Birth Story

It isn't that childbirth is more inherently dangerous in countries where many women die in childbirth than in those where relatively few die. The women who survive, statistically speaking, are getting appropriate help from trained attendants.

"...The main complications that lead to death during pregnancy or childbirth are fairly common among all women, regardless of where they live," write the authors of an article titled "Are We Making Progress in Maternal Mortality?" in the May 26 issue of the New England Journal of Medicine.

Hemorrhage, which most often occurs right after birth, is the leading cause of pregnancy-related deaths globally, accounting for 35 percent of all deaths in childbirth, according to the World Health Organization. And in fact, hemorrhage was the second most common complication seen in pregnancies in the United States in 2000.

However, most U.S. women who suffered hemorrhage were treated quickly, and survived, say the article's authors, Anne Paxton and Tessa Wardlaw.

WHO identified the second most common cause of maternal death as hypertensive disorders — pre-eclampsia/eclampsia, for example. Again, these disorders are a common problem all over the world, but women with access to good medical care have a good chance of surviving them.

The countries that are most dangerous for pregnant women are those suffering through wars, or burdened with a large population with HIV/AIDS, the authors write.

In general, poor women die in childbirth more often than affluent ones, rural women more often than urban ones. These populations are more vulnerable because they often deliver their babies without the benefit of skilled birth attendants, and lack access to obstetrical services like surgery by Cesarean section.

Sub-Saharan Africa, with widespread political unrest and HIV/AIDS infection, "has the greatest burden of maternal mortality," even though most countries there are seeing "small but promising" decreases in pregnancy-related deaths.

Worldwide, there is considerable cause for hope, Paxton and Wardlaw write. Maternal mortality has decreased globally by more than one-third since 1990, according to United Nations estimates.

"Dramatic improvements in China and other Asian countries...are associated with economic improvement, decreasing fertility rates and strengthening of health systems...," the authors write.

"The overall rate of decline in global maternal mortality, 2.3 percent, is lower than the 5.5 percent MDG target but is heartening nonetheless," they write.

Image: "Pregnant Graffiti" by Petteri Sulonen

It was 41 degrees Fahrenheit when we got up this morning here in Chicago, but this weekend, the Memorial Day weekend, marks the unofficial beginning of summer in the United States.

Officially, it's still spring, though. Here is a poem by e. e. cummings that relates both to the season and to our topic here on Birth Story:

O sweet spontaneous
earth how often have
the
doting

fingers of
prurient philosophers pinched
and
poked

thee
,has the naughty thumb
of science prodded
thy

beauty        how
often have religions taken
thee upon their scraggy knees
squeezing and

buffeting thee that thou mightest conceive
gods
(but
true
to the incomparable
couch of death thy
rhythmic
lover

thou answerest

them only with

spring)

Here's one Q & A exchange — the last one, in fact — from an interview Tara Parker-Pope, who writes the "Well" blog for the New York Times, conducted last year with Randi Hutter Epstein, physician, mother of four and author of the 2010 book on childbirth, Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.

Q (TPP)  Should the care of women during childbirth be reserved for other women?

A (RHE)  I look at it as a doctor-patient relationship history, more than a man-woman kind of thing. When you hear women say, “I’d much rather give birth with a midwife than a doctor,’’ I think, “Why?” I love my ob-gyn. It’s sad people think you’ll have a nicer person if you avoid the medical system. That’s the feeling you get when you talk to women. I think if women had better relationships with their doctors, I think that would help. They would be more informed. They would believe the information their doctors tell them.

I agree with some of what Dr. Epstein is saying. I loved both my ob-gyns, too. I believe, though, that to choose a midwife for a birth attendant instead of a doctor is to opt for, or at least to attempt to have, a qualitatively different experience.

It isn't just a hope to deal with a nice person. It's embarking on a whole different journey.

What do you think? I would love to hear from you.

A study released this week on home birth in America shows a substantial increase in the still very small numbers of women who are choosing to have home births.

The study, released online in Birth: Issues in Perinatal Care, shows that of the 4.2 million births in the United States in 2008, 28,357 were home births. That is 2/3 of one percent of the total, but it represents a 20 percent increase, from 0.56 percent in 2004.

Non-Hispanic white women accounted for most of the growth, with an increase of 28 percent between 2004 and 2008. More than 1 percent of those women now have their births at home.

The study was based on United States birth-certificate data.

Carla Bruni-Sarkozy, the first lady of France, reportedly is pregnant.

The Sarkozys have not confirmed the story, but it moved beyond rumor this week when the president's 82-year-old father, Pal, told the German newspaper Bild, "I'm glad to be having a grandchild."

The Italian-born Bruni-Sarkozy, 43, a former model and entertainer, has one child from a previous relationship. Her husband, French President Nicolas Sarkozy, 56, has three children from two previous marriages. The couple married in 2008.

The baby boom doesn't stop in the Elysee Palace. With an average of 2.01 children, the French have one of the highest fertility rates in Europe. The population hit 65 million last year, when 828,000 babies were born in France.

The family of David A. Sinclair MD, the late Honolulu obstetrician who delivered Barack Obama on August 4, 1961, were surprised and honored to learn of his role when the President recently released his long-form birth certificate.

Dr. Sinclair was a freshly minted young doctor in 1961. Born in Portland, Ore., Dr. Sinclair had moved to Hawaii with his family as a child. He served as a fighter pilot in World War II, settling back down in Hawaii after the war. There, he attended college at the University of Hawaii, where he met his wife, Ivalee.

Dr. Sinclair received his medical training, including his residency in obstetrics and gynecology, at the University of California at San Francisco. He returned to Hawaii in 1960.

He delivered babies all over Hawaii, but his practice was centered at a hospital now known as Kapi'olani Medical Center for Women & Children in Honolulu, where President Obama was born, according to news accounts.

Dr. Sinclair died in 2003 at the age of 81.

"I'm just honored and proud of my father," said Karl Sinclair, one of Dr. Sinclair's six children.

"I think it's great," said Dr. Brian Sinclair, another son. "Hawaii was a very small place back then so I guess I'm not surprised."

Childbirth is  “a truly murderous business,” the Scottish actress Tilda Swinton told reporters today at the Cannes Film Festival.

“It’s violent. And if one doesn’t embrace that, if one can’t embrace it — and it’s really tough to do that — then you’re up a gum tree because it means you’re going to be cutting off a whole part of yourself,” said Swinton, 50, the mother of teenage twins.

Tilda Swinton

Swinton told reporters that movies and television give people an idealized vision of birth, according to a story by Anita Singh in the Telegraph, a British paper.

“In movies, and particularly in television films, when people have babies, they are sitting in a hospital room and there are flowers everywhere. They are made up, magically, and they have a baby in their arms and it’s all really lovely,” she said.

Swinton made the remarks while discussing her latest film, "We Need to Talk About Kevin," directed by Lynne Ramsay, which is generating major buzz at Cannes. The film is based on a 2003 novel by Lionel Shriver.

Image courtesy of Wikimedia Commons

This week is National Women's Health Week, the U.S. Department of Health and Human Services' observance of the importance of women doing the things they need to do to stay healthy. The theme this year is "It's Your Time."

Today was National Women's Checkup Day, on which women are urged to make appointments with their health-care providers and to find out what screenings and immunizations they need.

The general message from Uncle Sam to the women of America is the usual good stuff: Eat a nutritious diet, get plenty of sleep and exercise, wear your seatbelt, don't smoke.

This is a great idea, setting one week aside for women, who often are too busy taking care of others to take care of themselves, to concentrate on doing what they need to do to maintain their own health.

What are you doing for yourself this week? I would love to hear from you.

This year it looks as if we are moving beyond shooing moms out onto the street at the crack of dawn on Mother's Day to raise funds to fight cancer. This year we are going after their brunch and posy money as well.

A new organization called the Mother's Day Movement pronounces itself "shocked to learn that $14 billion was spent in the US in 2010 on Mother’s Day celebrations including flowers, cards and meals."

Roses from my daughter Nora

The group's website says that, "given the number of women and children suffering globally, and here at home, it is time for everyone to rethink this holiday and donate a portion of Mother’s Day spending to those less fortunate."

Actually, last year was a low point for mom on her "special day," probably due to the weak economy. This year, the National Retail Federation estimates Americans will spend upwards of $16 billion on mom, even though the NRF opines in its press release that "mom doesn’t expect much for Mother’s Day."

And why is that, do you think? Perhaps because while more three-quarters of all mothers are in the work force, including more than 60 percent of those with very young children,  women still make only 83 percent of their male counterparts' wages?

I am all for supporting needy women and children, for working to bring down maternal mortality and for curing cancer.

But boy, do I hate it when proponents of these projects tie them to Mother's Day.

That nice Nicholas Kristof of the New York Times, who writes so compellingly about victimized women around the world, has suggested "we move the apostrophe so as to celebrate not so much Mother’s Day — honoring a single mother — but Mothers’ Day, to help save mothers’ lives around the world as well."

To which I say, talk to me about these issues on Monday.

Sunday represents one of two days all year — the other is my birthday — when I guiltlessly look my dear family members in the eye and say, "I don't know what's for lunch. I don't want to go to the park. I don't intend to get out of bed until the sun goes down."

Perhaps you think I am being humorous, but I'm not. Why do you think women around the world are in such wretched shape? It's because their needs come in dead last, behind the livestock in some places, and nobody thinks a thing of it.

No one should consider pilfering the small comforts society extends to mothers on this day.

Sure, affluent women will score even more great stuff on Mother's Day than they usually get. (People celebrating the holiday will spend an average of $140.73, the NRF reports.) But plenty of moms whose grown children call them a handful of times a year* might actually get flowers or a gift on Sunday or even — woo-hoo! — a meal they don't have to cook themselves.

On Mother's Day, every individual should look at the woman who gave him life, or think about her, and if she is a kind and decent woman, thank her for all that she was willing and able to do — and by the way, do something to bring her a little pleasure.

Because if we can't even do that, then heaven have mercy on the women of the world.

(*I am lucky enough to have a far more attentive grown daughter.)

As a followup to the post on the debate over the prudence of Major League Baseball's paternity leave list, I thought I would post a portion of Steve Lombardi's April 27, 2009, interview on WasWatching.com with New York Times sportswriter Tyler Kepner, who covers the New York Yankees.

In his recent story on the new paternity leave list, Kepner called it "baseball’s latest common-sense roster rule," in contrast to some other sportswriters who wrote that they thought ball players should show up for games even if it means they miss the birth of one of their children.

In Lombardi's Q & A interview, Kepner talked about his own experience of being a father of four on the one hand, and on the other hand holding down a job that rivals long-distance trucker for time spent away from home.

WW: How do you manage being the father of four young children while also being a beat writer covering the Yankees? What are the biggest challenges on both sides of that fence for you as you try to manage a work-life balance that fits your needs?

Tyler Kepner: That’s been the essential question of my life for the last 10 years. But this much is obvious: it would be impossible to keep any kind of balance without a supportive and patient wife and a fair and understanding boss. I am very lucky to have both.

All of my editors at the Times have treated me wonderfully, allowing me to build some flexibility into my schedule so I don’t miss too many family things.

Over my 10 years on the beat at the Times (2 with the Mets and now 8 with the Yankees), I can remember missing a series in Seattle for a birthday, the All-Star Home Run Derby for another birthday, the last game of a series at Tampa Bay for a school play, a series in Baltimore for a dance recital, a series at Minnesota for a wedding, and so on.

I still end up covering probably 75 road games a year, but having a boss who understands that you have a life outside your job is just so crucial. It takes away the burnout factor, which is a very real risk but has never been an issue.

By knowing the editors respect my personal life, I can give everything I have to the job on the days I work.

And on the days I’m off, I don’t do any work at all. Most of the time, I don’t even watch the game.

I would say Kepner's insights apply to ball players as well, even to the best ones, who might hold a game's outcome in their hands.

People aren't machines, and that includes elite athletes. They need to have balance in their lives just in order to perform well on the job. They, their employers, spouses and families, are the best judges of what that balance requires.

Many thanks to Steve Lombardi for letting me use this part of his blog post. Incidentally, I love, love, love the fact that one male baseball writer asked that question of another male baseball writer and elicited the response Kepner gave.