When birth comes to the village of Tsovak, Evelina Sahakyan comes just before it. Whether three in the morning, or during Sunday dinner, when labor pains begin, so does Evelina’s work.

Evelina (left) at the village ambulatory.

As a trained mid-wife, Evelina has been delivering babies for eight years in the village, some 100 kilometers north of Yerevan.

Tsovak has a population of about 1,500 families, plenty of whom have come into the world at the hands of the Evelina the midwife.

Like most villages in Vardenis , Tsovak relies on the skills of a midwife to help its young mothers through their most important hours. There used to be two midwives in Tsovak, but when the first retired, 35-year oldEvelina was left with sole responsibility. The nearest hospital is 10 kilometers away in Vardenis, reached with difficulty by families who may not have private transportation.

“Now things are getting better, we've just bought a car,” says Evelina, who received her mid-wife training at medical college in Yerevan.She used to work in a maternity hospital in Vardenis. Now, she is head of the village emergency care unit. “When they call me, we go there by car. But three years ago it was harder as I used to get to the inner district on foot at night.”

 Tsovak is one of the biggest communities of Gegharkunik region’s Vardenis subregion. Since the collapse of the Soviet Union, when social conditions got worse, almost all births take place in the village. In fact, the majority of home birth in the republic take place in the Gegharkunik region, particularly in Vardenis subregion. According to Ministry of Healthcare data, in 2000 41 percent of births in Gegharkunik took place at home (Aragatsotn region is second, with 14 percent.)

Strong nets are required for fishing, the main source of income in Tsovak

According to Hrant Mkrtchyan, a doctor at the Vardenis maternity hospital, this year there have been 75 births in the hospital.

In four villages (there are 39 settlements in the subregion) visited by ArmeniaNow, there have been 14 home births this year. In Tsovak, Evelina has delivered 10 of 17 babies, last year it was 30 of 36 babies.

In the past eight years, only one newborn has died, six years ago.

“Now, when people live a little bit better, ten percent of births take place in Vardenis maternity hospital but about two years ago almost all births took place in the village, except when complications were expected,” says Evelina.

Residents of Tsovak are mainly engaged in fishery and growing wheat and potatoes. Recently, profits from raising crawfish and from fishing have increased.

“But even now many people don’t want to go to maternity hospital,” Evelina says. “If I tell them take her to Vardenis, they will take offense at me and say: ‘Why did you deliver someone else’s baby but don’t want to deliver mine’.”

Most recently, Evelina helped Nely Gevorgyan bring a daughter, Ani, into the world.

Ani is the second child that Neli delivered at home.

And she says that she is often, jokingly, criticized if the baby is not the desired gender, a boy – especially if the family doesn’t yet have a male child.

“They shout at me as if I’m guilty that again a girl was born,” “Evelina says. “They say: ‘No way, we are not going to give you baksheesh, however later they give it to me anyway.” (Baksheesh is when someone thanks another one with money or gift, which is a masked method of shadow payment.)

Ani's father Vrezh is not unhappy that he had a girl, as the previous child (and firstborn), was a boy. Here 15 people live in a one-storey house: Vrezh’s parents and his two brothers with their families. Among all children born from three sons of Vrezh’s father, Ludwig, Ani is seventh grandchild and all of them were born in this house.

“We prefer it this way. We have everything ready at hand. A baby is before our eyes. But when you go to hospital it turns into a long story,” says Ludwig. He was born at home too. He remembers his sister’s birth in 1945. She was also born at home when he was a little child and was sent to call a midwife.

Over the years, fewer births occurred at home, and according to the doctor, Mkrtchyan, by the 1980s less than one percent of the region’s babies were home delivered. Only women who didn’t manage to make it to the maternity hospital gave birth at home.

Ludwig’s children were born in the maternity hospital of Vardenis. But after independence old traditions have returned. A child is born at home. Nobody even asks about a baby’s weight and height, as nobody measures.

Vrezh says his wife gave birth at home because it is expensive to reach Vardenis.

“If I took her to hospital I would feel more secure. But I would spend about $100 including petrol (Tsovak is 10 kilometers away from Vardenis), parcels and baksheeshes. This is all about money. Instead of moving forward we were thrown back 50 years,” he says.

Lyudvig and Vrezh. Father and son.

But at-home delivery seems as much tradition as necessity in the Vardenis subregion.

In nearby Tchambarak region, residents are poorer, yet home births are only in extreme cases.

Evelina earns 10,000 drams (about $18) for every birth. A few years ago she was earning more delivering babies than her husband. But as the crawfish business has improved, her husband’s job has provided more.

But Evelina also does a lot of pro bono work, because, typical of village life, she has many relatives for whom she does the work for free.

According to villagers, it will cost double if they go to Vardenis. Plus, if a boy is born then it can cost three times as many because midwives in such cases raise prices of baksheeshes.