Quick link: NYTimes on maternal deaths in Tanzania

23 May 2009 at 12:28 pm 4 comments

This article in The New York Times is the first of three in a series called “Death in Birth: Preventable Losses.” There are some heartbreaking pictures that accompany the article, and of course the goals mentioned in the article–to lower the maternal death rate in Africa, where many women “die during pregnancy and in childbirth, largely from problems that can be treated or prevented”–are essential, important goals for the UN, WHO, etc. 

But the article is very dismissive of midwifery, and seems to suggest that the answer to this problem is simply to improve the implementation of the medical model of childbirth, rather than to use a midwifery model. For example, this is what the article has to say about traditional birth attendants:

In rural areas, many women use traditional birth attendants instead of going to the hospital. The attendants usually have no formal training in medicine or midwifery. Many doctors blame them for high rates of maternal death and complications, saying they let labor go on for too long, cannot treat complications and fail to recognize emergencies that demand hospital care. But many women are loyal to them. For one thing, the price is right. Around Berega, they charge about $2 per birth. A normal birth at the hospital costs about $6, an emergency Caesarean $15.

While there certainly may be traditional birth attendants (read a much more thoughtful approach to them here) who are less skilled than others, the mere presence of “formal training” (as opposed to apprenticeship) should not rule them out as birth attendants. I also cannot believe that price is the only reason women choose traditional birth attendants; this article does not consider the pull of culture and tradition, which can be enormously strong.

Furthermore, the article seems to highlight examples of less-effective practice even when implemented by “formally trained” birth attendants–essentially, physicians’ assistants and nurses. In one case, a baby is described as being delivered by a c-section formed by “a quick vertical cut,” rather than the safer horizontal incision. In another case–described in the article in the typical sensationalist “home births can go bad!” manner that is so common today in the media–a woman hemmorrhaged to death after birth. Why?

A case in the Tanzanian city of Moshi late last year reveals how suddenly a seemingly normal labor can turn into an emergency in which every second counts. . . . 

An autopsy found that Mrs. Khalidi bled to death because the nurse who delivered her baby failed to perform one basic task, essential to prevent deadly bleeding: removing the placenta after she gave birth.

Normally, pulling on the umbilical cord will extract the placenta. But the autopsy revealed that the cord broke off. The nurse apparently did not know how to reach into the womb to remove the placenta.

There is nothing here about normal, mother-directed delivery of the placenta, or about how midwives in the US today do not recommend “pulling on the umbilical cord” precisely because it can break off, leaving part or all of the placenta still inside. 

Clearly, the article highlights a terrible tragedy in Africa today, but I’m not convinced that the answer is more “formally trained” nurses–such as the one described above–and more cramped, unsanitary hospitals.


Entry filed under: Uncategorized. Tags: , , , .

a bend in the path An Old Book for New Homebirth Women

4 Comments Add your own

  • 1. Tara Morrison  |  30 December 2009 at 8:29 am

    Hello, I am pleased to see awareness even in the form of question.

    We have founded a nonprofit based on these articles, so much research has been done.

    I would like to say, there are multipe reasons a woman may choose to have a birth attendant. They range from cultural, economic to transportation and timing.

    I don’t believe the intent of this article was to discourage this practice entirely. Infact, understood as a long standing cultural practice, many programs have been inciated to thoroughly train current and upcoming midwives throughout Africa.

    It is almost necessary to invest in midwifery in Africa as transportation and communication often fail in the time sensitive action of childbirth.

    We have started an organization for maternal heatlh bringing global solutions to one location, and we have chosen to begin in Berega. Midwifery education and training is certainly an aspect we hope to bring to Berega.

    I am almost sure the words “birth attendant,” were used to not offend midwifery. However, midwifery in its tools and requirements are very different in Tanzania, compared to America.

    I thank you for shedding light on this and I hope to bring good news for midwifery in Berega as we go. I know we are both working for the same cause of maternal heatlh!

    Tara Morrison

  • 2. Tara Morrison  |  30 December 2009 at 8:38 am

    (In Tanzania, the requirements of midwifery are very different, if implicated at all. Though not without its faults, professional care in a hospital has a lower rate of maternal mortality. It is a still a high mortality rate at the hospital, but for what was reported, and unfortunately, much goes unreported, hospital births generally have a lower mortality rate than home births in Tanzania.)

    We can change this with midwifery initiave programs. Please lend and suggestions or support to bring these programs to Tanzania.

    I would welcome any future partnership.


  • 3. Kandace  |  30 January 2014 at 9:59 pm

    Hello would you mind stating which blog platform you’re using? I’m going to start my own blog in the near future but I’m having a tough time deciding between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design and style seems different then most blogs and I’m looking for something completely unique. P.S Sorry for getting off-topic but I had to ask!

    • 4. mfom  |  31 January 2014 at 7:59 am

      it’s wordpress.


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