As I read everything possible about birth in the US, in the run up to my Lamaze teacher training, I keep contrasting Laos and the US in my mind.
Laos needs so much: training of midwives, a system of prenatal visits, supplies for birth (clean birth kits), transportation and access to emergency care, etc…
As I see it the US needs less. Less fear about and less intervening in what should be a natural process. We have C-section rates of +30% (WHO suggests between 5-15%) and rising maternal mortality rates. Excessive in-hospital monitoring and near-universal use of pain medications disrupt normal birth. Transforming Maternity Care reveals that our system is very costly as well.
The largely healthy and low-risk population of childbearing women and newborns experiences 6 of the 10 most common hospital procedures…
Care of childbearing women and their newborns is by far the most common reason for hospitalization, and facility charges billed for “mother’s pregnancy and delivery” and “newborn infants” ($98 billion in 2008) far exceed charges for any other hospital condition in the United States. Medicaid covers about 41% of births while private insurance covers about 52%. The United States spends far more on maternity care than any other industrialized country.
I know that we are lucky, especially when you compare neonatal and maternal mortality stats for the US and Laos. We benefit from access to life-saving C-sections, medicinal protection against hemorrhage and infection, and excellent care for our newborns that need it. However, I am pretty sure, as I read the literature, that the developing world should follow our lead.
Instead, it seems that training birth attendants for normal birth, supported by expertly trained midwives for more complicated, technical deliveries, with surgeons available for the rare C-section, would be best.
These are my thoughts as I read the literature on birth in the developing world and that in the US.
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