At most hospitals in low-resource settings it is very unlikely that women would receive pain medication during labor. This is a problem, however, when women must receive emergency C-sections. While some administer general (inhaled) anesthesia, the spinal anesthesia poses more risks when there is no adequate training. However, doctors and researchers have shown that spinal anesthesia can be successfully given in low -resource settings with proper training.
Doctors and researchers from the non-profit, Kybele, Inc, have worked at Ridge Regional Hospital in Accra, Ghana, a regional referral hospital that has an estimated 8,000 births per year, many high-risk deliveries. Kybele, Inc began the MOMS (Making Obstetric Management Safer) program at Ridge Regional Hospital where they teach nurses practical skills for spinal or epidural anesthesia.
Michelle Hartney has been an artist and activist for maternal health and obstetrics since the birth of her daughter and son: Shine and Seamus. While she says both of her deliveries were empowering, they were also very troubling prompting Hartney to create awareness through art about the high maternal mortality rate in the United States as well as obstetric abuse that she says is all too common for women across the country.
“I was shocked to discover that the way American women give birth now is rooted in a past that is riddled with misogyny, racism, and abuse. As I was reading as much as I could about the history of obstetrics in America, I was filling up my sketchbook with ideas and was flooded with visuals and topics that I wanted to make work about.”
For Hartney’s second delivery with her son, her doctor did not deliver her daughter, but she was instead assisted by a resident who wasn’t going into the field of obstetrics. She ended up fighting with the resident and a nurse about wanting to deliver her baby on her side; an option previously agreed upon by she and her doctor. Instead, they forcefully told her to “lie on her back” to deliver. Since Hartney had a doula who advocated for her during childbirth she was able to deliver on her side in four pushes, but the experience was difficult for her to handle.
Maternal health remains one of the most elusive Millennium Development Goal to achieve. While maternal deaths worldwide have been nearly halved since 1990, there is still a long way to go to ensure that more women’s lives are saved during childbirth. Currently 800 women lose their lives during childbirth due to largely preventable reasons. According to the new report, Strategies Towards Ending Preventable Maternal Mortality, by 2030 the maternal mortality ratio should be no larger than 70 deaths/100,000 live births and no country should have a MMR of 140 deaths/100,000 live births.
How can this be achieved?
The new report calls for more wellness-focused healthcare as opposed to emergency-focused care for expectant mothers despite available resources. Most importantly, the post 2015 maternal health framework is rooted in human rights for women and girls. In order to save more women’s lives, there needs to be a cross-sectional system of integrated care. According to the report, more women, girls, and communities need to be empowered to recognize gender equality and empowerment. Mothers and newborns must have integrated care as opposed to caring for both independently.
Roseline had delivered her baby during the chaos of our first day at Mama Baby Haiti, a birthing center for women near CapHaitian, Haiti. Mondays are the busiest day at the center, located on a dirt road just off Highway 1, as it is the intake day for expectant mothers that are new to the program. Three of us had arrived the night before from the early spring of Minnesota weather to be greeted by unseasonable warm Haitian weather – 95 degrees and high humidity.
While we were teaching 10 Haitian nurses and physicians asked about cervical cancer screening in a low resource setting and Roseline was laboring with the aide of a Haitian trained nurse midwife to deliver her healthy baby girl. She graciously agreed to be interviewed only hours after the birth of her child and shortly before she was to depart for her home (patients stay at the center for only 4 hours after an uncomplicated birth).
As is true for many of the 30-40 women who deliver at Mama Baby Haiti each month, she had heard of the program through a friend. She lives 20 minutes away and had been seen for five prenatal visits. She was appreciative of the nurse midwives that seemed to listen to her concerns and the cleanliness of the birthing center. This was Roseline’s first child. The father of her baby was sick and unable to work and she supported herself with side jobs and help from her family. The cost of her care at the center was much reduced from what her care would have cost at the local hospital. Without the services of Mama Baby Haiti, she would have had to deliver at home, either by herself or with an unskilled birth attendant.