“When a child is born, the entire Universe has to shift and make room. Another entity capable of free will, and therefore capable of becoming God, has been born. In that way, every child’s birth is exactly like the birth of a world teacher. Every child born is a living Buddha.” ~Stephen Gaskin

I am sitting on the terrace of my hotel in Kathmandu, sipping spicy masala tea and looking out at the cityscape for the last time. Below me, the pudgy, fresh-faced toddlers of affluent Nepalis learn to swim in the crystal-clear swimming pool, a far cry from the muddy, leech-infested floodwaters of the nation’s rivers and lakes. The all-seeing eyes of the Boudhanath stupa, the holiest Tibetan Buddhist temple outside of those in Tibet, gaze placidly down at me from their towering perch above Kathmandu, watching over the nation. In the distance, somewhat obscured by the dust and smog of the capital city, I can see the Himalayan foothills, their dark, untamed beauty seductive in its wildness. I think of my ten SBA students, scattered now throughout isolated villages in those very mountains, providing contraception services and prenatal care and delivering babies in remote clinics. I offer up a silent prayer for them, and for the women, children, and families they are serving.

I will fly out of Nepal this evening, and as my time here draws to a close, I find myself reflecting on all that I have been privileged to bear witness to while being here: the births and the deaths, the monsoons and the landslides, the power of new friendships and the tragic lack of respect for women in Nepali society. I think of the patients I have seen, the child brides whose expanding bellies I have measured, the strong hands that my own have grasped, the sweaty, tangled hair I have brushed during long labors, the warm cheeks of babies I have kissed, the slippery little bodies that I have helped coax into the world. I recall the stories that the women have shared with me, brief, sacred glimpses into lives so different from my own, but at the same time so very familiar – tales of botched home abortions and domestic violence, marital rape and traumatic hospital experiences alongside happier accounts of academic successes, fulfilling marriages both arranged and love-matched, enjoyable holidays spent with family and friends and the funny escapades of their sons and daughters. I look back on all of this, and I remember.

I remember the palpable love shared by an eighteen-year-old couple, the wife laboring behind the closed door of the hospital room, her young husband standing anxiously on the other side, stubbornly refusing to return to the waiting room until he had ensured that his wife was alright.

I remember the horror I felt upon learning that a mother we had cared for during her labor and birth had severely hemorrhaged postpartum and been transferred to the operating room, but that the surgeon who should have performed the emergency hysterectomy she needed had instead, without consulting the woman or her family, allowed her to continue to bleed out on the table until she eventually died, cold and in shock and surrounded by strangers. I remember being stunned by the physician’s inability to understand why the mother’s needless death infuriated me so much, and my inability to comprehend his refusal to perform the hysterectomy, based on the reasoning that, since the mother only had daughters, clearly she still needed her uterus in order to bear a son.

I remember the grace, humor, and power of the Nepali mother who believed (and rightly so) in her ability to vaginally deliver her twins, despite the insistence of the doctors and nurses to the contrary.

I remember standing for five rainy, interminable hours with a too-large, unwieldy oxygen mask pressed to the face of a severely pre-term infant, watching his chest retract with every respiration and willing him to continue breathing until the impossibly slow ambulance arrived from Kathmandu. For days afterward, I tried to find out what ultimately happened to that stubborn baby boy, but I never could.

I remember the glow of positive energy filling the birthing center in Dhading as a teenage mother birthed her first child in the occiput posterior position, the girl leaning against her mother-in-law as she was cared for by attentive midwives and loving female family members. I remember thinking that this was the way birth should be.

I remember the constant buzz of anger that seemed to permeate my time at the hospital, surging to the surface every time a physician stuck his fingers inside a woman without her consent or a nurse yelled at a laboring woman to be quiet. I remember observing the throng of nurses, students, and residents sitting comfortably in the first stage room, gossiping and taking selfies and playing games on their cell phones, completely ignoring the grunts and moans of the pregnant patients confined to beds along the wall, laboring alone through their contractions. I remember thinking that this was not the way birth should be at all.

But most of all, beyond the nightmare births and the textbook-perfect ones, beyond the treks and monasteries and rafting trips, beyond the ever-present mosquitoes and the monsoon rains, I remember the tremendous love I felt throughout my time in Nepal – love for the mothers and newborns that I took care of, love for the skilled birth attendants who transformed from my students into my friends, love for the cheeky street children and clever orphans that I played soccer with in the dirt behind the guest house, and love for the precious Nepali babies whose quick smiles and gentle spirits kept me going in the darkest of times.

I realize that there is little more that I, one lone nurse-midwife from America, can do to alter Nepal’s harmful birth culture and the status of girls and women in this country. I understand that such change, if it comes, must come from the Nepali people themselves, from the women and girls and also from the men who love them. All that I can do is to continue to support Nepal’s SBAs through education, evidence, and encouragement; share my story, full as it is of the myriad stories of the many Nepali mothers, women, and children that I came to know throughout my time here; and continue to work towards global health equity, reproductive justice, and the right to a safe, humane, and empowering pregnancy and birth for all women around the world, especially those who are most at-risk, marginalized, and discriminated against.

And so I return to America, bursting with new ideas about ways to educate, support, and affirm women, inspired to continue pursuing my passion for international midwifery work, and committed to utilizing all that I have learned and experienced here in Nepal to fight for improved women’s healthcare not only in the global setting but also in my own country. I return with a plethora of memories, some wonderful, some hilarious, some poignantly sad – all, now, a part of my transformation from a midwifery student into a true nurse-midwife. I return with renewed confidence, not only in my abilities but in my life’s calling, and with the knowledge that I am strong enough to withstand the struggles, frustrations, and inevitable heartbreak of the vocation I have chosen, because I have the strength of so many amazing women – patients, colleagues, mentors, and students alike – to draw from. I return exhausted but full of life. I return depleted, yet simultaneously renewed. I return a little more broken, and a little more whole.