Robin Lim

Special Relationship (Virtual)
Robin Lim
Indonesia
Elected in 2021
Because of the pandemic, Robin Lim was selected by Ashoka as a Special Relationship (Virtual) using an online process.

Introduction

Robin Lim is reviving culturally appropriate traditional midwifery practices of engagement with empathy, coupled with excellence of medical skills and resonance with nature, to make reproductive healthcare more accessible for women in Indonesia and the Philippines.

The New Idea

Ibu Robin realized that childbirth practices, including pregnancy and postpartum care in rural areas were not adequate for mothers, often experienced as dehumanizing, traumatic, and lacking community support. In the tradition of her grandmother, Ibu Robin resurrected beloved heritage midwifery practices for mothers, babies, and families. These evidence-based methods, supported by research, promote empathy, care, and a culturally appropriate model easily adaptable for professional midwives. Her hope was to make safe, uplifting mother-baby care more accessible and affordable, increasing attended births, and thereby saving lives. This model allows every woman a choice in ways of giving birth as their fundamental human right. She works with midwifery schools, hospitals, and local government, especially in rural and outlying areas, so that they can apply empathetic and loving care for maternal health services that had nearly disappeared under the strain of modernization. Ibu Robin’s model, developed in partnership with Indonesian and Filipino midwives as well as traditional birth attendants, with a foundation in research, incorporates processes that may be applied in prenatal care, labor, childbirth, postpartum healing, and breastfeeding support. Under Ibu Robin’s guidance, midwives are providing more humanized, reduced risk practices, which have a measurable positive impact on maternal and infant morbidity and mortality rates. Data from each birth is collected and compiled by Ibu Robin and volunteers to demonstrate efficacy of the amalgamation of time-honored midwifery practices and wisely applied medical skills.

Through Yayasan Bumi Sehat, a not-for-profit organization founded by Ibu Robin and other concerned citizens, registered in Indonesia, Philippines, and the USA, Ibu Robin is transforming the role of the family and community in supporting mothers, during the pregnancy, childbirth, and the postpartum period. Ibu Robin believes that the birthing process of a child into this world and the first phases of their lives play a very important role in one’s development as an individual and as a beneficial partner of their community. Ibu Robin encourages midwives, doctors, and nurses to uplift the mindset of new mothers, reminding them that giving birth is a miracle process to be celebrated by mothers and their ecosystem regardless of their social status, race, and religion. Ibu Robin believes that by caring for the smallest, most vulnerable citizens of Earth – babies at birth – and by protecting them from any unnecessary trauma so that each child is granted the opportunity to begin life with an intact capacity to love and trust, we may build peace: one mother, one child, one family at a time.

The Problem

Almost all global maternal deaths may be prevented by ensuring women have access to quality, respectful, and equitable maternity care. Yet, according to a report by the World Health Organization (WHO) published in 2015, mothers and their babies globally are still at great risk of death (commonly referred to as maternal mortality) due to complications during pregnancy, childbirth, or the postpartum period. Every Mother Counts reported that more than 800 women die every day from complications related to pregnancy or childbirth. Globally, the maternal mortality ratio (MMR) reached 211 deaths per 100,000 live births from 2000-2017. The MMR in Indonesia is one of the highest in Southeast Asia: 305 deaths occur for every 100,000 live births according to the official estimate of the Government of Indonesia. In addition, concerning the postpartum period, a study in Indonesia found that mothers who reported any delivery complications experienced a higher risk for postpartum depression compared to those who did not report any complications. Also, mothers with postpartum depression may not be able to adequately care for their babies, which leads to long-term impacts on a child’s development and results in more severe mental disorders, emotional problems, behavioral cognitive disorders, and dysfunctional interpersonal relationships with the family. Studies show that the health and well-being of a mother and child at birth largely determine the future health and wellness of the entire family.

The Journal of Reproductive Health, regarding the high causes of MMR in Indonesia, found that socio-economic and cultural factors had a real influence on childbirth behavior. The mothers’ socio-economic status also plays an important role in the adequate health service facilities; those who are disadvantaged, or who live in remote areas, borderlands, and islands, experience difficulties in accessing antenatal (prenatal) examinations, childbirth assistance, and immediate aftercare. Childbirth assistance in rural communities is mostly done by Traditional Birth Attendants (TBA), known as ‘dukun bayi’ in Indonesia. In response to that, the Ministry of Health launched a village-based midwifery education program and deployed one midwife to each village throughout Indonesia during the 1980s. This program resulted in increasing the number of skilled midwives between 1990 and 2003, and socio-economic inequalities were reduced for professional attendance at births. However, in many areas this has not yet been achieved due to the lack of midwives’ competence to deliver health education regarding safe childbirth to the community, including safe place of birth, nutrition, and breastfeeding. A study published in 2014 also reveals that a deficit of cultural competence awareness among midwives seems to be the major factor that influences community preference to seek the help from TBAs compared to professionally trained midwives.

Ibu Robin witnessed and experienced first-hand the challenges Indonesian women faced relating to pregnancy and childbirth when she first arrived in Bali in 1992. In fact, gentle, empathetic, and culturally appropriate methods, which were the power of traditional midwifery practices in ancient times, had all but disappeared. Ibu Robin believes it is possible to revive traditional midwifery practices rich with empathy, in resonance with community and culture, and integrate it into the practice of professional midwives. Bumi Sehat has demonstrated with their birth data that this approach preserves lives while leaving women with a more pleasant and fulfilling experience of childbirth. The methods pioneered by Ibu Robin are designed to make maternal/child health care more accessible and affordable. By respecting women’s choices in their childbirth process, the mortality and morbidity risk can be reduced.

The Strategy

In her early journey in Bali, Ibu Robin began her efforts to revive and preserve the empathetic care and culturally viable practices of traditional midwives and inspire hospital-based midwives, nurses, and doctors to integrate these time-honored systems into their practice. Ibu Robin interviewed women, the families of women who died in childbirth, dukun bayi (traditional birth attendants, TBAs), village-based midwives, and doctors, to understand the challenges faced by pregnant women and also to understand the challenges that traditional midwives and the medical professionals faced in their efforts to preserve the lives of mothers and babies.

Yayasan Bumi Sehat (Healthy Mother Earth Foundation) focuses on prenatal care, natural birth services, postpartum care, and breastfeeding support for the most at-risk populations: marginalized, poor, rural, and disaster survivor communities. In their fully functioning Community Health and Birth Centers in resource-poor areas, four in Indonesia and two in the Philippines, Bumi Sehat implements capacity building with 4,000 to 8,000 midwives and Traditional Birth Attendants (TBAs) per year from all across Indonesia and the Philippines. The midwifery team also provides free classes for women to educate them on issues of childbirth preparation, reproductive rights, mindfulness, and parenting. This ensures that the Gentle Childbirth vision and practices are widely implemented and equips midwives with a new mindset and skills to promote empathy in the hospitals and clinics where they are serving. To increase the impact of the successful Bumi Sehat model and reach more women and midwives across many countries, Ibu Robin is actively sharing free learning materials, distributing thousands of copies of guidance books for mothers, midwives, and families, while conducting and planning online Master Classes for BirthKeepers on her social media platforms. Due to the global pandemic, her online teaching has increased. The Gentle Birth model has become well known among many Indonesian and Filipino influencers and has helped more women and midwives become aware of the possibility and benefits of better maternal health practices and reproduction rights protection.

Since the clinic opened in 2005, Bumi Sehat has promoted a personalized childbirth model based on the mother’s preferences to achieve a safe, pleasant, loving, and less-traumatic experience with accessible and affordable healthcare services. As a result, the Bumi Sehat midwives were able to improve the rate of exclusive breastfeeding in the first six months of infants’ lives in accordance with Indonesian national policy through the campaign to inspire women to breastfeed their babies. They were also able to reduce mothers’ stress and risk of trauma, by providing services that aid in achieving more functional families and communities. Bumi Sehat has worked to help families, especially new fathers or any other caregivers, by increasing their understanding and enlisting their help in supporting new mothers and babies. The midwives’ strategy has been to model respectful and loving care of women, while building a circle of support to prevent domestic violence and abuse of women. Data from the Local Health Department in Bali showed the maternity rate in the villages decreased from 72.1% in 2013 to 68.6% in 2017. Additionally, attended deliveries in health facilities has increased nationally to 59.4%, and 90.8% in Bali in 2010.

The Bumi Sehat midwives, guided by Ibu Robin, also focus on improving the people skills of BirthKeepers, i.e., conventional midwives, doctors, and nurses, to awaken their empathy as individuals, beyond and within their profession. Within hospitals, Bumi Sehat promotes optimal obstetrical evidence-based women-to-women care, including support of female choice and improving the rate of breastfeeding. Ibu Robin also created a curriculum with training manuals for Ob-Gyns, midwives, and doulas on Gentle Childbirth practices. This Master Class model is currently being tested in online courses for Japanese midwives and doctors. She creates and teaches hands-on capacity building workshops for Indonesian and international health providers, moving toward a more effective, empathy-based model of care. In the future, Bumi Sehat plans to introduce the methods of Midwife-to-Mother care to even more BirthKeepers throughout Indonesia and Philippines. Ibu Robin’s dream is to increase the reach of an effective and safer model of care accessible for all women.

Additionally, Ibu Robin along with midwife Deborah Flowers, launched Awakening Birth, a website providing free access to learning materials, in an effort to make her knowledge accessible globally to all new mothers, midwives, and families. She has developed health/education materials to give autonomy to women in their childbearing years, e.g., books for Exclusive Breastfeeding, Natural Mother, Natural Midwife, Natural Child, along with educational and documentary films. This material, available freely in printed and digital copy has been largely distributed to new parents in Bali, Lombok, Sentani Papua, Aceh and the Philippines. To complement, Robin and her team offer a comprehensive range of allopathic and holistic medicines, as well as pre- and post-natal care, nutritional education, pre-natal yoga, and scholarships for midwifery students in Indonesia. Ibu Robin believes that if a young woman has a dream to serve her own people as a midwife or a nurse, it must be supported. Outreach health projects have brought Bumi Sehat's doctors, midwives, and nurses to outlying, more impoverished areas of Indonesia and the Philippines, including disaster zones. Bumi Sehat has been working with local foundations, to revitalize integrated healthcare centers in far flung areas, to improve maternal and child health as well as advocating for marginalized, displaced, low-income people from all islands, faiths, and cultures. Bumi Sehat’s vision is built on three principals: Respect for Nature, Respect for Culture, and the wise implementation of the Science of Medicine. This reflects the traditional Balinese philosophy for well-being of Tri Hita Kirana; harmony with Divine, harmony among people and harmony with nature/environment.

By empowering teachers of midwifery and the local healthcare officials, the Gentle Birth model has begun to be replicated in other areas in Indonesia and Philippines with independent management, making health services affordable for the poor and marginalized by promoting community support. Ibu Robin started the Community Health and Birth Center in Bali as the first area and later expanded to Aceh, Papua, and Lombok after severe disasters struck, as well as advising on the maternal health crises in Haiti, Nepal, and Cox’s Bazar. Bumi Sehat then began their work in Leyte and expanded to Palawan Island under Wadah Foundation when the Philippines suffered devastation in the aftermath of Typhoon Haiyan.

In the aftermath of the 2004 Indian Ocean tsunami, Ibu Robin developed systems to build bridges of understanding, so that qualified midwives work in tandem with community TBAs, increasing the frequency of maternal healthcare and reducing the incidence of maternal death in Aceh. Under the guidance of Ibu Robin, Bumi Sehat has been also responsible for the translation of International Childbirth Initiative (ICI) documents from The International Mother-baby Childbirth Initiative (IMBCI) into Bahasa Indonesia and Tagalog. All six Childbirth clinics under the wing of Bumi Sehat are ICI demonstration sites, fulfilling all the criteria of a human rights-based birthing facility by following all the 12 guidelines for safe, respectful MotherBaby care.

The Person

Born in 1956 to a Filipino-Micronesian American family, Ibu Robin shadowed her grandmother, a Hilot (practitioner of the ancient Filipino art of healing and receiving babies into the world). Her grandmother served the people before, during and in the aftermath of World War II. When all infrastructure and healthcare systems were destroyed, it was Vicenta Munar Lim’s expertise in traditional medicinal herbs that preserved lives. When starvation plagued the refugees, Lim’s family practiced charity. The traditional beliefs of her grandmother then enlightened Robin to not rest until she become the person she had the potential to become.

Since her early age, Robin had been marching for justice and peace. She experienced discrimination due to her mixed-race origin, especially when it came to health facilities. She also lobbied for women’s empowerment at school after witnessing and experiencing unjust treatment based on physical appearance. In her first experience of giving birth as a teenaged mother, she suffered obstetrical violence when taken to a hospital for a simple suturing procedure, and realized it was something many women experienced. It led her to advocate for skilled, kind, respectful care for all humans, especially mothers and babies, so vulnerable in childbirth. Another traumatic event occurred when in 1991, her own sister, living in the United States, died from complications of her third pregnancy under the care of an OB-GYN. Her death was preventable, but even though fully insured, the healthcare system did not work equally for a mixed-race woman who was married to an Asian man. The deaths of women in childbirth at the rate of one every two minutes on earth is very personal to her. She promised herself to do everything she can do under the spirit of Woman-to-Woman Care.

Robin began volunteering to promote maternal and child health in Bali, Indonesia in 1995 and was then deemed a Certified Professional Midwife (CPM) by the North American Registry of Midwives in 1998. After giving birth to her youngest child in her own home, many local women started to come and learn from her. In the same year, she began to offer pre-natal care, birth services, and post-natal care in the small village where they lived. The demand for birth services grew until Robin and her team decided to open a small clinic in Nyuh Kuning, Bali. She then founded Yayasan Bumi Sehat (Healthy Earth Mother Foundation) in 1996 and was officially certified as a not-for-profit organization in 2005. With a meaningful vision for building Peace, one Mother, one Child, one Family at a time, Yayasan Bumi Sehat is built on three principals: Respect for Nature, Respect for Culture, and the wise implementation of the Science of Medicine. The foundation of Ibu Robin’s ability to innovate and sustain her work has been her husband, Wil, eight children and six grandchildren.

After all her success stories with Yayasan Bumi Sehat to create a better world for women and children through gentle birth services, she had received numerous honors and awards including: the Woman of Peace award in 2005, the Bayanihan Award in 2015 from Republic of The Philippines, the People of Change Award in 2016 from Republika Indonesia, CNN Hero of The Year in 2011 and Earth Company Impact Hero 2016. To spread and promote her idea, Ibu Robin has been actively writing books about natural family planning, natural birth, parenting, breastfeeding, poetry related to women, children, and childbirth, and a novel about the courage of women over six generations. Her most well-known masterpiece is titled “Placenta the Forgotten Chakra” which released in 2010, available in English, Spanish, Russian, French, and Italian.  

Ibu Robin perceives the current medical model of maternal health care as a broken system, as it has failed to deliver respectful culturally appropriate, kind, skilled accessible care to women globally. She puts forward the concept that wise implementation of systems of well-being has the potential to uplift individuals, support families, and strengthen communities and countries. If we can welcome generations of babies to Earth, without trauma and with intact capacities to love and trust, they will become the stewards of our air, land, water, and all species on this ailing planet. The time is now, we can and must follow the kindest protocols for mothers, babies, and families, because Ibu Robin believes that peace begins with birth.