Tuesday, September 16, 2014

September 2014

I have been working in Haiti to decrease maternal and infant mortality by increasing the access women have to skilled maternity care. So I have been amazed and dismayed to learn there are actually women in this country who sometimes choose to have their births “unassisted”- without a skilled midwife or doctor close by. It is true that most of the time, with a full-term pregnancy, a woman’s body knows what to do and a healthy baby is born. And it is true that sometimes medical interventions cause complications that would otherwise not occur.

In most cases women in this country who chose to have a skilled birth attendant nearby will not need their expertise. They will frequently just enjoy the reassuring and caring presence of someone who has cared for them during their pregnancy and wants the very best for them and their baby. I know a midwife who knits sitting next to her patients as they labor. But I know she would have interventions ready in a flash if that mother or baby started showing distress.
 Photo: "A woman, as long as she lives, will remember how she was made to feel at her birth." -Anna Verwaal
The reality is that occasionally even women and babies who have had the very best of prenatal care and are in the very best of health have bad things happen during labor and birth or soon after birth. Whether one chooses to birth at home, at a birth center, or in a hospital, having a skilled birth attendant has been proven to make the difference between life and death for mothers and babies. In case you wonder what can go wrong here are just 10 of them:

10 things that can happen to any woman during birth regardless of race, wealth, medical history, or location in this world.

1. The baby may not breathe on its own after birth. This happens about one percent of the time and is more frequent if the baby is premature or has been exposed to certain medications. But it can happen to anyone. It kills about a million babies each year in this world.

2. A piece of the placenta remains in the uterus. This only happens about 4% of the time but can be a cause of heavy bleeding and can happen to anyone.

3. The uterus can bleed too much after birth by not contracting well on its own. It is more common if a piece of the placenta remained inside but it can happen to anyone even if the placenta was completely expelled.

4. Your baby’s shoulders can get stuck in your pelvic bones. This is more common with big babies but can also happen to anyone.

5. Your baby’s cord could prolapse or come out in front of the head. It is more common when the bag of water is broken artificially but it can happen to anyone.

6. You can get an infection. In even the cleanest of situations there are bacteria that you can be exposed to during birth.

7.  Your baby could be stressed by the labor and not get enough oxygen.This is more common if the placenta is not healthy but can happen with even healthy placentas.

8.  Your baby could be in a position that makes it difficult to exit the pelvis well and labor could go very long.

9.  Your uterus could invert- turn inside out while the baby is coming out. It is pretty rare but sometimes happens to women who have had a lot of babies.

10. Your placenta could be retained and not come out at all. This may be because of conditions where it grows into the wall of the uterus or just will not detach on its own for some reason.

Here’s what can happen as a result of any one of these complications and you are a woman in a rural village in 72 countries in this world - or if you are one of the women who wants an “unassisted birth” in this country.

1. The baby could die.
2. You could bleed to death.
3. You could bleed to death.
4.  Your baby could die.
5. Your baby could die.
6. You could die.
7. Your baby could die.
8. Your labor could be so long you and your baby could die.
9. You could bleed to death.
10. You could bleed to death.

So every two minutes in this world a woman is dying from one of these things or one of the things that can happen if they did not get prenatal care such as seizures, placenta previa, and incomplete miscarriage.

And the babies- more die on the first day of their life than at any other time. At least 114 died in the hour I wrote this- the majority from preventable causes that a skilled midwife could have prevented.

Christy Turlington Burns is a model, global maternal health advocate, and founder of the maternal health organization, Every Mother Counts. After a perfectly normal, natural birth, in a state of the art birth center next to a hospital in New York,  she had a post-partum hemorrhage (PPH). Her situation required rapid intervention by the midwife and doctor who were caring for her to keep her from bleeding to death. Soon after, she educated herself on PPH and realized that if she had not had immediate access to care, she would have died. She became passionate about helping more women to have access to skilled care in even the most impoverished situations. She knows about those 10 things. She knows why we do what we do and we are grateful for all of you who know.

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