Maternal mortality; Fear from centuries past still grips parts of world

[NRSKarenRN, BSN, RN]

Found at Nurseweek.com

Copyright 2002 News World Communications, Inc.

The Washington Times...12/18/2002

By Cheryl Wetzstein, THE WASHINGTON TIMES

http://webpublisher.lexisnexis.com/index.asp?layout=story&gid=1730000973&did=47G8-9T90-00JJ-S3NF-00000-00&cid=1920004392&b=s

One of the "greatest miracles" in the past century for American women is the likelihood they will give birth safely.

Even as late as the 1930s, American women had a pervasive and legitimate fear of dying in childbirth.

"How soon, my Dear, death may my steps attend. How soon't may be thy lot to lose thy friend," 17th century New England poet Anne Bradstreet wrote in the dread-filled days before the birth of one of her children.

"Died in childbirth" was a likely epitaph for one in eight mothers in Colonial days, says the Gilder Lehrman Institute of American History in New York City. Common lethal complications included massive blood loss, infection, convulsions, obstructed labor and dehydration.

Now strict sanitation laws, antibiotics, blood transfusions, prenatal monitoring for life-threatening complications and other medical advancements have brought U.S. maternal mortality to a record low of 7.1 deaths per 100,000 live births.

"This may be one of the greatest miracles of the 20th century" for American women, said Janice Shaw Crouse, senior fellow at the Beverly LaHaye Institute: A Center for Studies in Women's Issues.

"Today, women prepare for childbirth by painting a nursery; in an earlier age, they wrote heart-wrenching goodbye letters to loved ones in case they did not survive childbirth," she said.

The United States is one of about 20 countries with maternal mortality rates of fewer than 10 deaths per 100,000 live births. U.S. officials want the rate to go lower - to 3.3 deaths per 100,000 live births - by 2010.

However, maternal mortality continues to destroy families in dozens of countries.

The World Health Organization has identified 23 nations in which the maternal death rate is greater than 1,000 per 100,000 births. Rwanda has a staggering 2,300 deaths per 100,000 births.

"It is no exaggeration to say that the issue of maternal mortality and morbidity, fast in its conspiracy of silence, is the most neglected tragedy of our times," editor Peter Adamson wrote in a scathing UNICEF report, "The Progress of Nations 1996."

About 600,000 women die each year, he said, including an estimated 140,000 who die while "violently pumping blood onto the floor of bus or bullock cart or blood-soaked stretcher as their families and friends search in vain for help."

Mr. Adamson recommended that all birth attendants be trained "to do no harm" - for example, to not touch mothers with unwashed hands or use unsterilized knives. Birth attendants and fathers-to-be also should be educated to recognize warning signs in a pregnancy so women can be brought to medical centers in time to save them, he said.

Developing countries must provide more emergency obstetric-care facilities with basic equipment and drugs, said Dr. Allan Rosenfield, dean of the Mailman School of Public Health at Columbia University in New York and a specialist on maternal mortality.

Prenatal and preventive care aren't enough, by themselves, to reduce maternal mortality, Dr. Rosenfield said. Instead, most deaths are caused by complications that arise without warning. "So once there is a complication, women need access to services" so they can get intravenous medicine, a blood transfusion or a hysterectomy, "whatever they need," he said.

Having drugs to control seizures, bleeding and infection; forceps; and vacuum aspirators to aid birth and afterbirth, in the hands of trained health professionals, could save "tens of thousands of lives each year," said Dr. Lynn Amowitz of Physicians for Human Rights, whose research on the high maternal mortality in Afghanistan was published in September in the Journal of the American Medical Association.

Other medical researchers say health officials should do more to help women avoid pregnancy when they are too young, too old or still recovering from an earlier birth.

Maternal morbidity "would drop substantially if women in developing countries were able to limit childbearing to their 20s and early 30s," Alan Guttmacher Institute researchers said in a paper released in March.

Contraceptives would allow women to space their pregnancies, and legal abortion services could prevent tens of thousands of maternal deaths caused by botched abortions, the institute researchers said. Adopting the U.N. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which has been ratified by 170 countries but not the United States, also would ensure women have "access to adequate health care facilities, including information, counseling and services in family planning," they said.

Mrs. Crouse of the Beverly LaHaye Institute, who opposes CEDAW, said that poor women would be better served if, in addition to modern medical services, more emphasis is placed on improving nutrition and sanitation.

"There's no way you can complete surgery under sanitary conditions in vast areas of the world," she said. "It's just unconscionable to me that the United Nations would not stress providing pure water and basic sanitation around the world as a priority (in childbirth). Instead we talk about providing abortion and reproductive health services like condoms."

A hundred years ago, the U.S. maternal mortality rate looked like those of many Third World countries, with 850 deaths for every 100,000 live births. The U.S. maternal mortality rate began falling in the early 1900s as medical professionals began scrubbing their hands and sterilizing instruments to prevent the spread of infections, Dr. Rosenfield said.

A steeper decline came after lifesaving antibiotics and blood transfusions were introduced in the 1930s. By 1946, the U.S. rate fell to 157 deaths per 100,000 live births.

Legalizing abortion in the 1970s further reduced the maternal death rate by reducing the number of unsafe abortions. Since 1980, the U.S. maternal mortality rate has been fewer than 10 deaths per 100,000 births.

Today, U.S. researchers are focusing on reducing deaths among minority mothers, especially black and foreign-born mothers, because they have higher death rates than white mothers.

[fergus51]

I am disgusted that my country is unwilling to recognize the need for contraceptives or safe abortions. We would rather see women die than even support birth control? I find it completely hypocritical that most American women have access to and USE contraception but that our government thinks that it is morally correct to chastise CEDAW for wanting it for other women. I mean really, how many American women are having 8 or 9 kids nowadays? I doubt all the rest are using the rythm method.

I am glad that we have recognised the need to continue to improve our own mortality stats. The desire to halve our rates are not unreasonable, as other countries have shown.

[RN2B2005]

I cannot imagine a more singularly horrible way to die, than to die in childbirth. I had a very easy labour and delivery with my son, but in those last three or four minutes, when the baby's crowning, you feel like NO ONE in the world can help you.

Can you imagine that feeling, that thought, if you were poor woman in, say, rural Rwanda...your child breech or transverse...both of you dying, perhaps over the course of an hour or a day or longer, but dying nonetheless. Death by this means was so common until the early part of this century that many children in 19th century photos appear wearing a wide, black silk sash around their waist. Why? The black sash signified that the child's mother died either in childbirth or within the first year of the child's life; that the significance of the black sash was so well-known speaks to the commonality of death in childbirth.

Want to help change things? Go to the Mercy Corps or World Vision websites and donate money through the purchase of a "Childbirth Mercy Kit", which is actually a donation with funds earmarked for the provision of supplies necessary to a sanitary birth--educating lay midwives, providing clean water and disposable obstetrical supplies and the training to use them.

I'm not 100% sure, but I don't think either of the above charities provide funding for abortion services, but they do provide family planning funding. You get a good feeling, a tax deduction, and a little card.

[flowerchild]

Link for the Midwife Delivery Kits from World Vision.

http://www.worldvisiongifts.org/wv/offer_327.htm