Maternal mortality
The homebirth movement propounds a variety of myths and lies about obstetrics in an attempt to deny obstetricians credit for their tremendous successes. One of the biggest lies is that 99% drop in maternal mortality achieved in the last century was due to "public health" measures like improved sanitation and handwashing.The following information was taken from an article about maternal mortality in the underdeveloped countries. The focus of the article is applying what we have learned about maternal mortality in the US and Britain to save lives in poor countries:
During the 19th century, living conditions (nutrition, sanitation, etc.) in Europe and North America improved, and this resulted in sustained and impressive declines in infant mortality, and in deaths from infectious diseases among adults (e.g. tuberculosis), well before medical technology to fight these was developed.So the 99% drop in maternal mortality achieved in the last century was due to the technology to treat obstetric complications such as antibiotics banked blood and C-section. It was not due to improvements in public health.
During this period, however, maternal mortality remained high. For example, from 1840 (when the first maternal mortality statistics were available in Britain) to the mid-1930s, maternal mortality remained as high in Britain as it is in many developing countries today. Then, after nearly a century of stagnation, maternal mortality declined so sharply that within 15 years it was no longer a major public health problem. Why? Because the technology to treat obstetric complications became available, including antibiotics (first sulfa drugs and then penicillin), banked blood and safer surgical techniques. In 1934, there were 441 maternal deaths per 100,000 births in England and Wales. By 1950, there were 87, and in 1960 there were 39. Similar patterns obtained in other European countries and in the United States ...
In other words, it was not that women were less likely to develop obstetric complications, or more likely to survive complications in the absence of medical care, that led to low levels of maternal mortality in developed countries. Rather, it was the fact that women had access to treatment for complications... [F]or decades the focus of maternal health programmes was on antenatal care, screening of pregnant women, and training of traditional birth attendants to do clean deliveries. These activities were based on the assumption that most life-threatening obstetric complications can either be prevented or predicted...
The first antenatal clinics, which were introduced between 1910 and 1915 in Australia, Scotland and the United States, represented a new concept of care for pregnant women – the monitoring of apparently healthy women for signs of illness. It was generally believed ... that widespread use of antenatal care would reduce maternal deaths. But this did not happen...
The problem was (and still is) that the major causes of maternal death cannot be detected and averted during pregnancy. Post-partum haemorrhage, the leading cause of maternal deaths, can be caused by a number of events, such as a small piece of placenta being retained in the uterus, or the woman being exhausted after delivery. These problems cannot be predicted, even late in pregnancy, because they only happen during labour and delivery, or the post-partum period. Prolonged labour can be managed by medical intervention, such as use of drugs or caesarean section, but it cannot be prevented...
While some cases of infection will be prevented through clean delivery techniques, other cases of infection will still occur because infection can arise without being introduced from outside the woman’s body. For example, in the event of prolonged labour or prolonged rupture of the membranes without delivery, infection often arises from the damaged tissue itself.
Labels: maternal mortality
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