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Lessons in Maternal Mortality

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Blog Post written by 2012 Yoga & Seva Journey participant, Madeleine Shaw

Midwifery has always struck me as more of a vocation or calling than a career choice. I have never heard of anyone "falling into" it, for example, and the midwives I have had the good fortune to meet have been without exception models of competence, compassion and gravitas: one does not take such women lightly.

As part of our time spent with Shanti Uganda, on their 2012 Yoga & Seva Journey, we were briefed on the current state of this issue by Sister Mary, the birth clinic's Head Midwife. What she had to share was as eye-opening as it was devastating.

Participants listening to Sister Mary speak on maternal mortality in UgandaShe started her presentation by posing the question "Why are not all Mothers' lives valued equally?" (from a global perspective). African women are 175 times more likely than women in developed nations to die in childbirth: in Uganda alone 529,000 women die from pregnancy and childbirth-related complications, a rate of (conservatively - we'll get to that later) 435 per 100,000 live births. To put this in perspective, in Canada the rate is less than 10 per 100,000.

The causes are numerous, and, tragically,  largely preventable. Start with a high fertility rate (6.7 on average), add lack of access to birth control and abortion (the former is not widely socially accepted and the latter is illegal: 13% of the deaths detailed above stem from unsafe abortions), high rates of HIV and Malaria, the poor prestige of maternal medicine at medical schools, lack of emergency transit, cultural biases towards young women "proving themselves" as worthy through their fertility, and finally a male-dominated culture whereby a husband must grant permission in order for a woman's choices to be honored (choice of hospital, for example, or the amount of money available for transportation or extra care), and you have a recipe for needless mortality and morbidity.

Many conditions that are routinely treated at Western hospitals, for example hemorrage, infection, eclampsia and malpresentation or obstruction, are largely unable to be treated due to lack of supplies as simple as gloves and suture supplies. For a reality check we visited a small town hospital, where we witnessed a maternity ward that consisted of a dozen beds packed with wom

"there is a secret in our culture - its not that birth is painful, its that women are strong"

en in various states of labor and postpartum: there was practically no ceiling, no screens on the windows, no privacy, and obviously very few tools or people to assist these women in their hours of greatest need.

The delivery rooms (there were 2) were bare-bones basic, and the corridor outside them clogged with filthy discarded mattresses. The lone private examination room was reserved for families whose Mothers or babies were simply not going to make it. The lone operating theatre, with broken glass windows, was often left in disuse when needed due to lack of supplies.

It was hard for me not to flash back 6+ years to the births of my daughter and two nephews, all of which required medical intervention, and wonder how things would have worked out for us and our babies had we been Ugandan. 

By contrast, the Shanti Uganda birth house is an oasis of comfort, support and celebration. "Every birth is sacred" is inscribed in Luganda, the local dialect, on the wall of the two birthing rooms. Staffed by traditional Ugandan Midwives and Birth Attendants, and supported by a vibrant community that includes all manner of pre-delivery health checks as well as education for teen girls and income generation for mothers, it feels like the kind of place that Western hospitals, for all their modern equipment and supplies, could learn from when it comes to bedside manner: woman-centered, gentle and conscious care. Among my most moving memories or our four days spent on site at the Birth House was hearing a woman labouring in the room next to me, knowing that she was as well supported as she could possible be. (Only a few hours later, we learned she gave birth to a girl!)

How can you help? Support Shanti Uganda's pioneering work. Their goal is to create a training centre that will in turn lead to more birth houses throughout Uganda.



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