Stories in contrast
Just days apart and worlds apart. In the news...
From Uganda:
Uganda: High Maternal Death Points to a Health Crisis
One woman dies every minute during pregnancy or childbirth, adding up to more than 500,000 dead women each year. And this is just the tip of the iceberg. For every woman who dies, there are 20 to 30 others who survive childbirth but suffer debilitating injuries. If we are serious about providing health security to women, we must guarantee universal access to family planning, skilled attendance at birth, emergency obstetric care and services... Complications from pregnancy and childbirth are the leading cause of death among young women aged 15 to 19 in developing countries....
Ensuring skilled attendance in delivery, backed up by emergency obstetric care, would reduce maternal deaths by about 75 per cent. To commemorate the International Day of the Midwife on May 5th, the United Nations Population Fund, (UNFPA) pays tribute to midwives around the world. We join others in voicing our appreciation for the loving care these skilled health workers provide to pregnant women, young mothers and infants. And we call for urgent action to address the shortage of midwives in many countries....
Yet, half of the world's pregnant women still lack access to skilled care at childbirth and the consequences are devastating. Every year, an estimated 529,000 women die from complications of pregnancy and childbirth, four million newborn die, and another four million babies are stillborn....
While Ugandans are desperate for quality prenatal and delivery care, the news from the UK reports on the growing trend for “freebirth”:
Freebirthing involves giving birth alone, without a midwife and often even a partner or friend in attendance ...To prepare for the three-hour labour, Sarah had read everything she could on the subject, and says she “would have known instinctively if anything was wrong....
[T]here is a growing online community of freebirthers or “UC-ers" (unassisted childbirthers) in the US who are celebrating “the primacy of autonomous birth." Laura Shanley, 49, from Boulder, Colorado...believes that “women are the true experts of birth. Birth is sexual and spiritual, magical and miraculous", she says, “but not when it's managed, controlled and manipulated by the medical establishment." ...
[T]here is virtually no historical precedent for this movement: “Since the beginning of time women have turned to other women for help in childbirth. There are one or two very small tribes where giving birth alone is a means of status - but even within those cultures people rush to the woman's side afterwards to make sure she and the baby are OK." ...
Because freebirth is such a fringe movement there have been no studies on it. However, a report in the magazine New Scientist recently quoted a survey undertaken in a religious community in the state of Indiana, where there were more than 300 unattended births in the 1980s. The neonatal death rate was calculated as 19 per 1,000 live births, compared with 7 per 1,000 for the rest of Indiana....
This will be a heart-stopper for most neonatal and obstetric medical professionals. It just takes one delivery, the one that will never leave our memories....that one baby born with a sudden unexpected problem where minutes counted and were lost...watching that one mother suddenly hemorrhage in just minutes. But reading an online interview with the leader of this new movement may leave you numb and bring tears to your eyes in fear for these young people. Young prospective parents are hearing it's best to shun prenatal care, the medical establishment, and medical assistance at the birth of their baby, in order to have a natural, spiritual experience and are actually following this path.
From the U.S.:
What we really are talking about is a woman or couple who chooses to give birth without the aid of medical or midwifery care. By choice, thousands of women and their families are making this decision for a variety of reasons. Some believe that it is a spiritual calling, something that they believe in religiously. Others believe that medical or even midwifery care are interventive and will interfere with the natural process...
Good candidates for unassisted birth are people who believe in themselves. A belief in some sort of God or spiritual reality is helpful, but an overdependence upon organized religion can be a detriment. Church leaders are seldom supportive of independent birthing, and couples who are eager to get official sanction for their birthing choices, often feel a conflict. Because our bodies are so responsive to our thoughts - especially in labor - this conflict can make for a problematic birth....A woman should be comfortable with her body, and accepting of her sexuality.
I don't go to doctors when I'm not pregnant, so I saw no reason to go when I was. Pregnancy is not a disease, and it requires no special care as far as I'm concerned.
Unassisted birth, to me, is a very natural choice. Most babies are conceived without assistance, and they can be birthed without assistance - provided a woman doesn't stand in her own way. Fear causes major problems for women in labor....
According to the CDC report,“Achievements in Public Health, 1900-1999: Healthier Mothers and Babies:”
At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications....In 1950, 2,960 women died in childbirth. In 1998, 281...There are still too many. The Centers for Disease Control estimates that more than half could be prevented using accepted interventions.
Maternal mortality rates were highest in this century during 1900-1930. Poor obstetric education and delivery practices were mainly responsible for the high numbers of maternal deaths, most of which were preventable. Obstetrics as a speciality was shunned by many physicians, and obstetric care was provided by poorly trained or untrained medical practitioners....During the 1930s-1940s, hospital and state maternal mortality review committees were established. During the ensuing years, institutional practice guidelines and guidelines defining physician qualifications needed for hospital delivery privileges were developed. At the same time, a shift from home to hospital deliveries was occurring throughout the country; during 1938-1948, the proportion of infants born in hospitals increased from 55% to 90%....Medical advances (including the use of antibiotics, oxytocin to induce labor, and safe blood transfusion and better management of hypertensive conditions during pregnancy) accelerated declines in maternal mortality....
From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births... The decline in infant mortality is unparalleled by other mortality reduction this century....
Is there an answer to helping young people who are feeling such growing distrust and fear of modern medicine and science that they would jeopardize their lives and those of their babies? Perhaps, instead of the mandated high school classes on “humane education,”“healthy eating” or whatever are the other social engineering classes they have to sit through, replace them with some sound medical, scientific and online media literacy could help prevent us repeating history. But it goes beyond critical thinking skills and education. The healthcare industry has some work to do, too. It does itself and consumers a disservice when in the eyes of the public it blurs the distinction between good, credible science and untenable modalities. It's more than the growing incorporation of woo into mainstream practices and healthcare policies. As I was about to post this, I read the commentary by Dr. James Gaulte, M.D. and wish there weren’t so many of these stories of public health and clinical guidelines with troubling conflicts of interests behind them, that profit some and harm others, and steadily erode the public's trust, and wish so many of us didn’t feel the same way:
I don’t know if trust in physicians is lower now than before but I do know that my trust titer has tanked and I am many times more skeptical and critical in regard to medical articles that in the not too distant past I would have read without a nagging doubt about the motives of the authors.
Medicine and science will never be perfect — but we need to find a way to help people regain trust in it and recognize the life-saving benefits and good things modern medicine and science can bring and does bring to our lives. That starts with us.
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