Sep 19, 2023

Advocating for the Laborers


Alayna Dorrell

How a childhood in the Philippines shaped a passion for labor and delivery nursing

Image By:
Kaiser Shaffer

I found my passion, the one that would later shape the course of my life, at a maternity clinic in rural Philippines. I was around eight years old, on the island of Mindanao, where my mom and I would drive down the dusty road to the clinic where she would see patients for their prenatal visits. The facility was a fairly small, concrete building. There was no air conditioning, so the windows were left open for the humid, tropical breeze to circulate the space. 

As we entered, there were laboring women downstairs with midwives. They were all in one room on twin beds, separated by curtains. We would quickly bypass them to climb the wooden staircase to the second floor, where we would meet women for their routine visits, earlier in their pregnancy. Mom would take their vitals and measurements; I would record notes in their chart. 

One of the main roles of this clinic was to identify barriers that stood between these women and the resources they needed, assist in meeting those needs, and empower them as they were preparing for childbirth and to become mothers. I began to see the bigger picture as I spent more time with the women who chose to devote their lives to helping other women. They weren’t just recording numbers and checking boxes, they were enabling better lives for the women they served.

Six years later I was living in the capital city, Manila, where I found myself at yet another maternity clinic. I was in the basement of the clinic with my friends, organizing paper delivery records for community service hours. We had been chatting and laughing—probably too loudly—because we didn’t hear the commotion of a laboring woman upstairs. The woman and midwife must have had grace for us, though, because when it was time to deliver the baby, they invited us into the “delivery room,” which was actually just a curtain surrounding a bed. 

We huddled close to the woman as she delivered her baby. I had never been so captivated, and I had never been so proud of someone that I had just laid eyes on. The woman became the picture of “strength” in my mind for years to come. Not just because she delivered a baby naturally while barely making a sound, but also because she made the vulnerable and selfless choice to let some high school girls in to witness her most intimate and painful moment. She allowed us to support her as she delivered, while also encouraging us as young women who had never seen a vaginal birth. We were, quite frankly, freaked out by the thought of it until that point. 

They weren’t just recording numbers and checking boxes, they were enabling better lives for the women they served.

Throughout the next few years, I found myself drawn to opportunities to witness and support women in a variety of outlets, and decided to pursue education that would allow me to play a role in women’s health for my career. This pursuit led me to my current work as a nurse in labor and delivery in Kentucky. 

Though the hospital setting in the United States is very different than those clinics in rural Philippines, many women are experiencing barriers to healthcare in both countries. In the U.S. there are disparities related to federal policy and social practices that lead to this country actually having the highest rates of preventable and maternal mortality among developed nations, predominantly among Black women. Despite a global decline in mortality rates, in 2021 the U.S. maternal mortality rate was 32.9 per 100,000, which was an increase from 2020 (23.8 per 100,000) and 2019 (20.1 per 100,000), with Black women almost three times more likely to experience mortality than other ethnic groups (Hoyert, 2021). 

The reason for this is complex and systemic. Long-standing policies have contributed to a lack of adequate federal health insurance coverage (especially in the postpartum period), closures of rural maternity clinics, and lack of resources given to low delivery volume facilities. Black women, women living in rural and low income communities, and those covered by Medicaid for their labor and delivery are often predisposed to chronic health conditions that negatively impact pregnancy and delivery. In addition, there is implicit bias among healthcare workers and policy makers that contributes to higher rates of preventable maternal death in these populations. 

We must advocate for these women; beginning with preventive activities and education for patients and healthcare providers, and continuing the advocacy all the way to the bedside setting. Some suggested policies and community engagement activities to reduce the rate of maternal mortality include funding and prioritizing research for evidence-based care, education geared toward cultural competence and respectful care, community partnerships that identify and address barriers to transportation, food, and housing in rural settings, and policy development that allows women to be adequately insured through pregnancy and the postpartum period (Chinn et al., 2020).

I am one person in this large, complex system, and I sometimes find myself minimizing the work that I do because given the complexities, creating change feels daunting. The day-to-day often feels like I am checking boxes and recording numbers—not dissimilar from how I once observed the women at the clinic in the Philippines. But even in the midst of the sometimes monotonous reality of this line of work, I am often reminded of how I could recognize then that the simplest tasks were bettering the lives of the women served. And I recognize my own simple moments, that remind me why I chose to devote my life to supporting women and new parents—

Suddenly I’m a kid again, captivated by not only the beauty of birth, but by how the patients allow me to be part of their story.

When I am encouraging a woman that doesn’t believe she can get through labor. When I’m allowed into a new family’s most vulnerable and joyous moment. When I’m there for the worst news they’ve ever received. When I’m identifying barriers and needs for a single mom. When I’m there for the mother who is making a selfless choice to give her child up for adoption. When I’m empowering a woman who doesn’t believe she can break cycles of addiction. Suddenly I’m a kid again, captivated by not only the beauty of birth, but by how the patients allow me to be part of their story.

I have to believe that I play a significant role in advocating for the women in front of me, even in the moments when it seems like I have little influence. And the same is true for all of us—as women, we can all participate in empowering other women, fighting for a safer healthcare experience, and supporting new parents around us. No matter our context, sometimes the greatest advocacy is not contained in grand, pivotal actions, but rather in the sum of our small, everyday choices over the course of our lives.

Chinn, J.J., Eisenberg, E., Dickerson, S.A., King, R.B., Chakhtoura, N., Lim, I.A.L., Grantz, K.L., Lamar, C., Bianchi, D.W. (2020) Maternal mortality in the United States: research gaps, opportunities, and priorities. Am J Obstet Gynecol. 10.1016/j.ajog.2020.07.021
Hoyert, D.L. (2021). Maternal mortality rates in the United States. NCHS Health E-Stats.

Alayna has been working as a Labor and Delivery nurse in Lexington, KY for seven years after receiving her Bachelors of Science in Nursing from Eastern Kentucky University in 2016. She is married to Jacob and mom to a three-year-old, Maya. Alayna grew up in a missionary family in the Philippines, where she lived for thirteen years.