This site http://show.mappingworlds.com/world/ enables the visitor to change the size of countries of the world by choosing different criterion, including maternal and child mortality. Choose “People”, “Health”, “Maternal Mortality.”
Enjoy!
CBK Organizations: Global Health Training
Global Health training does great work in Honduras, Uganda and India. They bring medical supplies, including clean birth kits, and provide birth-related training. I love the message on their front page http://globalhealthtraining.org/:
We have the opportunity to save lives and improve the quality of life for families in remote communities by taking basic birth supplies and education into their villages and communities. We can make a significant difference by teaching basic healthcare principles.
Thinking about Clean Birth: US vs. Laos
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.
Midwife with Clean Birth Kits Headed to Haiti
Just as the name suggest, http://trainmidwivessavelives.org/, Carrie Blake’s site details her efforts to bring midwifery training — and clean birth kits — to women in the developing world.
Carrie is a homebirth midwife in North Idaho who wants to:
train the “unskilled birth attendants” (based on the World Health Organization’s definition of “skilled birth attendant”) in the most basic “skills” associated with the problems most prevalent in pregnancy and birth: postpartum hemorrage, pregnancy induced hypertension, obstructed labor, and basic neonatal resuscitation. A pictorial, modular training that could be used by any “skilled birth attendant” to train and “unskilled birth attendant” will hopefully be the end result.
She is headed this month to Haiti stocked up with clean birth kits. Well done!
“Birth by the Numbers”
I am preparing for a Lamaze childbirth educator training next week. As a result I am reading alot about birth in the US. Quite a different picture than Laos or Uganda. While moms and babies desperately need skilled attendants and resources in the developing world, the US medicalizes birth to a dangerous degree.
Here’s some numbers/insights I got from “Birth by the Numbers”on the Orgasmic Birth website :
4, 138, 349 births in the US 2005
1% or 40,000 births
18,884 infant deaths (1st month of life) 2005
1, 248, 815 C sections
Calculate neonatal mortality rate =
infant deaths in first 28 days x 1,000 / live births
US 4.6 deaths/1,0000 = We are 42nd in the world.
Critics say: 1. Not fair to compare US to small homogeneous countries. 2. Use perinatal stats not neonatal because countries count deaths differently.
If we look at countries with 100,000+ births and use perinatal mortality stats the US ranks 15 of 16. We also have the highest maternal mortality. African American women die at a rate 6 or 7x times higher than birthing women in other industrialized countries.
US made no improvement in neonatal mortality in 2000-2005. Industrialized countries are improving. Maternal mortality in US is getting worse – 54% more deaths. Industrialized countries went down 16%.
C-sections are overused in US, leveled in Scandanavia, UK, Germany. If 30% rate then you are doing c-sections on low risk mothers, who has the risk of surgery: complications, infection without benefits to mom and baby.
It’s not a question of moms age: women of all ages
It’s not a question of baby age: all gestational ages
Black women have highest rates. Strong regional patterns of rates.
Mothers driving, asking for? In a study of 252 only 1 (0.4%) met the criterion for 1. request before 2. asking for csection for no medical reason. They are rare.
Did they feel pressure to have c section? 25% of scheduled c sections, 25% emergency csections, 35% VBACs, 1% vaginal.
Mother are not driving this. It is a shift in the nature of maternity care.
Risk conditions: diabetes, blood pressure (eclampsia) reduced c section rate between 1991-1996 and then back up 1996-2005.
Same for fetal distress, cord prolapse, placenta previa etc… The rates went down 1991-96 and then back up 1996-2005.
Same indications lower threshold.
They have set up a system that reflects the 1% doctrine = fear of the small risk that color the whole type of care.
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