CleanBirth - Saving Mothers and Babies in Laos

CleanBirth.org - Donate $5 Saves 2 Lives

Let’s not export our flawed social views on Maternal Health

Today I had a conversation with a friend who is in her 50s about breastfeeding her four children, who were born over approximately a 15 year period.  She said with her first, she didn’t breastfeed at all.  With her second, she breastfed for a month.  And with her third and fourth, born 22 months apart, she breastfed each for a year — and was sad to stop.

What made the difference with her last two?  She said that noone breastfed when she had her first, there was no support.  By the time the last two came, breastfeeding was acceptable if not embraced.  Breastfeeding in the US is increasingly embraced but breast milk substitutes are still being given to almost half of US babies by day 7, according to the CDC.

Thinking about this conversation about social context,  it is clear that society drives what is acceptable/good when it comes to breastfeeding and birth.

In the US C-sections (often scheduled) are de rigeur among celebrities, thus they are regarded by US Weekly fans everywhere as a preferred choice.  The role of midwives is misunderstood, thus they are not sought out.  Birth is seen as dangerous and excruciating and voices opposing this media-driven view are drowned out.  Breast milk and formula are both regarded by many as equally nutritious, with formula having advantages like “baby is more full and sleeps better.”

One of my fears is that our views of maternal health will be exported to the developing world.  It has already begun in the areas of c-section and breastfeeding.

C-section rates in the developing world are on the rise.  One study by Belizan et al comments:

Although the epidemic of caesarean section in Latin America is not new,6 little action is taking place to reduce its use. This is partly because caesarean section is now culturally accepted as a normal way of giving birth.23

Breast milk substitutes are being pushed on populations with neither the money nor the clean water nor the need for them.  Laos is one example where the population has historically had high levels of breastfeeding, but influxes of breast milk substitutes are changing the situation.  This 2010 study by Barennes et al finds:

In Laos, mothers with the highest socio-economic status are showing a tendency to give up breastfeeding. Successful educational strategies and advocacy measures should be urgently developed to promote and sustain breastfeeding in developing countries.

Women in the third world need many things: among them community health workers, midwives, medicine, emergency care and supplies.    However, importing our flawed views of breastfeeding and birthing will not save lives.  Instead, practical solutions need to be found on the ground, where C-sections and milk substitutes are reserved for medically necessary conditions.

Save the Children in Laos

Save the Children’s Laos Health Program has had great success in the area of the country that they have been serving for 20 years.  They have seen an 80% drop in maternal and infant mortality compared with the whole of Laos.  But by their own admission there is a long way to go:

The health situation of women and children in Laos is amongst the poorest in Southeast Asia; Infant mortality rate is 70 per 1000 live births and under five mortality claims 98 per 1000 live births1.  Every day 36 children under-five die due to preventable and treatable diseases. Percentages of underweight children have been almost unchanged between 1990 and 2006 (40% and 37.1%) and the prevalence of stunting in under-fives is up to 40.4%. According to UNICEF/WHO official estimate (2007), immunisation coverage has declined—only 27% of children by their first birthday have received all eight recommended vaccinations2.  Maternal mortality remains very high at 405/100,000 live births, approximately 800 deaths per year or 2 deaths per day. A high percentage of children (71.5%) are born to mothers who received no antenatal care and 84.8% of pregnant women give birth at home3 . These are clear indicators of low health service utilization and poor quality health services/facilities.

5 Innovations to Save Moms

I am excited about this article, “Five Maternal Health Innovations That Could Save Lives on the PBS Newshour site.  Check it out for full details of each project.  I love, love, love seeing these innovative, simple solutions.

Here is the list of 5 and short descritptions:

1.  Preventing low birth weight with chewing gum

Baylor College of Medicine in Houston, Texas

…Some chewing gums contain sugar alcohols, called polyols, that prevent gum disease2…

2.  Stopping HIV transmission with a vacuum pack 

Duke University from Durham, N.C.

…Duke University developed a foil, polyethylene pouch — much like a fast-food ketchup pouch — that can store medicine for months so that ARVs can be administered as soon as a child is born…

3.  Mobile heart monitoring and data gathering
Save the Children Federation from Westport, Conn.

—A mobile fetal heart rate monitor powered by human energy, which won a 2009 Index award, and a mobile phone based data gathering platform will be tested together to improve monitoring…

4.  An innovative alternative to forceps
The World Health Organization in Geneva, Switzerland

…The devices is a film-like polyethylene material that looks like an open plastic bag wrapped around the head of the baby, sealed and used to help extraction during complications…

5. Diagnosing with paper stamps
Diagnostics for All, Inc. from Cambridge, Mass.

…Diagnostics for All will create two postage stamp-sized paper tools that can detect anemia and hypoglycemia and hypertensive disorders, all indicators of high-risk pregnancy…

Obstructed Birth

I just read an article about shoulder displacia and non-cesarean, low tech techniques for safely addressing this often fatal birth complication, compliments of the awesome midwives at The Farm (where the C-section rate is 2%).

This fairly technical paper from the WHO revealed to me that “distacia” is one of the conditions that qualifies as obstructed birth.  Others include “labour lasting more than 12 hours to uterine rupture, feto-pelvic disproportion or abnormal fetal presentation.”

Fistulas are often a side effect of obstructed birth, once the baby is delivered.

When I think about the future of mother and infant care in the developing world, this category of mortality has me stumped.  In some cases  midwifery skills aren’t enough – you need a surgeon.  The risk factors aren’t conclusive for screening and according to the WHO  the problems often are clear during delivery — not before.

What are the chances that women, lacking transport and far from hospitals, will make it to a surgeon in the precious moments between determination of “displacia” and the death of the baby?  Not good.

Babies Need their Healthy Mommies

Thanks to Maternal Health Task Force for posting this article.  Be sure to join Maternal Health Task Force’s email list to easily get information relevant to maternal health.

A Closer Look at the Interconnections: Healthy Mother, Healthy Newborn
Apr 13, 2012 11:15 am
Written by Shafia Rashid, Family Care International

There is ample evidence illustrating that the health of a woman and her newborn baby are intimately connected. We know that:

most maternal and newborn deaths are caused by the mother’s poor health before or during pregnancy or due to inadequate care in the critical hours, days, and weeks after birth
when a woman dies in childbirth, her newborn baby is less likely to survive

Recent research conducted by Dr. Zulfiqar Bhutta and colleagues at the Aga Khan University in Karachi, Pakistan confirms what we already know, and goes one step further: it identifies which maternal and newborn health interventions benefit both mother and newborn. These include:

Family planning/birth spacing: Family planning, including counseling on and provision of contraceptive methods, prevents unwanted pregnancies and unsafe abortion, and increases spacing between births. Adequate birth spacing (between 18-23 months) reduces the risk of maternal and newborn-related deaths.
High-quality antenatal care: Antenatal care provides a critical window to address a range of health care needs, such as treating HIV and sexually transmitted diseases (STDs), and providing counseling and educational support. Well-designed, good quality ANC reduces the risk of preterm birth, perinatal mortality, and low-birth-weight infants
Detection and management of maternal diabetes: Treating maternal diabetes (through dietary advice, glucose monitoring, and insulin) reduces maternal and perinatal morbidity, specifically antenatal high blood pressure and neonatal convulsions.
Exclusive breastfeeding during the first six months of life: The benefits of breastfeeding for the mother are both short- and long-term. In the short term, she is likely to recover more rapidly from the birthing process. It also has a significant impact on reducing the risk of breast cancer. For the newborn, exclusive breastfeeding for the first six months of life is recommended for optimal growth, development, and health.

This research is a critical step in better understanding just how deeply interconnected are the health of a woman and that of her newborn baby. It also underscores how vital it is to interconnect health care for women and their newborns — to promote greater efficiency, reduce costs, limit duplication of resources, and achieve greater impact.

As part of efforts to promote investment in and implementation of health interventions that can save the lives of both women and their newborn babies, FCI developed two publications summarizing the findings from this research and its impact on advocacy, policy, research, and programming:

A pocket card for non-technical audiences including policy makers, health officials, and civil society groups.
An Executive Summary for program managers and implementers working in low-resource settings.

With only three years remaining until the 2015 deadline for achievement of the Millennium Development Goals (MDGs), this year will be a critical moment for efforts to improve global health. Because the health-related MDGs — and particularly MDG 4 (Reduce child mortality) and MDG 5 (Improve maternal health) — are furthest off-track, advocates, researchers, programmers, and policy makers must work together to develop, support, and implement effective, integrated policies and programs.

This post was originally posted on the FCI Blog.

Pin It on Pinterest