Thursday, May 24, 2007

ripples of grief or joy

what do hungary, canada, the united kingdom, greece, croatia, qatar, ireland, kuwait and at least twenty other countries have in common? answer: they all have maternal mortality rates that are better than the united states according to a 2005 UN report. I have read other research which states that the us ranks 31st in the world in terms of maternal death. in fact the situation for the united states in terms of maternal deaths has worsened since 1982. the situation might even be worse than we think, according to a CDC report the actual rate may be from 1.3 to 3 times higher because of a problem with underreporting. one completely tragic aspect about maternal mortality in the usa is that at least half of these deaths are completely preventable!

a couple days ago a friend of mine turned me on to a project that she is involved with to help raise public awareness about this tragic and unnecessary situation, the project is entitled the safe motherhood quilt project. when I saw susan the other day she brought along the block she is making to memorialize and honor a mother of who died in march. through the project susan was provided with the name, location and date of death for her mother, however, susan went on to research more details about this woman. what a heartbreaking story, susan discovered. her young woman died while giving birth to her seventh child; along with raising her children, she had been a vibrant and active member of her community in salt lake city. the ripples of her death went far in terms of all the lives this woman's life touched. what is known is that the woman died of an air embolism. this is an extremely rare event that can happen spontaneously but is more frequent with certain medical interventions. from what susan could glean, it is not clear whether this was a terribly unfortunate natural event or an iatrogenic event - in other words due to something that was done to her (physician treatment, a drug administered, or a surgery performed). for me even the possibiity of an iatrogenic event adds another layer of outrage to an already tragic death.

the safe motherhood quilt project was birthed by ina may gaskin a midwife who many consider the leading voice for safe and woman and child centered birth for over thirty-five years. I 'discovered' ina may in 1978 when I learned I was pregnant. as an incurable researcher I took to the literature to learn as much as I could about my 'birthing options.' in the course of my 'research' I discovered gaskin's wonderful book entitled spiritual midwifery (which by the way is now on it's fourth edition) between reading gaskin's book and suzanne arms equally powerful and ground-breaking book entitled immaculate deception: a new look at women and childbirth in america I decided that for me, a young, healthy, fit woman the safest and 'truest' option was to have a home-birth attended by a well-trained midwife. this decision while relatively easy for me and my partner to come to was, shall we say not well-received by some of our family and friends who could not understand why in this day and age of the 'marvels of medical science' we would opt for a home birth. one dear friend, who was attending medical school in another state, actually accused us of 'child abuse' - her arguments were not persuasive and if anything only strengthened my resolve. it might have been my friend who provided me with my first glimpse of the arrogance of doctors. (hey, don't get me wrong, I have a lot of respect for many doctors; in fact devoted many years to working with doctors and training doctors and can say completely without facetiousness many of my best friends are doctors.) this old college friend has gone on to have a very successful career in medicine as a gynecologist-obstetrician who specializes in gynecological surgeries; I am proud of her and admire all she does even if I'm disappointed that she has never come around to broadening her acceptance of birthing alternatives. among my family members perhaps my father's objections were the loudest, however, his protests were quickly quelled when I reminded him that he, his six siblings, my mother and her siblings were all born at home - safely and without incident!

I have often said that I wish my experience with childbirth was the norm - the experience I had in terms of everything from prenatal care through postpartum care was a model that every woman should be able to have. I accept that most people can't fathom the concept of a home birth and probably should NOT opt for one, there should be other 'in between' alternatives that are ready and waiting - for instance, free standing birthing centers (an alternative that ironically is become more and more scarce). along with a home birth, my prenatal care was also home based, for the first seven months the midwife came to my home every two weeks to check my blood pressure, provide childbirth education, monitor my psychological and physical progress with the pregnancy, and conduct a physical exam if necessary. the last month the midwife's visits were weekly. the birth of my daughter was incredible, yes physically it was intense, but hey they don't call it labor for nothing. in terms of after the birth care or follow-up, the midwife came to the house several times in the days and weeks that followed to make sure everything was going well and to ascertain whether I had any questions regarding breastfeeding, sleep, or other new mother concerns. my experience with the birth of my daughter was ideal and I believe a model of mother and child centered care; unfortunately, in the united states my experience is almost completely obsolete, in many developed countries, my experience with care and follow-up is the norm. in the last twenty-five years childbirth has become increasingly medicalized, planned inductions are becoming normative, c-section rates in some communities are astronomical, and I have found an incredible sense of fear about childbirth among many of the women with whom I talk. there are many complex and complicated socio-politico factors at work in terms of health and the health care system in the united states. the experience of childbirth should be a joyous, positive, and life-affirming experience. while it might be impossible to avoid all infant and maternal deaths, it is possible to improve the situation significantly.

I often hear people proclaim that 'the united states has the best medical care in the world' unfortunately the data does not support this not by a loooooong shot. while our country does spend more per capita on health care than any other country we lag behind on many key health indicators - among the 191 countries on which the WHO collects and analyzes data, the us health care system ranks 37th, our infant mortality rate is ranked 26th, life expectancy at 24th, and so on and so forth. we have approximately 46 million people without health insurance in the united states. to some extent, the example of childbirth in the united states is perhaps a microcosm of the larger health care system. maternal mortality is by and large a preventable situation.

when there is birth we need to create a system in which the ripples associated with that event will be ones of joy and not of grief. I am very moved by the work of the safe motherhood quilt project and will be joining my friend susan in contributing towards the efforts to help spread awareness of the problem. during one of ina may gaskin's talks she stated that she felt compelled to become a voice for women who have died in childbirth for they can no longer speak for themselves. participating in the quilt project is one little thing to do to help raise stimulate action to eliminate the problem of maternal mortality - good mouse medicine...

if anyone is interested contact the project: safe motherhood quilt project
42 the farm
summertown, TN 38483
or email:


Unknown said...

home birthing is having a renaissance. several of my friends have done it in the past two years. all great experiences!

mouse (aka kimy) said...

that is great to hear!!!! as long as their are women have some modicum of control over their own bodies there will be home births. accessibility to trained midwives willing to attend home births varies widely by region, the west coast has many more birthing options than the rest of the country. one of best friends daughter-in-law is a midwife with a thriving home-birth practice in oregon. I lived in texas when I had my home birth experience. eleven years later, which was the next time I faced a personal decision regarding where to give birth, I lived in new england, I found a home birth was no longer an option, the city I lived in had no providers with the type of training (and experience) I wanted. but at least I was able to find a midwife group who practiced authentically woman-centered care. kudos to your friends!!

Anonymous said...

This best friend reports that her daughter-in-law now heads the Oregon Midwifery Council and the Eugene Library currently has a great display of the organization, featuring the belly molds of two moms-to-be.

mouse (aka kimy) said...

gig, tell colleen "you go girl!" do you think the head librarian would like to send me a ticket to check out the belly molds! don't know if I can wait a whole year to get out to the pnw!