Saturday, October 18, 2008

Maternal Mortality

I read an article about the maternal mortality rate in Sierra Leone, one of the poorest countries in the world. 1 in 8 women die in childbirth there. This truly is a horrendous problem, one that is frequently overlooked when dealing with other health crises and providing other services in such areas. The poor family the article talked about suffered a terrible loss in the death of a young mother. But there is more happening there than just having a doctor on call to staff the hospital. This poor mother did not know that fasting for the last three weeks of her life in observance to Ramadan would affect her health. Pregnancy is not a time to fast. This poor mother and many like her also need education and nutrition. Many of the problems they face could be resolved right there.

One of the shocking facts in this story (yes, absolutely shocking!) was that the rate of maternal mortality in the U. S. 1 in 4800. Doesn't sound too, bad, does it? Compare it to another statistic in the article... the maternal mortality rate in Ireland: 1 in 48,000. Hmmm. Maybe I'll have my next baby in Ireland. This little island has the best maternal mortality rate in the entire WORLD. And those of us here in the United States face mortality rates 10 times worse.

The AMA keeps telling us we have the best medical care in the world, and that the hospital is the safest place to have a baby. Apparently, neither is true! While the AMA is supporting legislation to OUTLAW homebirth in the United States, telling us that birthing at home is risky, they're actually losing more women in the hospital.

About 1 or 2% of birthing women choose to have their babies at home. Even if 1 or 2% of those mortalities took place at home, that would be 48 to 96 out of 4800. The other 4752 to 4702 mortalities are in the hospital. I know women are subjected to interventions that end up causing problems during labor in the hospital... I've been subjected to them myself. What about giving women hands on care instead of using monitors? What about educating them about nutrition? Helping them to labor naturally instead of breaking their waters, stimulating their labors with pitocin, or cutting them open when they don't need a cesarean? Just last year a news story broke about two teachers at the same school who both ended up with cesareans... and both died.

Midwifery care has been shown to have better outcomes and less intervention. I support more midwives. Obstetricians are trained to handle emergencies... they should do just that, and stop messing with normal labor until they cause emergencies.

For those poor women in countries like Sierra Leone... many of them can be saved with the same answers that will save more women here in the States. Let OBs take care of the real emergencies and midwives take care of normal pregnancies and births. With better mother education that most midwives provide, there should be an improvement all the way around.

Thursday, October 16, 2008

A Birth from the Past

Today is my birthday. I don't know anything about my own birth. My mother was knocked out for her labor and birth and doesn't remember any of it. I was her first born child... she was 20.

Thirty-one years later found me in labor with my third child. He chose to be born on my birthday, even though he wasn't technically due for another week. This was my third hospital birth and second VBAC. We had a certified nurse-midwife, and we spent a long time walking around the hospital before retiring to the shower for the last part of active labor. We tried a birthing stool for awhile... I know it was working because I absolutely hated it and couldn't wait to get off of it! It felt so strange to feel the baby moving down like that. I wanted to lie down so much and everyone kept trying to keep me up. Once I finally laid down, I wriggled all over the bed. I think this was because the baby had been posterior, and he was finally turning. I opted for a half dose of fentanyl at 9.5 cm... but it really did no good at all. It didn't change my perception of my pain at all.

The CNM pulled so hard on my son we heard a large cracking sound. We were afraid his clavicle had broken... luckily it was okay. Our second son was born at 3:03 on the morning of my birthday. He is the best birthday present I've ever received. Now we look forward to sharing our day.

Monday, October 6, 2008

Celebrate Fertility!

I think our ancestors were onto something. They celebrated fertility and fecundity. A round belly was something to proud of... for both mother and father. In some cultures, couples did not marry until the woman was pregnant.

Today, we have a twisted sense of fertility. During our most fertile years we are urged to abstain. We suppress our fertility with fake hormones. We install foreign bodies into our wombs to make them inhospitable to growing babies. Sex is recreational rather than procreational.

Suddenly we find ourselves older. Everyone begins asking if we'll ever have a baby. Now, however, it isn't so easy. Our most fertile years are behind us. Every cycle becomes a stressful wait for ovulation and then another even more stressful wait to see if we conceived. After months of unsuccessful trying, we go to fertility specialists who load us up on drugs and run expensive tests. More often than not, they return with a diagnosis of "infertility from unknown causes." Then we're told of the options... all of which range from expensive to outrageous. And they offer a very slight chance of success.

We've got it all wrong. We're missing out on all those fertile years. We're set up by society's and our own expectations. Time is fleeting, and before we know it, so many of us are left with that indescribable yearning for a baby. Before it is too late, think your plans through. I think our society needs to rearrange priorities. Let's celebrate some fertility.

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