhais, like traditional birth attendants in many parts of the developing world, don't think that colostrum - the mother's early milk - is good for babies. So they prevent mothers breast feeding during the first few days. This is the opposite of what is now widely taken to be good practice in the West. This early milk is full of crucial nutrients and antibodies that increase the baby's immunity.

The World Health Organisation recommends that breastfeeding should start within an hour, and that babies should continue being exclusively breast fed for the next six months.

The mother was suspicious of hospitals

In a neighbouring village we filmed a child who had died after eight days without breast milk. It started to dawn on us that this wasn't uncommon. And in fact, around the world, three million children die each year because they are underweight. Lack of breast feeding plays a large part in this unnecessary toll.

We'd become close to Morjina and her little family and I wondered whether things could be different if we could persuade her to get to a doctor.

But the expensive journey to the nearest proper hospital, a two-hour journey by boat, wasn't the only thing that deterred her.

She revealed a deep suspicion of hospital staff and modern medicine. She seemed to think that going to give birth in hospital would mean being operated on and being rendered "unable to eat or do anything", especially work.

Even the most motivated and well-meaning NGOs can find it hard to challenge these traditional beliefs, for fear of offending local cultures or being accused of being opposed to religious values.

Worried for both Morjina and Shomona, we returned every day to see how things were going. After five days, Shomona still had not had any breast milk and was getting visibly weaker.

We decided to stop just being film-makers and intervene. We planned to take a doctor to see her - our film was starting to pale into insignificance alongside the human tragedy that was unfolding before our eyes. But to our relief, we returned the next day to find that Morjina had started feeding her baby daughter and all was well.

I thought back to the birth of my own children in the UK in a perfectly appointed labour suite surrounded by reassuring medical staff who probably could have saved me and my baby whatever happened.

Many in the West assume that is a mother's right when, in fact, it is an incredible luxury afforded to the lucky few.

• You can see more on this on Survival - A Healthy Start. It will be shown four times on BBC World - at 0810 GMT and 1710 GMT on 8 November and at 0110 GMT and 1410 GMT on 9 November.