Saturday, December 30, 2006

Let them eat cake!

One of the most pressing global health problems is the issue of maternal mortality. Therefore, it is quite suprising to see the editor of Midwifery Today publish an editorial criticizing the world wide effort to stem the tide of unnecessary maternal deaths. In an article informed by nothing more than personal opinion, Jan Tritten criticizes this comprehensive effort because .... it doesn't have homebirth as the centerpiece! Imagine that. All those doctors, epidemiologists, public health workers and women's health advocates think that saving lives is more important than promoting homebirth!

According to an editorial in the Lancet:
"Making sure women throughout the world can give birth in a health facility, in the presence of a midwife, is the best strategy for substantially reducing maternal mortality worldwide, according to a landmark series of papers. The authors are calling on governments and donors to prioritize this strategy over alternatives, such as homebirths with a relative, traditional birth attendant, community health worker or midwife, to save the lives of over half a million women who die in pregnancy or childbirth each year"
These conclusions are the result of a comprehensive study of newborn, child and maternal survival extending over 3 years and comprising more than 100 scholarly papers written by hundreds of experts in maternal and child health.

To this body of scholarly work, Ms. Tritten responds with this absurd and inane comment:
In a series of papers, The Lancet recommends implementing its own plan, rather than working within communities in villages to find appropriate, committed individuals to train. I always find interesting how imperialism rears its ugly head with the idea that "we know what is best for you."
Ms. Tritten, I have some questions for you:

What is the maternal death rate in underdeveloped countries? Your editorial mentions nothing about how many women die of "normal" birth each and every year.

What are the leading causes of maternal death in underdeveloped countries? In order to know whether home based care would be effective in lowering maternal death rates, you would need to know, at a minimum, what the actual causes are?

What are the treatments that are needed to reduce mortality from the leading causes of maternal death? In order to know whether home based care would be effective, you would need to know what treatments are needed.

Can these treatments be implemented within the setting of a home? In order to know whether home based care would be effective, you must know whether the specific treatments can be delivered effectively within a home based setting.

The self absorption of homebirth advocates reminds me of nothing so much as Marie Antoinette. When informed that the common people had no bread to eat, she responded with "Let them eat cake!" When informed that homebirth with traditional attendants is resulting in the deaths of millions of women from lack of blood transfusions, lack of antiseizure treatments, lack of anesthesia and lack of operative facilities, the editor of Midwifery Today responds with "Let them train traditional attendants!" as if that could possibly address the problem.

I have argued repeatedly that the homebirth advocacy community suffers from a fundamental lack of knowledge about human birth as it truly occurs in nature (as oppose to the fantasy constructed by advocates). That the editor of Midwifery Today could condemn a massive world-wide effort to save the lives of millions of women, without so much as a shred of data, only confirms this devastating lack of knowledge.


0 Old Comments: