I am not a medical person — my role in the delivery room as a doula is waist up.  However, as I read the research on clean birth kits and birth-related mortality, I am constantly looking medical things up.

As I read more about birth complications and the deadly consequences for mothers and babies, I keep looking back to the leading killers.  Hemorrhage tops the list.  OK.  What can be done?  Oxytocin isn’t the answer in the developing world because it needs refrigeration and must be administered by trained personnel.  But Misoprostol might just be.

Misoprostol, an oral preparation of prostaglandin (PGE₁) analogue, is a prime candidate given its uterotonic properties; ease of use as an oral, vaginal, or rectal preparation; relative low cost in some areas; and stability at high temperature.

Read on http://www.medscape.com/viewarticle/484023_5:

and here http://www.guttmacher.org/pubs/journals/3303907b.html

I am currently reading “Get Me Out, A History of Childbirth” by Randi Hunter Epstein, MD.  It’s a great read — engagingly informative.

I got to a chapter that talks about fistulas and was stopped in my tracks.  Here’s an explanation from The Fistula Foundation (http://www.fistulafoundation.org/whatisfistula/)

Obstetric fistula is the most devastating and serious of all childbirth injuries. It happens because most mothers in poor countries give birth without any medical help. So many are young girls. Complications from pregnancy and childbirth are among the leading causes of death and disability for women of reproductive age in these places. Obstetric fistula was largely eliminated in the United States in the latter part of the 19th century and early 20th century with improved obstetric care in general and the use of c-sections in particular to relieve obstructed labor.

After enduring days of agonizing, obstructed labor a woman’s body is literally broken by childbirth. During labor contractions, the baby’s head is constantly pushing against the mother’s pelvic bone — causing tissue to die due to lack of blood flow to this area. All of that pushing creates a hole, or in medical terms a “fistula”, between the birth passage and an internal organ such as the bladder or rectum. A woman cannot hold her urine, and sometimes bowel content as well.

Her baby is unlikely to survive. If she survives, a woman with fistula is likely to be rejected by her husband because of her inability to bear more children and her foul smell. She will be shunned by her community and forced to live an isolated existence. These women suffer profound psychological trauma resulting from their utter loss of status and dignity, in addition to suffering constantly from their physical internal injury.

The numbers are staggering

Right now, hundreds of thousands of women are suffering from this heartbreaking, treatable childbirth injury because they are too poor to afford surgery that costs about $450.

This number keeps growing bigger. Each year approximately 100,000 women develop this childbirth injury — or 273 each day. The international capacity to treat fistula patients has been estimated at 6,500 a year — or 18 patients each day. Surgeons would describe this as an enormous backlog of untreated patients. There is clearly an overwhelming need for treating far more women.

The fix is simple but surgical and thus unavailable to women in the developing world.  I met a surgeon at the Kenya airport going to do just these surgeries.  What amazing, needed work.  Overwhelming.