Tuesday, May 10, 2011

Disturbing story of birth in Africa and developing countries

I watched this video which discusses some of the issues for women birthing in Africa. I am disturbed and concerned that many women in Africa and in some developing countries do not have access to the health care they need to support them to birth safely. The video starts by showing a baby being held upside down and slapped and suggests that this is the type of care that is lacking. Now I know that the health of women and babies in these societies is often compromised. They often begin labour in a state of anaemia and may be malnourished and have many health issues but I am disturbed as much by what is suggested as good care for them. The video says many women choose to stay at home, well so would I if that was the type of care I could expect to receive in a hospital.

I have worked with many mothers who have emigrated to New Zealand from the Philippines. Many of these women have already had babies in the the Philippines and just about all of these women who have birthed in the Philippines have had a caesarean birth. Most tell stories of not having wanted a caesarean but having been told that the baby will die if they do not with little or no reason for why this may be. These are not the poorest of Philippine women who would not be given a caesarean because they could not afford it, but are women who will struggle to pay for this care. They are then sliced from umbilicus to pubis instead of the accepted low line incision that is common practice in most developed countries. This leaves them with an enormous, ugly and uncomfortable scar.
This is not the care that these women need. Yes women need to have care during pregnancy, yes they need advice on how they can best care for themselves. Yes women's place in society needs to be valued much higher so that they can get the care they need. They need and deserve the best of care. They do not need to be coerced into birthing in dirty disgusting institutions where they and their babies will be subjected to care which is known to be harmful. Practices such as dangling a baby by its feet and slapping it are of no benefit and are known to be harmful.
I wonder how others feel about this.
I feel distressed that women do not get the care they need. I do not believe that any support is better than no support. I believe that we can do more harm than good by interfering when it is not required. I believe that what the world needs now is many well trained midwives and a reasonable number of excellent obstetricians, who support midwifery care, and provide necessary medical care when it is indicated that it is required. I believe that this is what all women need and deserve no matter where they live. It is what society needs as women are the mothers of the next generation.
We have a serious problem in most developed countries where women are experiencing far too much unnecessary intervention. In developing countries women cannot get the intervention they require. We need to start getting this balance right for goodness sake.

A politician with passion and evidence supporting homebirth

This man would definitely get my vote.

Another jump in caesarean section rates

Recently the Otago Daily times published and article which reported that the caesarean section rate in Dunedin hospital had reached the rate of 42.6% in the month of February 2011. I was moved to post this on my facebook page and this resulted in conversation some of which I wish to share here. The reason for this post is to try to stimulate a wider discussion.
What do you think about this rate of intervention in what, for most women and babies, should be a normal and natural process?
Is there anything you think that midwives can do to help turn this around?

Here are some of the comments I placed on my facebook page.

I am greatly worried but these statistics. Jenny says that when the decision is scrutinised there is a reason for that particular caesarean. However the reasons for performing caesarean seem to grow all the time. How do so many women get to this point where they are being advised to have a caesarean?

It is an enormously complex issue. There isn't one group who are more accountable for these statistics than another, one group cannot change this. For years now we (well midwives at least) have been gasping in horror at ever rising caesarean rates.I think, as more and more women birth by caesarean it (CS) becomes less feared. While more and more women are afraid to birth away from secondary care services because they might need to have a caesarean or other intervention. We shouldn't ...forget that caesarean is not the only intervention in the birth process. Every birth then virtually becomes a "trial of labour". I do think as midwives we have a responsibility to help women and those close to them to understand that the best way, for the 80% of women who can anticipate having natural, uncomplicated birth to achieve that, is to choose to birth away from secondary care services.
I think it is a society issue and until society are shocked and horrified and choose to do something about it there is little else that we can do. Many midwives too are frightened to take that step to experience birth away from secondary ca...re services. As a midwifery educator this is something I struggle with every day. How do I play my part in trying to help midwives see what is happening and find the way to support the women they work with to birth away from secondary care services, whether that is at home or in a primary unit? Without blame we need to look at every birth and try to see the decision points which led to intervention in the normal process, assess where this could have been changed and how this might impact on the outcome.

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