MAKLI, Sindh: Earlier this month close to the crack of dawn, a free ambulance service in southern Pakistan received a call that a 26-year-old woman from a remote village in Thatta had gone into labor without a health facility nearby for miles. 

Within minutes of receiving the call, a Sindh Integrated Emergency and Health Services (SIEHS) ambulance staffed with health workers trained in emergency obstetric care sped off toward Shabeera Bibi’s location in the Sindh province. The paramedics stabilized her and left with her for the nearest health center but realized soon that there just wasn’t enough time to reach the facility.

With her husband’s consent, Shabeera’s baby boy was delivered in the moving ambulance, one of 100 babies born in an SIEHS ambulance in this year alone. 

“I was in a lot of pain when I was about to deliver, the baby’s condition was also at risk and my water had broken,” Bibi recalled, sitting on a charpoy back at home in her mud home in Hussain Notiar village. 

In her arms, she held her newborn son Fayyaz. 

“I am simply grateful to Allah for saving my baby and my life, and that my baby is still with me today.”

Pakistan’s Sindh province is the second most populated province of the country where 30 percent of women receive no prenatal care, 60 percent do not give birth in a health facility, and the maternal mortality ratio is thrice the UN’s Sustainable Development Goal 3 target.

As per a recent United Nations report, Pakistan was among four countries that accounted for nearly half of all maternal deaths worldwide in 2023. The situation is dire in rural districts such as Thatta, where the health infrastructure is shoddy and few skilled birth attendants are available.

Set up in 2021, SIEHS, which runs as a public-private partnership, wants to fill the gap, with its ambulances, called ‘HOPE,’ providing free and round-the-clock assistance to people in Sindh though the 1122 helpline. 

“Our job is to respond to emergencies,” Farheen Haider, an emergency Mmedical technician (EMT) at SIEHS, told Arab News. “When it’s a delivery case, we respond immediately. If the situation is more critical, we try to manage the patient on the way.”

Since its establishment, SIEHS has delivered 400 babies in ambulances across Sindh, with the mothers surviving in all cases, Haider added.

Shabeera’s was one such case in which paramedics worked in the confined space of the ambulance, performing the delivery and administering immediate postnatal care, including carrying out an APGAR scoring to gauge the health of the baby, as well as cleaning the mother and baby and cutting the umbilical cord. 

The baby’s grandmother, Haseena Bibi, recalled the ordeal the woman went through that day. 

“We are very poor and we couldn’t reach the hospital … we were very worried and then the girl [Shabeera] said that she couldn’t bear it anymore,” Haseena said.

She said the ambulance arrived quickly and Shabeera gave birth on the way.
 
Around 600 HOPE ambulances are operating in various districts of Sindh, Wazeer Ahmed, SIEHS regional manager told Arab News. 

One of the main objectives of the service, he explained, was to move expecting women to hospitals:

“But if there are complications or the baby is about to be delivered, we take permission from the parents or the husband and proceed with the delivery inside the ambulance.”