There is a great website called Good.is that I get e-mails from. In the last digest was a link to an article about using solar panel-powered lighting in birth clinics in Malawi. Interest piqued, I followed the link. But as I read, my face fell. The idea, is amazing. Superb even. But the details in the article (which was written by a female Obstetrician) were heart-wrenching, and made my stomach twist in knots as Birth Fear was, consciously or unconsciously, spread further by the author’s words.
“Pakati,” she told me. “What does that translate to?” I asked. “Between life and death.”
This caught my attention. It was the first thing at the beginning of the article. I immediately knew the rest of the article was going to be in regards to maternal mortality. But birth IS just that. It is a woman’s Journey, her Shaman’s Quest. She is the walker-between-worlds. When she enters the Delta brainwave state and goes into a kind of trance, she leaves her body and crosses the threshold, “Between life and death”, to meet her baby and bring them back. But in today’s world, the meaning behind the word for “pregnancy” has come to mean a very good chance of meeting Death on the day of the your baby’s birth, as the author pointed out with the WHO statistics for Malawi:
In 2010, the WHO reported the Maternal Mortality Ratio for Malawi was 470. That means that for every 100,000 live births, about 470 women will lose their lives. And my Malawi colleagues on this trip suggested the risk in rural areas is significantly higher. In fact, a young woman in Malawi faces a 1 in 36 lifetime risk of dying from pregnancy-related complications.
I would put money on WHY their rates are so high. The author claims lack of adequate prenatal care and access to birth clinics and technology for assessing and remedying complications. Lack of adequate prenatal care is surely part of it. But I would argue against the need for birth clinics and technology. They both have their place, and are at times indeed needed. But, I believe, adequate nutrition and over-all health of women before conception and during pregnancy, plays the biggest part in the occurrence of complications. There are of course multiple factors at play here: poverty, lack of resources, lack of adequate nutrition and food sources, lack of clean water, lack of properly trained health-care workers (that you don’t have to trek for miles to see). Without all these things, and without good nutrition and over-all health, then yes women are going to have higher rates of complications and have higher rates of needing clinics and technological interventions.
The greatest threats to life: hemorrhage (excessive bleeding); obstructed labor (inability of the baby to fit through the birth canal); eclampsia (high blood pressure leading to convulsions); and sepsis (disseminated infection)—usually manifest close to the time of delivery. These conditions may not be preventable, but they are certainly treatable with proper medical and/or surgical care. They need not result in death. But appropriate treatment does require skilled clinicians capable of providing immediate emergency care.
This particular comment stuck out to me the most, and stirred an anger deep down inside of me. Wrong wrong wrong. The wording of this quote makes it out to seem that these complications (though very real and very serious) can ONLY be treated with medical and techno-cratic methods. Which is far from the truth (except perhaps treatment of sepsis, but the prevention of it can be alternative). Again, multiple factors are at play here (those previously mentioned) but when those factors are not at play, it is actually very rarely that any of these complications result in the need for obstetric (usually surgical) intervention. And again, in a rural, poverty-stricken country with tremendously less-than-ideal situation in regards to health care/disease prevention and nutrition, these cases are in deed higher. But that is where we should be focusing, fixing the root of the problem.
In Malawi, community health workers and village leaders are called upon to encourage pregnant women to deliver in a health center. The law now forbids home births. This means that women must be able to reach functional health centers: facilities stocked with clean equipment, medical supplies, trained health providers, and something that is often overlooked—light.
The law now forbids home births. Yes, you read that right. Let me repeat that: The law now FORBIDS HOME BIRTHS. My heart broke when I read this. I couldn’t believe it. I had heard that some places had unofficially outlawed home births, like Peru (they make it very difficult for mothers to have babies at home). THIS IS NOT THE ANSWER. Making home birth midwives illegal, making HOME BIRTHS illegal, is the complete opposite direction that we should be heading. That kind of thinking is leading us further down the tunnel towards darkness– higher intervention rates, and higher maternal and fetal mortality rates.
We’ve designed the WE Care Solar Suitcase to help address this problem. The Solar Suitcase is an economical, easy-to-use portable power unit that provides health workers with highly efficient medical lighting and power for mobile communication, computers and medical devices. It was originally designed to support timely and efficient emergency obstetric care, but can be used in a range of medical and humanitarian settings.
It might seem like I’m totally bashing this author. That’s not my intention. I know she’s an OB, that’s what she knows. She seems like a humanitarian-type person, and her article is well-intended. That doesn’t mean that it’s not entirely correct, and doesn’t keep it from adding to the spread of birth fear. But their innovative idea is definitely something that can help us work towards a better outcome for mothers and babies. For the instances that clinicians and the techno-cratic mode of care is indeed needed, light is paramount. And their solar powered portable lighting and charging unit (for cell phones and laptops) is an amazing thing that should be made widely available.
On this trip to Malawi, we travel for hours to reach each clinic. As our four-wheel drive carefully maneuvers muddy dirt roads with deep trenches of water, I ask myself if I would choose to make the trip by foot if I were in labor. Would I be willing to leave the security of my home to arrive at a clinic shrouded in darkness? In Malawi, clinics lacking electricity expect women to bring their own candles and matches as part of their birthing kit. For a woman living in poverty, even the price of a candle can be a deterrent to obtaining skilled care.
They traveled for hours, in vehicles. How many villagers have vehicles, or bikes? The majority of women have to walk to these clinics, and as she said– in the dark. Imagine going that while in labor, fearing that you may have your baby before you get there, or that something could happen or go wrong during the trip. “Would I be willing to leave the security of my home…” That line just makes me shake my head. Why should these women be FORCED to do just that? I would be willing to put money on the hypothesis that women having to undergo these stressful and potentially dangerous journeys just to deliver their babies in a clinic that has no lighting (if at night, which most women naturally go into labor at night), is a large part of why these women are having such high levels of complications and need for interventions.
So many women make a calculated risk. They stay home. They make the same choice their mothers made, and try and deliver by traditional means. They take their chances. And, in places like Malawi, where skilled health care is far and clinics are often in darkness, many of them are unable to obtain the care they need when problems arise. And pregnancy tragically does become a period of time “between life and death.”
This is another quote that makes me grind my teeth. When a reader comes across this, what else are they to think but that home birth is dangerous? When they don’t realize why there is the potential for danger for these particular women? (Risk factors mentioned previously). Home birth has been shown time and time again to be as safe or safer than a hospital birth. These women are at risk because of a multitude of factors, and it is wrong to put out to the masses the declaration (whether blatantly stated or left for the assumption to be made) that home birth is dangerous. “They take their chances”. Staying home is a “calculated risk”, that is not true for all women. Or even, for these women if they had trained village home birth midwives to attend them.
I think about the thousands of babies I have delivered in the United States, and wonder how I could have functioned without the entire hospital infrastructure in place.
To be blunt, this quote shows the obvious lack of knowledge in regards to alternative birth practices and the midwifery model of care. There is so much that can be done to care for women without hospital structures or obstetrical “medicine”. I understand that with her training, as an OB, she would seem out of her comfort zone. But there is so much more outside of that…
I pull out the bright yellow suitcase that is the reason for my visit. When I open it and turn on the lights, the room becomes visible again. And now Fanny has a wide smile on her face. She immediately realizes that she will no longer rely on cell phones or candles at night. That her cell phone can always be charged. That the fetal Doppler we include with the Solar Suitcase will make it easier for her to hear the fetal heart beat.
This is a beacon of light in the darkness. A small glimmer of hope. But it is only one step. But it does not address the root of the problem. Not fixing the root problems are letting these complications arise in more serious mannerisms than would normally occur. Not fixing the root of the issue, and as the issue arises treating it with a techno-cratic model of care/procedure is only putting a bandaid on a wound that will continue to fester, continue to not heal.
–Start at the family and community level and work up, not backwards.
–Work on implementing village midwifery training or volunteering midwives to villages to overlook home births.
–Work with families and the community to make sure families and mothers are getting adequate food supply and nutrition.
–Teach women (and their partners) about their bodies and methods of facilitating labor (vertical birth, alternative positions for pushing, etc.)