(This story was originally published December 9, 2008.)

PORT-AU-PRINCE, Haiti -- Cradling her oversized belly, the expectant mother waddles into the delivery room where six other Haitian women lie with teeth clenched, their legs apart.

The howls follow the woman as she makes her way toward the only empty bed. But before she gets there, gut-wrenching pain makes her drop to one knee and blood spills out, turning the tile red.

On any given day at the three-story Doctors Without Borders Jude Anne Maternity Hospital, women give birth on the floor. Often, the delivery ward is so crowded that some women don't even make it onto the sheetless plastic cots.

"Here anybody wearing a pair of gloves will be catching a baby at some point, " says Dr. Wendy Lai, lead medical doctor at the hospital run by the international medical humanitarian group's Holland contingent.

Lai, a French-speaking family physician from Toronto, calls it the floor delivery index: The number of babies born on the floor, in the stairwells or in the courtyard determines the kind of day -- calm, medium or busy -- the staff is having.

But more than a measure of births, the floor delivery index has come to illustrate the greater struggle for life inside a country gripped by death and hammered by crisis amid a failing public healthcare system. The chaos inside the maternity ward of one of the few free round-the-clock hospitals for expectant mothers in this deeply impoverished nation of 9 million is only a peek at a far wider and more complex problem.

"At the moment, as far we are concerned, on the level of maternal care, we are in a crisis, " says Hans van Dillen, chief of mission. "We have had cases where women die on our watch because we couldn't observe them because we were all over the place.

'THEY JUST DIED'

"While they were waiting for emergency surgery, and the operation theater was fully occupied, they just died, " he adds, his voice drowned out by the wails of dozens of women laboring in natural childbirth on benches in the crammed outdoor waiting room. "They died in our hospital, which is a very difficult thing to swallow, of course, for the family, but also for the staff involved."

The latest healthcare crisis began in October when doctors and nurses at the country's largest medical center, the General Hospital in Port-au-Prince, went on strike. Haiti was still reeling from four successive storms -- including two hurricanes -- and just emerging from a nearly five-month-old political stalemate. Two other public hospitals that care for pregnant women in the capital also would temporarily close.

Suddenly, the doctors and midwives at Jude Anne found their caseloads multiplying as women from all over the capital and countryside crowded their front gate. Last month, they logged 1,250 deliveries. October brought 1,600 -- or four times the numbers initially envisioned when the maternity hospital opened two years ago to treat high-risk pregnant women in slums.

"We can no longer manage. The women, they come from everywhere, " van Dillen says.

Situated at the crossroads of two of the county's most volatile slums -- Cité Soleil and La Saline -- the maternity hospital is the latest international effort to help Haiti reduce its exorbitant maternal mortality rate. More women die here before, during and after childbirth than anywhere else in the Western Hemisphere.

Dr. Paul Farmer, a world-renowned American physician and longtime advocate of the right to safe motherhood for poor women here, says there is no indication that Haiti's maternity problem is worsening. If anything, he says, the frenzy at the Port-au-Prince hospital shows what happens when "deadly user fees, " which keep poor people out of hospitals and leads to 76 percent of women delivering at home, are removed.