As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.
After recently receiving a press release about a pregnancy docuseries on Facebook Watch I have been hooked! As a maternal health advocate, it takes a lot to stop me in my tracks, but 9 Months With Courteney Coxhas really opened my eyes on the realities of pregnancy in America. After all, it has been twenty years since I had my last child, so things have definitely changed!
My proclivity these days is to focus on vulnerable communities when it comes to maternal health and mortality and yet there are so many women who have to deal with pregnancy complications and care, health issues, and disparities, as well as fertility options and disappointments when it comes to carrying a baby full-term. The most important thing for all of us to remember is that women the world over have personal struggles with pregnancy. Those experiences are certainly different from one country to the next, and most certainly from one woman to the next. They all are valid for those who are carrying a baby or are desperately trying to.
9 Months With Courteney Coxhas honestly shone a brilliant light on pregnancy in the United States in its docuseries from a mother who found out she was pregnant and had cancer at the same time, to a couple who have tried for years to get pregnant, only to miscarry time and time again, to a mother who couldn’t imagine ever delivering a ninth child to add to her already eight children. These are just a few of the couples’ experiences of the ten that are laid bare in this riveting Facebook Watch show.
Want to watch? Start on episode one and enjoy. I will admit, I wish the episodes were longer because I really want to know what happens, but they are timed perfectly for busy people. Each episode is about 15 minutes.
Maternal mortality continues to be a major problem the world over. The United States is the only developed country where maternal death rates are increasing especially for non-Hispanic black women. And in low-and-middle income countries, approximately 830 women die each day from pregnancy-related, preventable causes.
Maternal health organizations are working diligently to save more mothers’ lives, but one death is still too many especially when it is likely preventable. I like to list organizations that you can support with donations in order to help them keep more women and their children alive on the local level and make sure mothers are a part of their families’ lives.
This list highlights local organizations that help some of the most vulnerable communities in countries with some of the highest maternal mortality rates. And, in the cases of the United States and Australia, the organizations help the communities that experience the most maternal deaths. Each site allows direct donations that go directly to maternal care and/or advocacy.
Sasha is 22-years-old. She was married off when she was just nine and by the time she was 11, she was pregnant with her first child, and unprepared for childbirth.
So when labor came, in the middle of the night – in her geographically isolated village in rural Kenya – she was unaware of the painful fate awaiting her.
During childbirth, the baby’s head was too big to fit through Sasha’s pelvis, causing the baby to get stuck in her birthing canal. Traditional birth attendants tried their best to help Sasha but they were not skilled enough to handle the complications. She needed surgery, and quickly. But because she could not access emergency obstetric services, she spent the next six days trying to push out the baby that was stuck inside of her.
In the end, Sasha delivered a dead, rotten baby in macerated form. She was not only in grief of her lost child, but was also traumatized by her experience which left her with profound injuries and a double obstetric vaginal fistula.
We know that women in low-and-middle income countries are especially prone to maternal mortality. Those of us of who write about maternal health and keep up with worldwide maternal health, mortality, and morbidity statistics understand that in the world’s poorest countries we find the worst outcomes for both mothers and their infants. In recent years, we have also discovered that maternal health rates in the United States are far higher than acceptable. In fact, the United States has the highest maternal mortality rate than any other developed country in the world. The countries that have the lowest maternal mortality rates are European. But that can be misleading as well.
Safe Motherhood Week , that is recognized each year between October 2 – 8, is the first coalition of partners of its kind to focus on maternal health in Europe. Some statistics will surprise you. Did you know five European women die every day from maternal health complications and in 2013, 1900 European women died from maternal health complications. Additionally, 1 in 10 women in Europe does not have access to maternal health care in the first few months of their pregnancies.
As a mother of two, I did not have optimal experiences either time I was pregnant. Each of my pregnancies was different, but the feeling I had with both of them was identical. I never felt like my physicians really cared about my pregnancies or deliveries, but that I was just a number to them. I have always chalked it up to being relatively young. I was in my mid-twenties. Even still, I believe to this day that I should have been treated with more dignity and respect. Even in two different states, I was treated the same way – with relative indifference. Even though my oldest daughter is 19, I’m still bitter about it.