maternal mortality
Mamas on Bedrest: LifeWrap May be Life Saving for Mamas all over the World!
January 23rd, 2012There is a new and potentially lifesaving device available for mamas called LifeWrap.
The LifeWrap (generic name: Non-pneumatic Anti-shock Garment or NASG) is a first-aid device used to stabilize women who are suffering from obstetric hemorrhage and shock. According to the LifeWrap website,
“The leading cause of maternal mortality (deaths from pregnancy and childbirth related complications) is obstetric hemorrhage in which a woman bleeds heavily, most often immediately after giving birth. A woman somewhere in the world dies every 4 minutes from this kind of complication.”
LifeWrap has been studied extensively by SuEllen Miller, CNM, Ph.D, professor at UCSF and the director of the Safe Motherhood Project at UCSF. As Miller shares with KGO TV in San Francisco,
“If they (women) bleed they’re (often) very far from skilled care. They need something to buy them time so they can get to the kind of facility where they can get a blood transfusion or get surgery and that’s what the anti-shock garment does. It (LifeWrap) buys time.”
The LifeWrap is made of neoprene and VelcroTM and looks like the lower half of a wetsuit cut into segments. The LifeWrap reverses shock by returning blood to the heart, lungs and brain. This restores the woman’s consciousness, pulse and blood pressure. Additionally, the LifeWrap decreases bleeding from the parts of the body compressed under it. Recent research has identified that the pressure applied by the LifeWrap serves to significantly increase the resistive index (i. e. increase the tone and help reduce free flow of blood) of the internal iliac artery (which is responsible for supplying the majority of blood flow to the uterus via the uterine arteries). Best of all, LifeWrap is a very low-tech device and can be applied by anyone after a short, simple training. It is very low cost, approximately $300 per suit, so it can be readily accessible by purchase or donation to countries and practices in need.
According to the Interview with KGO TV in San Francisco,
“The UCSF team is hoping to present results from its current clinical trial to the World Health Organization (WHO). If the LifeWrap is added to the organization’s approved medical device list, it would clear the way for donors to provide it to poorer countries, potentially saving thousands of lives.”
This is truly ground breaking news and research! It will be wonderful to live in a world where all mamas can safely give birth and actually live to see their babies.
An actual LifeWrap being used in Zambia. This image comes from the LifeWrap website.
Resources
KGO TV News Report with Carolyn Johnson
WikiPedia: The Non-Pneumatic anti-shock garment
Mamas on Bedrest: Is childbirth really OB vs Midwife or Men vs. Women?
January 6th, 2012We are 6 days into 2012 and the battle over “who is the better birth provider” and “Where is the best place to give birth” continues.
On December 30, 2011, The Feministing blog posted an interesting interview with Ina May Gaskin as part of a series on birth professionals. Ina May Gaskin is one of the world’s most recognized midwives, authors and teachers of childbirth. For those of you unfamiliar with Ina May’s work, here is a very brief summary, shortened from the biography provided in the blog post.
Ina May is the famed “midwife of modern midwifery” and has revolutionized the way the world views this ancient practice since the emergence of her seminal book “Spiritual Midwifery.” …A pioneer in the natural birth movement, Ina May firmly places control back into women’s hands from what she calls “male-centered, misogynistic birthing processes” which views women’s bodies as defective designs and allows for profit to be made from women’s fears of their own bodies….
She and her husband Stephen Gaskin established The Farm, a 1,750-acre commune in Tennessee, with a population once at its highest of 1500 residents, where Ina May runs The Farm Midwifery Center. The cesarean rate at The Farm’s clinic is less than 2% and people from all over the world come to receive their home birth services.
The post continues on with the inteview of Ms. Gaskin. As with any blog post, there will be those who like the information provided and those who oppose it. I personally am for opposing viewpoints as we’re all entitled to our opinions, it makes for interesting conversation and I tend to learn something from the other person’s viewpoint-even if I’ll never agree with them. But when the viewpoints become venomous and attack the author and/or the content of the blog rather than convey a viewpoint backed by solid evidence, then the conversation degenerates. I think that the commentors on this blog post did fairly well in that many cited specific articles and studies to back their opinions.
I had no sooner read this back and forth on “the dangers of home births” when I received an e-mail notifying me that there was a comment on a post I had written for Science and Sensibility, the Lamaze International Blog, back in November. While my post was addressing racial disparities in health care delivery, in maternity care in particular, the comment was coming from a mother/grandmother who lost both her daughter and granddaughter during childbirth following (an unwanted) labor induction. While all the details of the birth were not provided, I am gathering (and again, I don’t have all the facts) that the induction was not medically necessary. The delivering mama tried to refuse the induction but in the end succumbed. The events that transpired are unknown to us, but the end result was tragic-a mother and a baby both lost their lives.
I am always struck by physicians who scream from the mountain tops, “Home births are unsafe!”. Who do you think delivered your grand parents? And their parents? And their parents and so on??? Midwifery is mentioned way back in the book of Exodus (The second book of the bible) and existed well before that. Yet we also know that throughout time, millions of women have died during childbirth. Those of us in the childbirth arena well know, childbirth is risky business. As one of my mentor’s Dr. Linda Burke Galloway says, “Obstetrics is the specialty of the unexpected”.
But I’d like to think that we’ve come a long time since the bondage of the Israelites in Egypt, and truly we have. An article that I found in the Postgraduate Medical Journal gives a historical recount of the genesis of obstetrics. From this article and several others that I have read, obstetrics originally came to pass as a way to deal with breech birth presentations and save the mother’s life (if not the baby’s as well). Instrumentation was orginally frowned upon in childbirth and was typicaly only used for stillbirths. Interestingly, forceps, anesthesia and antisepsis, all were introduced by men and increasingly used when “accoucheurs” (male midwives)” became fashionable in the 17th century in France. Modern obstetrics as we know it became a medical specialty, taught in medical schools, in the 19th century in Europe and later towards the end of the 19th century in the United States.
As I look at the history of childbirth attendance, there is an interesting shift that takes place. When you look at the early records, the bible, documents from early civilizations, and up until about the 16th century in western civilizations women were the birth attendants. Women cared for women and did the best that they could, with information handed down from generation to generation, to take care of themselves and eachother (Remember, women weren’t allowed to be educated in many cultures-they could not read or write or conduct any sort of scientific experiment.). Child bearing and childrearing was considered “women’s work” and men took no part.
But in other areas of medicine and science, men were studying and discovering ways to ward off disease and improve longevity. However, they were not attending births and women were not allowed to be educated so these advances were slow to reach childbirth and women continued to die. As men began to slowly infiltrate and attend childbirths, they brought with them instrumentation, anesthetics and techniques of antisepsis which we know improved outcomes. Midwives, female attendants, began to be marginalized. Regarded as ignorant, their services were increasingly less sought after for childbirth delivery.
During the 19th century in Europe and most certainly by the 20th century in the United States, childbirth increasingly took place in hospitals, mortality rates improved and midwifery (by women attendants) was relegated to poor women unable to afford the services of a doctor or hospital .The modern obstetrical model of the male educated and authorative figure dictating what and how things will take place during childbirth had been widely accepted and was the primary model of childbirth and healthcare delivery-until very recently.
From my perspective, this is the origin, the very core of this “OB vs. Midwife” debate. While both sides are very adept at going tit for tat as to who has the most untoward outcomes, the core argument stems from these simple facts,
- Women used to care for women and babies before, during and after childbirth.
- Men began studying ways to improve outcomes and prevent death during childbirth.
- When men began implementing what they learned, they pushed the women attendants aside, labeled them as igorant and uneducated (which they were because they were not allowed to attend medical school!) and ousted them from the birth arena.
- Childbirth and women’s health went from an intimate community (I’m thinking of the book The Red Tent by Anita Diamante) in which women cared for one another and shared wisdom from one woman to another to an austere, more academic environment in which little beyond the immediate health issue was considered.
- Women (those giving birth and those women who attend births) are rallying against the academic environments and are demanding that they be given equal access in women’s health, bringing in the more intimate interpersonal relationship between provider and patient/client and allowing women patients more authority in the treatment process. Those that can, opt out and choose birthing centers or home births with (female) midwives.
For me, the question isn’t OB vs Midwife (especially now that there are female OB’s and male midwives). It really isn’t entirely about mode of care, more interventional (obstetrics) vs. more attendant (midwifery). At its core, the fight being waged over childbearing is between men and women and who (should) call the shots. From this perspective, it’s a completely different argument, one I’ll continue in the next post.
Who do you think should direct a woman’s care before and during childbirth? What is your experience? Share your thoughts below. We’ll be chatting about this on Twitter (@mamasonbedrest) and on our Facebook Page. To follow this topic, sign up for our RSS Feed at the upper right hand corner of this page.
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.
