Making a difference in maternal mortality

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.Pregnant Graffiti

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


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

In these three days, 2,942 deaths in childbirth

Every ninety seconds, somewhere in the world, a mother dies in childbirth. For three days this week, in Times Square in New York City, Amnesty International, a global human rights group, placed a "maternal death clock" to note each minute-and-a-half marker.

The clock was hung in conjunction with the big meeting the United Nations was hosting, the subject of which was how the nations of the world are doing on eliminating poverty and other ills, including infant and maternal mortality.

So far, Goal 5 (of the eight Millennium Development Goals), cutting maternal mortality by 75 percent by 2015, is lagging the rest.

All told, nearly 1,000 women die in childbirth every day, according to estimates by the U.N. and the World Bank.

“It’s such a clear example of people dying who don’t need to,” Larry Cox, the executive director of Amnesty International USA. told the New York Times' Clyde Haberman this week.

Summit goals: Save more mothers, babies

World leaders gathered in New York this week for the so-called September Summit to beat the drums for the Millennium Development Goals of the United Nations, one of which is slashing the rate of maternal mortality in the developing world.

The official name of the meeting is "The High-Level Plenary Session of the General Assembly." This year, the spotlight is on the MDG. Only five years remain until the 2015 deadline for meeting the eight goals; however, only a couple of them are likely to be met by then.

Barring a breakthrough, Goal 5, reducing maternal deaths by 75 percent, will not be one of the successes.

The World Health Organization, an agency of the United Nations, recently issued an update on Goal 5. The goals were set in 1990. The update looked at the most recent figures, which are from 2008.

While 10 of the 87 countries targeted in the program have brought down their rates of maternal mortality by 5.5 percent, 30  other countries have made little or no progress.

Ninety-nine percent of maternal deaths in 2008 occurred in the developing world.

How hospitals can promote breast-feeding

The Baby Friendly Hospital Initiative, an international program, has created a list of things birth facilities in the United States can do to optimize the chances that mothers will choose to breast-feed their babies.

Here are "The Ten Steps To Successful Breast-feeding," from BFHI USA:

    1. Have a written breast-feeding policy that is routinely communicated to all health-care staff.
    2. Train all health-care staff in skills necessary to implement this policy.
    3. Inform all pregnant women about the benefits and management of breast-feeding.
    4. Help mothers initiate breast-feeding within one hour of birth.
    5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.
    6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
    7. Practice “rooming in” — allow mothers and infants to remain together 24 hours a day.
    8. Encourage breast-feeding on demand.
    9. Give no pacifiers or artificial nipples to breast-feeding infants.
    10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

The BFHI is underwritten by the World Health Organization and the United Nations Children's Fund (UNICEF).