Birth Story 2010

Following one topic, childbirth, for an entire year has given me an unusual perspective on what is happening on that front, both here in the United States and also globally.

If you ask me, the newly apparent muscle of the holistic birth community was the most important “birth story” of 2010. One sign of this was the passage of the so-called Midwifery Modernization Act in New York, which eliminated a requirement that midwives obtain a written practice agreement from a physician or hospital to practice in New York State.Pregnant Graffiti

Also, as we just discovered from a new report from the Centers for Disease Control, released last week, birth by Cesarean section reached a new high, 32.9 percent of births in 2009, up from 32.3 in 2008. The steadily rising rate — up every year since 1996, when the rate was 20.7 — has been a major story all year.

That CDC report also showed the birth rate for U.S. teen-agers hit its lowest level last year since records began to be kept seventy years ago — 39.1 births per 1,000 teens, down from 41.5 per 1,000 in 2008. The record low held true for all racial and ethnic groups.

A couple of other big birth stories of 2010, sadly, revolved around the fact that too many mothers are still dying in childbirth.

In March, Amnesty International called out the American childbirth establishment on a rising rate of maternal mortality in a report called “Deadly Delivery: The Maternal Health Care Crisis in the USA.” The human-rights advocacy organization pointed out that while the United States spends more on health care than any other country in the world, “maternal mortality ratios have increased from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006.”

Many other groups joined in that call for changes to improve birth safety in this country.

Meanwhile, in the developing world, the United Nations’ Millennium Goal 5, which aims to bring down rates of maternal mortality by three-quarters in places like sub-Saharan Africa and Southern Asia, is the subject of much scrutiny, with a major push in some places creating bright spots in what appears to be a generally gloomy picture with just five years to go.

Pregnant Graffiti by Petteri Sulonen / Wikimedia Commons

Malawi eases rule on birth attendants

The African nation of Malawi will take a new tack in its campaign to improve its maternal-mortality statistics.

Almost immediately after his return from the United Nations meeting in New York on the Millennium Development Goals, President Bingu wa Mutharika lifted a ban on traditional birth attendants.

The fifth MDG is to cut the number of women who die in childbirth worldwide by 75 percent by the year 2015. Malawi, along with a number of other countries, has experienced disappointing progress on Goal 5.

Malawi shares Africa's dismal statistics on maternal mortality; a mother's lifetime chance of dying in childbirth there is 1 in 36, according to the latest figures from the World Health Organization. (HIV/AIDS is a major factor in Malawi.) Not only that, but decreases in the rate of deaths, presently 510 per 100,000 births, have only been running about 3 percent per year since 1990.

Banning TBAs was part of an earlier effort to get more women to deliver their babies with assistants trained in modern medical techniques, who would be able to recognize and respond to emergencies. Only 54 percent of Malawi women delivered their babies in a health-care facility in 2005.

However, one result of the ban has been that more women have delivered their babies without any kind of real birth attendant, traditional or modern, or with TBAs working under the threat of fines.

Dorothy Ngoma, executive director of the National Organization of Nurses and Midwives in Malawi, told The Nation, a daily newspaper in Malawi, "They [TBAs] never really stopped.... What happened is that they went underground."

It appears that President Mutharika decided after the UN summit that training TBAs to be part of the solution made more sense. The president married Callista Chimombo last spring, and the new first lady appears to be taking an active role in addressing the country's poverty.

The Nation reported that her Safe Motherhood Foundation will train 20 TBAs from the countryside next year in modern birth methods. They will then return to serve their communities as midwives.

Healthcare facilities tend to be concentrated in Malawi's cities, while 70 percent of the nation's 15 million people live in rural areas. There are reportedly two doctors for every 100,000 Malawians.

"We should not abandon TBAs, as they are very important to our program of safe motherhood," President Mutharika was quoted as saying in The Nation.