Journey to Motherhood
Mamas on Bedrest: Priorities for Maternal and Child Health Identified
December 21st, 2011
Click to take the postpartum depression survey conducted by Case Western Reserve University http://filer.case.edu/~axp335/postpartdep.htm Thank you very much for your consideration.
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On the heels of the 20/20 special segment, “Giving Life: A Risky Proposition” World Health Organization (WHO) has released Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health. This comprehensive document outlines the necessary steps and guidelines nations (developing low and mid income nations in particular) must adopt in order to further reduce maternal, infant and child mortality and to have a chance of reaching Millennium Development Goals .
Maternal, Infant and Child mortality is a global issue. According to the report,
Annually, 358,000 women die worldwide during pregnancy and childbirth. Approximately 7.6 million children die before the age of 5 years, and those in low-income countries are about 18 times more likely to die during that time than children in high-income countries. Under-5 mortality rates are highest in sub-Saharan Africa and Southern Asia.
Maternal, newborn, and under-5 mortality rates have declined in accordance with Millennium Development Goals 4 (reduce the under-5 mortality rate by two thirds between 1990 and 2015) and 5 (reduce the maternal mortality ratio by three quarters between 1990 and 2015). However, the improvements are not occurring quickly enough to reach the 2015 targets.
WHO and its partners The AGA Khan University (in Pakistan) and The Partnership for Maternal, Newborn and Child Health performed a survey of more than 50,000 review papers to determine what steps are necessary to critically impact maternal, newborn and child health. Their goal was to identify key interventions that low and middle income countries can implement that are cost effective, will maximize resources and maximize the health and mortality of women, infants and children and thus help these countries reach worldwide millennium health and development goals. Their research has revealed some 56 key evidence-based interventions that when implemented, will have a significant impact on maternal, newborn and child health.
Rather than try and list all the interventions here, I refer you to their report, Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
For each intervention, the authors indicated whether they recommend the intervention be delivered,
- Through the community or in the home-These health care workers are often community volunteers and/or influential outreach workers who have knowledge of the local community and are trusted by the community.
- Via healthcare professionals, outreach workers, or community health workers-Health care providers at this level are skilled professionals as well as outreach workers.
- In hospitals-Either local hospitals or regional referral hospitals that can provide higher levels of intervention and care.
The interventions were classified broadly as adolescents/prepregnancy, pregnancy, childbirth, postnatal (mother), postnatal (newborn), infancy and childhood, and cross-cutting community strategies.
Researchers believe that the recommendations in this report will help low and middle income countries’ health care workers best utilize their resources in an effort to reduce Maternal, Newborn and Child deaths. These guidelines will also help countries develop policies and regulations that will not only benefit women and children’s health, but also take into consideration the health care and policy environments of the countries so that all citizens will benefit.
Mamas on Bedrest: Giving Life: A Risky Proposition
December 17th, 2011
Wow, I just watched Diane Sawyer’s special on ABC’s 20/20, “Giving Life: A Risky Proposition”.
First and foremost, I am really glad to see mainstream media tackling such an important global issue. Diane Sawyer and her colleagues traveled around the world to some of the most impoverished countries and witnessed some of the most horrendous conditions under which the world’s women are giving birth (and losing life!). The statistics were often staggering and disheartening,
- Girls under 15 are 5 times more likely to die in childbirth (and in many developing countries, girls even younger are giving birth!)
- In developing countries, 20% of women will give birth with no medically trained attendant.
- 1 in 21 women die in childbirth in Sierra Leon, more than in any other country in the world.
- Peripartum hemorrhage is the leading cause of maternal mortality. Misoprostol is critical to stop post partum hemorrhage and is in short supply to developing nations.
- The US ranks 50th in maternal mortality in the world. (This is the stat presented in the TV piece. “The US rank is 41st in maternal mortality” is what’s printed in the ABC News Press release.)
- Georgia has one of the highest rates if maternal mortality in the US.
- 2 women die in childbirth daily in the US. Rates are 4x higher for African American women in the US.
As one expert (sorry, I didn’t catch his name) said so eloquently,
“We have what it takes to save lives. The Question is will we decide to do it?”
I just had a similar conversation with , LM, CPM, founder and Executive Director of Common Sense Childbirth, The Birth Place, Easy Access Prenatal Clinics and creator of prenatal care “The JJ Way”. Jennie has put together an effective early access prenatal care program and is working tirelessly to bring it to women throughout central Florida, across the United States and globally where ever needed. As we talked about the issues affecting maternity care in the United States, we reached a similar conclusion; That low cost, low intervention, effective methods of delivering prenatal care are available. We have to decide as women and as a nation whether or not we are going to make the choice to make safe, accessible maternity care available to ALL women.
It really is a choice. While watching the 20/20 special, they showed a young obstetrician who had traveled to Sierra Leon and was desperately trying to help women in a nationally funded hospital that was so poorly equipped and so poorly staffed that she literally watched as a woman hemorrhaged post partum because there were so few tools available for her to intervene. Yet, there was a clinic staffed and supported by the women of Sierra Leon and there, women received supportive care and the outcomes at this locally supported clinic were far better than the outcomes for the nationally funded hospital.
In Bangladesh, maternal mortality was spiraling out of control. When skilled maternity workers realized that women were not coming to the hospitals and clinics erected, they started taking maternity services to women in their homes-the method used for centuries and the method of childbearing most familiar to the women. As a result, Bangladesh has dropped is maternal mortality rate 43%. In addition, birth workers in Bangladesh are using cell phones and an increasing rate and as a result, they are able to communicate with physicians and other workers as needed while still serving women in their most comfortable environment.
In Mexico, the government started a national campaign for contraception when birth rates and maternal and infant mortality were skyrocketing. Since implementing a contraceptive campaign and extolling the benefits of smaller families and fewer conceptions for women, Mexico has seen 76% of women using contraception. It must be noted that for all its benefit, contraception is still not widely accepted amongst men, and many still hold onto old notions of “Machismo” where the more children a man sires, the more manly he is! As a result, many women access contraception secretly in an effort to improve their opportunities in life, to have reproductive choice and to improve their overall health.
So what’s it going to be? Are we going to continue to wring our hands and lament the abysmal maternal and infant mortality numbers in this country or are we going to do something about it? Jennie Joseph is doing it. Shafia Monroe is doing it with her International Center for Traditional Childbearing.DONA International is doing it. Centering Healthcare is doing it. We can do it. Million Moms Challenge showed what can be done when we work collectively. When Johnson & Johnson pledged to donate $100,000 if the Million Moms Challenge gathered 100,000 supporters, they went to work, gathered the supporters and recouped the money. In fact, Million Moms raised more than $1.5 million dollars to support work that improves health of women, infants, children and communities.
It has been stated and shown, “We have what it takes to save lives.” The question now is, “Will we do it?”
Photo is courtesy of yfrog and printed with permission.
What will you do to improve maternal mortality in the US and abroad? What would you like to see done? Share your vision with us here, or send an e-mail to info@mamasonbedrest.com. We’re talking about it on Twitter, @mamasonbedrest, and will also take your comments on Facebook. To stay in the loop, be sure to subscribe to our blog via the RSS feed on the upper right hand corner of our pages.
Mamas on Bedrest: Don’t Miss the Boat! There is no shame in “Assisted” Childbirth
November 14th, 2011Click to take the postpartum depression survey conducted by Case Western Reserve University http://filer.case.edu/~axp335/postpartdep.htm Thank you very much for your consideration.
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A man was advised to leave his home as a storm was coming and everyone was to evacuate. He refused, but as the storm swelled, he found himself trapped. In an effort to “go above the rising waters”, he climbed up on his roof and begged God to help him. Not long after, a boat came by. The driver told the man to climb in and he’d take him to safety. The man refused saying, “God is going to save me.” The man in the boat continued on. After another couple of hours with the water reaching the eaves of his roof, the man again pleaded, “God, Please Save Me!” Then Emergency rescue personnel arrived and offered to help the man down and take him to safety. Again, he refused stating, “God is going to save me.” Shortly thereafter, the man perished. When he arrived in heaven, he asked God, “God, I begged and pleaded for you to save me. Why didn’t you?” God replied, “I sent you a man in a boat and a rescue squad, what more did you want?”
As humans, we often question and wonder why things happen the way that they do. When I was struggling to have my children, I often cried out to God, “Why can’t I have my children normally like every one else?” Normal is a very relative term.
There is a movement within the birth world to “return birth to its natural state”. I’m all for that. But not all women are going to be able to have the picture perfect pregnancy and birth. Some of us will require medication to become pregnant. Some of us, like me, will require medication (progesterone in my case) to remain pregnant. Others will require assistance to deliver their children. For example, my sister was a preemie born at 6 1/2 months. When she was having her children, she never went into labor. Her obstetrician “learned” (and I have no idea how they figured this out) that she did not receive the “signals” from her babies that would initiate labor. They summized that due to the fact that she was born early certain systems didn’t develop. (She was also born without a common Bile duct, so when she had her gall bladder out, they had to “reconstruct” one for her!) No matter what the reason, she has two healthy grown men now, thanks to “God’s provision” in the form of obstetrical care.
Sometimes life just doesn’t go as planned. I am so thankful that there are skilled physicians because without them, I would not have my children. While I wonder about the effects of bed rest on a mama’s body, I also know that in certain cases, it is the one thing standing between life and death for both mother and baby. We do far too many cesarean sections in this (United States) country, yet, had I even tried to deliver my daughter, she likely would not have survived, I likely would have hemorrhaged to death and my son wouldn’t exist either. Three people now live and are able to bless this world because there are skilled physicians who intervened on our behalf. They were blessed with skills. We are blessed with life.
Recently I posted a message about classes that I am offering for mamas on bed rest. I got this response from a CPM (Certified Professional Midwife):
I don’t believe in bedrest, so none of my clients would be on it. I believe it only prolongs the inevitable. Barring an incompetent cx, if the baby is healthy, it will stay in until its ready, if its not, might as well let nature take its course and get it over with.
Wow. That’s all that I can say. According to this woman, nature will always work and when it doesn’t, we should just let it go. I am here to say that I wholeheartedly disagree!! For me, the difference between having two healthy children and losing two pregnancies was progesterone. The difference between hemorrhaging to death and surviving were the skillful hands of my obstetrician who was able to manage my bleeding so that I live today! The difference between many women having children and not is the skills and care that many obstetricians and reproductive endocrinologists provide for them. So now it is wrong, somehow “unnatural” for those of us who need that assistance to forgo it, demanding instead “God’s provision in the form of a “natural” pregnancy and birth?
Every one is entitled to their opinion and this CPM is certainly entitled to hers. But I want to reach out to Mamas on Bedrest and to mamas who may not be on bed rest, but needed “a little help” to conceive or to deliver. There is no shame in assisted reproduction or in assisted childbirth! I am sure that like me, many of you prayed long and hard for your children. Are we now to refute them or the methods used to get them here? Of course not!
This woman’s words struck a cord in me because I have had many people comment that I am helping or encouraging women to go against nature. I totally disagree! I believe that if there is a path to your heart’s desire that is legal and effective, Take it! If I can help a woman to have a healthy child by supporting her through the tough patches, then I am going to do it. I see this as no different than helping families with children with special needs or helping a person with an illness manage it so that they can live a quality life. I know that I am speaking to the choir here, but for those of you feeling “less than” because you did not conceive naturally or deliver vaginally, look at it this way,
At least you didn’t miss the boat!!
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