When Do I Give Up?

As many of you know I (Ruth) have been leading a childbirth class/support group for pregnant women in a community of Managua called Nejapa for the last year and a half.  In that time, I have developed classes on 14 topics related to pregnancy, childbirth, and newborn care (all in Spanish). I have loved doing this because it is one place where I am able to use my experience as a labor and delivery nurse and my love of pregnant women to make a real difference in the lives of these women by empowering them with knowledge. 

Recently, though, I have been feeling discouraged.  We run the classes in a 16 week series (because no one stays pregnant forever), and we are currently on our fifth group of women.  The average size of our group has been about 4-5, which I think is an ideal number for building relationships.  Our previous group had 13 women, which was wonderful, but almost too big (imagine trying to do yoga with 13 women on the small patio of a clinic).  This time, though, only 1 or 2 women have been coming each time. 

Honestly, it is really hard to be motivated to put time and effort into planning a class that only one person comes to (especially if she arrives 45 minutes late!).  It also makes it hard to plan interactive activities, which I think are essential to the success of the class (“Choose a partner and share your delivery experience… oh wait, you’re the only one here!").  One of the main goals of this group is that it will be a place where women can feel supported and encouraged by other women who are in similar situations.  That is very difficult to accomplish when so few come.

So, lately I have been asking myself a lot of questions… Why aren’t women coming? What could we be doing differently? Is it even worth doing the classes? At what point do we just give up?

I truly believe that there is a need for more education among pregnant women in Nicaragua.  I have no data to support this, but from the time that I have spent listening to the women who come, it is obvious that they are hungry to learn and understand.  I have also been made aware of how little education they get from their doctor at the clinic or in the hospital.  Basically (and sadly, literally), they are told to just be quiet and obey.  When I first started teaching this class, I did a lesson on informed consent, asking questions, and communicating personal opinions and desires with your health care providers.  I quickly learned that as nice as these concepts sounds, and as important as they seem, they really aren’t practical here.  Sadly, doctors are not open to questions or opinions.  This makes my job as leader of these groups even more important, my goal is to explain everything they need to know and answer questions they may have ahead of time.  So yes, I think it is definitely worth doing the class.

BUT.... I also understand that these women make a lot of sacrifices to come to the class.  It is two hours a week when they would normally be cooking, cleaning, and accomplishing the long list of task they have to do to provide for their families.  Many have other children at home, so bringing them along or finding someone to watch them is not very practical.  To get to the class, they either have to walk a considerable distance (pregnant, in 90+ degree weather), or pay money they don’t have for a moto taxi.  I understand that they have many reasons not to come. These women live their lives in survival mode, and they don’t need this class to survive.

But, does that mean we should stop doing it?

I don’t have an answer to that right now.  Maybe you do…..