"But women used to die in childbirth *all* the time" - Page 2 - Mothering Forums

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#31 of 44 Old 11-07-2007, 02:10 AM
 
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Originally Posted by wagamama View Post
We are living in Nigeria at the moment, and UCs and homebirths are the norm, except for the very rich. It seems, anecdotally, that a lot of babies die during or shortly after childbirth. I'm surprised at how often I hear such stories from local people. I haven't heard any stories of a mother actually dying.
It's always that way - maternaty mortality is always measured at least an order of magnitude above neonatal mortality, even here. Some of the folk practices of many cultures contribute to this, by the cord practices (cutting the cord with unsterile instruments is a BIG problem), denying colostrum, etc.
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#32 of 44 Old 12-24-2007, 10:53 AM
 
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Thank you for this wonderful thread!! I am pregnant with my second baby, and although the birth of my DD couldn't have gone better, and was intervention-free and midwife assisted, a family member has me on edge because women used to die in child birth *all* the time. They weren't aiming to upset me, it was all very much in context of what we were talking about (strangely enough). I am planning a home birth this time (last time, it was midwife assisted in a hospital), partially because the birth of DD went so incredibly fast, I fear I will give birth in a grocery store! So yeah, home is best

I googled statistics for Canada and found http://www.phac-aspc.gc.ca/rhs-ssg/matmort_e.htm from the Government of Canada website stating that in Canada, as of the 1990's, the maternal mortality was less than 5 in 100,000. That's pretty good! The slight rise in the chart in the 1930's leads me to believe a lot of the high statistics in the past is due to poor nutrition (the depression?).

Anyhow, I am very happy that I came across this thread, and I feel much better now
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#33 of 44 Old 12-26-2007, 02:49 AM
 
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When I read A Midwives Tale I was struck at how Few women died. I think 4? I don't think we have odds that good today. I feel that if birth was so dangerous then we woudn't have the population we do today. Esp in the 3rd world countries where medical care and hygiene are non existent. Yes, Medical care has saved lives that once would have been lost but its also taken lives that wouldn't have been lost before so its a wash. Or worse, when drs weren't washing between patients and corpses and disease spread, I am sure more women died than were saved.

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#34 of 44 Old 12-26-2007, 04:27 PM
 
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Yes, Medical care has saved lives that once would have been lost but its also taken lives that wouldn't have been lost before so its a wash. Or worse, when drs weren't washing between patients and corpses and disease spread, I am sure more women died than were saved.
I'm not online long today, but I did recently read something somewhere about this. The article cited maternal mortality rates of about 25% in the "lying in" wards, and said some of them reached 100%. This was a long time ago, when birth first moved into the medical field...but it was also much, much higher than the maternal mortality rates that were occurring outside the wards. However, while I'm sure rumours were spread, those women simply didn't have access to the kind of information we have, and probably didn't really realize just how many other women were dying.

Sometime in the next few days, I'll try to find where I read this stuff, and post it. It wasn't that long ago.

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#35 of 44 Old 12-26-2007, 04:35 PM
 
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There was a book about Semeilweis that had a bunch of info on that I just read. Also Birth as an American Rite of Passage, The American Way of Birth, and really pretty much any book on the history of midwives, unless it was written by an OB.
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#36 of 44 Old 12-26-2007, 04:48 PM
 
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Originally Posted by Arwyn View Post
It's always that way - maternaty mortality is always measured at least an order of magnitude above neonatal mortality, even here. Some of the folk practices of many cultures contribute to this, by the cord practices (cutting the cord with unsterile instruments is a BIG problem), denying colostrum, etc.
Not to mention that some babies are born with medical problems. Some of these babies would still die even with modern medical care, and others would become NICU babies, requiring oxygen, a feeding tube, and/or surgury before being healthy enough to go home. A baby who can't breathe or eat isn't going to live very long.

Not all neonatal mortality is related to birthing practices.

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#37 of 44 Old 12-26-2007, 04:51 PM
 
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Well, of course. We're never going to have a 0% neonatal mortality rate. It's simply impossible. Anyone who says otherwise is kidding themselves. There are, of course, things we can do to affect the rate one way or another, but it will never ever be zero.
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#38 of 44 Old 12-26-2007, 05:20 PM
 
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It seems that there are really 2 conversations going on here:

1.) Why people have a fear of birth, why our culture supports that fear, and how modern medicine contributes to this atmosphere

and

2.) Actual reasons for materal and infant mortality- historically and today

These are really 2 very different things.

In the US, birth is not something to be feared. Even home births are usually within close enough proximity to doctors and hospitals that with a trained midwife, a healthy mother, and adequate resources, the outcomes are overwhelmingly successful. Addressing our cultural fear of birth and why we view it as a medical procedure is important.

For the second aspect, I think that it is important to address that not everywhere, for everyone is birth "totally safe" and death is not the only possible negative outcome. For example, fistulas in very young women (girls) in many parts of Africa are not fatal (though usually the long and difficult labors are for their babies), but it essentially ruins their lives anyway. In many parts of the developing world, there are no doctors for when things do go wrong. Sanitation and nutrition are scarce. Girls are married at a very young age, before their bodies are ready for babies. In the chant for "no c-sections, no medicalized birth" we need to remember that who we are directing this toward are women in industrialized countries with adequate medical support and other resources. The foundation of the senitment is universal, but millions (billions, really) of women do not have the option, support, or facilities, a march against doctors and care is directly in opposition of their best interests. In addition, in sub-Saharan Africa in particular, AIDS is a HUGE issue, with some places having a 50% HIV positive population. Without drugs at or near the time of birth and accurate information and assistance, there is a much, much higher risk of mother-infant infection.

I guess what I am trying to say is that there are different issues and difficulties facing women in different parts of the world.
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#39 of 44 Old 12-26-2007, 05:37 PM
 
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imho there are a LOT of issues being discussed here but I think having soundbites and quick one liners is the ultimate goal for the OP as a way to get the "hook" and then the cold hard facts as a means to back them up.

I don't personally have any of those case studies or statistics that were originally asked for (I'm a BIG citations gal, meself! ) but I am quite interested in what I am reading here.

For me the phrase is "you are so BRAVE to have a baby at home....I would be afraid of something going wrong." or something to that effect, as an aside.

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#40 of 44 Old 12-26-2007, 09:11 PM
 
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In the chant for "no c-sections, no medicalized birth" we need to remember that who we are directing this toward are women in industrialized countries with adequate medical support and other resources.
I'm curious about your reference to the "chant for no c-sections...". I spend a lot of time (too much) here and on the ICAN support list, and I can't recall anyone in either place ever saying "no c-sections". I've seen a lot of people say that too many are being done, and that they're often medically unnecessary, but I haven't seen anyone say not to do any.

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#41 of 44 Old 12-27-2007, 08:32 PM
 
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To the OP:

THANK YOU for an excellent thread topic. This topic first interested me when I started researching my family history. I have poured through local death registries, (both online and in archived hard copies), from 100 and 200 years ago. Many of these list the causes of death, and it caught my attention that I have only RARELY encountered women dying in childbirth. Infants died a lot more often, but it wasn't always connected to the birth itself.

Granted, the best I can offer you is what I have seen anecdotally. I have yet to encounter a study to confirm my hypothesis that the "double tombstone" scenario did not occur as often as we've been led to believe!

The research concept is pretty easy, but it would take a historian with a lot of time and resources to gather a large sample of these town records, control for various environmental factors, and compile the stats. But it definitely could be done!

When looking at past deaths, it's fair to consider that doctors didn't have as much medical knowledge as what may be required to determine causes of death.

Then there's the more recent past and the present. From the time that hospital births became the norm up until today, mortality reporting has been laced with politics. Doctors have been able to fudge charts and manipulate wording in order to suggest that women and babies have died from causes OTHER than childbirth. All of this happens to keep up appearances; hospitals are PERFECTLY safe and doctors are NEVER fallible. It makes you wonder what the honest U.S. childbirth mortality rate might look like....

As PP's have suggested, Cassidy's book is certainly a good start, but I think hitting the original sources would ultimately be better. Next time I'm on campus in my infinite spare time I'll see if I can find anything in the history journal abstracts. It should only take a quick keyword search...

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#42 of 44 Old 12-27-2007, 09:11 PM
 
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Well, of course. We're never going to have a 0% neonatal mortality rate. It's simply impossible. Anyone who says otherwise is kidding themselves. There are, of course, things we can do to affect the rate one way or another, but it will never ever be zero.
But there seems to be a cultural assumption that it COULD and SHOULD be zero. If you look at any given case of neonatal death, there's very few that feel completely inevitable. Even when a baby is born extremely prematurely, we've got the March of Dimes working hard to find out WHY that baby was born too early and how we could have kept it in there longer so it would survive. We're ever advancing the technologies to resuscitate and sustain the life of extremely premature infants. We do ultrasounds that, in the grand scheme, appear not to have any statistical effect on neonatal mortality, on the off-chance that SOME child SOMEWHERE will be saved by knowing before birth that they have a heart defect or a defective liver or something.

The GBS protocol is an excellent example. We're injecting multiple doses of penicillin into about a million women a YEAR to save, maybe, 325 babies' lives. Yes, sepsis is the #1 cause of neonatal death, and GBS is the #1 cause of sepsis, but the CDC's own statistics say that a colonized mom has a 1 in 200 (0.5%) chance of birthing a baby who develops an early-onset infection, and that those babies have a 6.5% death rate.

Half a percent of a million (which would be just shy of 25% of the number of live births the US experienced in 2000; given that 30-40% of women will test GBS positive, and the number of births has likely gone up with population increases, but some women will decline testing or antibiotics or avoid birth locations where it would be routine, it seems a reasonable figure) is 5000. Five thousand babies a year would have gotten sick without this protocol; with it, 250 STILL will, *and* will have been pumped full of antibiotics already (CDC reports that the antibiotic protocol drops the transmission rate from 1 in 200 to 1 in 4000; it does NOT make it zero). We are using one million women's bodies every year as a lab to create a superbug, to save 325 lives of newborns. I don't have statistics on how many women or babies die from anaphylactic reactions to penicillin or other complications from the antibiotic treatment, so we probably don't even save that many. Also, subtract out the 16 babies who get sick and die anyway even though mom DID get the abx.

"Number one cause of death" is a dangerous phrase. Someday, maybe we'll wipe out neonatal mortality completely, and then some woman is going to have an unplanned UC next to a swamp out in the bayou when their car breaks down, and an alligator is going to eat the baby. Then alligators will become the number one cause of death among US newborns, and the CDC will have to have them all hunted down and turned into boots.
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#43 of 44 Old 12-27-2007, 09:18 PM
 
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"Number one cause of death" is a dangerous phrase.
A long, long time ago, I mentioned to someone that the number one cause of death is life. I think she thought I was crazy, but I stand by it. With respect to neonatal death...I've gone through a million things that I could have/should have done differently that might have saved my son's life. They're all maybes...except one. The only way I could have guaranteed that he wouldn't have died is if we'd never conceived him at all. There are no guarantees in birth, just as there are none in life. Obviously, I wish it hadn't happened. I wish something that started out with so much hope and was so exhilarating hadn't turned into my worst nightmare...but nobody ever guaranteed that it wouldn't. I've taken that chance every time I've become pregnant - and I plan to roll the dice again.

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Someday, maybe we'll wipe out neonatal mortality completely, and then some woman is going to have an unplanned UC next to a swamp out in the bayou when their car breaks down, and an alligator is going to eat the baby. Then alligators will become the number one cause of death among US newborns, and the CDC will have to have them all hunted down and turned into boots.
:

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#44 of 44 Old 12-27-2007, 10:08 PM
 
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There are no guarantees in birth, just as there are none in life.
Very True!

This is the thought I had at the end of each of my four pregnancies.

Each ended well. There is always a little luck involved all of the time.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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