Wednesday, 4 August 2010

what the women say

“She rushed me to hospital when I went into labour and helped me through an easy and memorable birth,” third-time mother  said.

First-time mother 23, said the ante-natal treatment, constant updating and explanations which the midwife provided, left her confident that giving birth would not be difficult.
“Even as I sit here I know the exact position my baby is in, and I know ... how to go about making the process an easy one,” she said.

And some photos need no words to say how they feel:

Taking good birth rural

"Garage" birth centre helps rural expectant mothers

 In most parts of the world, good birth seems to be available only to the elite. In Britain woman need to pay in the region of 4000 pounds to have a midwife that they know come to their home for a home birth. In Europe and New Zealand perhaps this kind of care is more available to those are not very wealthy. In most countries, however, during birth a woman is assisted by a midwife that is a stranger to her and most times birth is not a pleasant experience for woman or midwife.
Why is this so?

It has not always been like this. My mother was welcomed into the world by her Aunty Teen who was a midwife. In those days midwives attended the births of the babies in their town or village. In some areas, the midwife actually moved in with the family for the last month of the pregnancy and would cook meals, darn clothes and generally help out...wouldn't that be nice.

Then the world got more people and life got busier and everything got more expensive. As a result, not only did they close down all the little cottage hospitals where women used to have their babies with midwives that they knew, in many countries they also took away the community midwife too.
Although the community midwife does still exist in some countries, she now works in a large team and most times the woman is unclear who she will be having attend her when she goes into labour. This is often as unsatisfactory for the midwife as it is for the woman. Midwives like to know their clients and feel a connection with them and want to attend their births. Similarly, a woman may like a certain midwife and would like her to attend the birth too.

Because of the lack of finance and lack of midwives, we have now shifted care to be neither woman nor midwife friendly. Is this necessary? Is good care unaffordable?
Perhaps we need to look at it from a different angle, to find a new way.

This article describes the start of finding a way to bring back something old in a new way.

Tuesday, 3 August 2010

Why women and babies die

In a recent study published June 21, 2010, Kinney et al state "According to the most recent World Health Organization (WHO) analysis, most maternal deaths in Africa are related to direct obstetric complications that occur around the time of childbirth (mainly hemorrhage, hypertension, sepsis, and obstructed labor, which combined account for 64% of all maternal deaths.) Non-pregnancy related infections, such as HIV/AIDS and pneumonia, account for 23% of the deaths and unsafe abortion accounts for 4% of maternal deaths in Africa. More than half of maternal deaths take place within one day of birth. Malnutrition, including maternal anemia, iodine deficiency, and poor-quality diet, also contribute to maternal mortality and the high incidence of stillbirths and congenital abnormalities. HIV-infected mothers' risk of dying is ten times higher than that of HIV-negative mothers. (Sub-Saharan Africa's Mothers, Newborns, and Children: Where and Why Do They Die?)

When one looks within the existing health care system in South Africa, it is evident that care is not optimal. Why is this so? Is it because midwives are human? Is it perhaps that working conditions are overwhelming?  That when responsibilities are beyond human capabilities, in order to survive emotionally and work every day, the midwife withdraws? Is it possible for one midwife care for 4 women in labour, as well as other demands, simultaneously, without becoming removed and distant? Could it be that she needs to stop caring in order to be able to function on a daily basis?

Perhaps we need to look at creating another way. A way in which we as midwives can maintain our humanity and serve women well that are in our care. But how is this to be achieved? I would suggest with difficulty and with very careful changes. I believe that midwives want to care, they just do not work in environments where this is possible.

Busfare babies is suggesting another way. This is not a new way, in fact it is a very old way. It is a way that can be more beneficial now that we have advanced technologically. Previously all the midwife had was her hands, her little suitcase and no other back up. We now live in an age of gadgets and technology and these really can make childbirth safer when used carefully and when necessary.

The combination of a skilled midwife and the availability of appropriate technology is a formidable force in combating the current statistics that affect women and babies in Sub-Saharan Africa.

The aim of Busfare Babies is to provide good, careful and care-filled care to the woman in the area. It is my belief that within a short space of time, statistics will show that without excessive cost, care can be improved and that less mothers, babies and children will die if we bring back the midwife to the community. This is a system that is being revisited in parts of the developed world with obvious improvements, why not offer it to the developing world and see how simple changes make a big difference.