A PBS series tonight chronicles the story of Mozambique, where the maternal mortality rates had reached such crisis levels that they decided to train midwives to do obstetric surgery.
Sub-Saharan Africa is the world’s deadliest place to give birth. Each year over a quarter of a million women die in childbirth in the region. But Mozambique is combating high maternal death rates by implementing unconventional programs.
I have only seen the preview, which you can also watch here. Despite the rather dramatic tone (why do they have to make childbirth seem so scary?) I like the sound of the show.
Midwives often take the blame for high maternal mortality (and infant mortality) in developing countries. They are demonized when governments (both local and international) step in and build hospitals and try to “modernize” maternity care. The midwives are portrayed as backwards, uneducated and elderly. Rather than work with midwives, often this process is rather imposing, attempting to force all women to give birth in the hospitals they build with doctors instead of midwives.
There are many problems with this approach, as transportation to the hospitals built in primarily urban centers in a challenge. Additionally many of these hospitals don’t even have the resources they need (doctors, medicines, equipment) and are not providing much better care for all women than the midwives.
Much of my opinion comes from some time spent in Ecuador, both working at the public maternity ward and talking to midwives in different parts of the country.
So approaches like training midwives to do some emergency surgeries, in addition to other basic skills (like when to take a woman to a hospital) seem like a good solution to me. In the US, midwifery care remains at odds with the ob/gyn practice, I think that’s mostly a business concern. There is no reason why other countries can’t adopt a diverse a multi-tiered system. I know of another program called Nueve Lunas (nine moons) in Mexico that provides additional education for rural indigenous midwives. (Note, the link for that school is in Spanish)
The show premieres Tuesday July 15th on PBS.