Is Childbirth Safe?

Most women have, in the back of their mind, unasked questions about the safety of childbirth. The general knowledge that women used to die in pregnancy and childbirth leaves many holes in our understanding of the birth process. Why, exactly, did women die giving birth? We can find most of the answers to our questions by looking at data for maternal and infant mortality around the world. You see, as much as we like to think death from childbirth is a thing of the past, it is still very real in some parts of the globe.

How many women die?

About 529,000 women die worldwide every year during pregnancy, childbirth or the immediate post-partum. This is .4% of all pregnancies. However, there is a great difference between countries. Developed nations such as Japan and Italy have maternal death rates of .01%, while countries in sub-Sahara Africa or southern Asia have rates of 1%. The highest rates are Sierra Leone and Afghanistan, where 2% of all pregnancies end in death of the mother. When you factor in the number of pregnancies typical of women from these countries, 1 in 16 women will die while pregnant or soon after giving birth. These numbers are scary and outright appalling. Why is it that so many women die in childbirth?

Prenatal Causes

The first thing to note is that only 11-17% of maternal deaths happen during childbirth. Up to 25% of maternal deaths occur during pregnancy, before labor ever has a chance to happen. These deaths are more often caused by disease, unsafe abortion and violence than actual issues with pregnancy. In fact, violence is attributed for as many as 16% of the deaths of women in pregnancy all over the world. In contrast, actual problems with the physical process of pregnancy are rare. Pre-eclampsia and eclampsia occur in only 2.8% of the maternal deaths in developing countries (.4% in developed countries), and hemorrhage from placental problems in pregnancy is responsible for 4%. Ectopic and molar pregnancy are even more rare.

Between 50 and 71% of maternal deaths happen in the postpartum period (45% of those in the first 24 hours after birth). This is important because it tells us it is not necessarily the process of labor and giving birth, but how they are handled that determines whether a woman will or will not die.

Hemorrhage

The single most common cause of maternal death in both developed and developing countries is severe bleeding (hemorrhage). Occurring in 10% of live births around the world, and responsible for 25% of maternal deaths, post-partum hemorrhage is able to end the life of an otherwise healthy woman in two hours making it the swiftest of maternal killers. When there is quality first level care (a midwife in attendance or available), severe bleeding is quickly dealt with by either an injection of oxytocin or, when necessary, manual removal of the placenta. The small percentage of women who need further care are moved to a hospital for transfusion or surgical intervention.

Obstructed Labor

A similar picture emerges for the second most frequent killer, obstructed labor. While it is difficult to determine its frequency, it is estimated to occur in 4% of births and be responsible for 8% of maternal deaths. It occurs as little as 1% of births in some countries and as high as 20% of births in others. When a skilled midwife is available to assess the situation and a hospital available for surgical birth if necessary, results for mother and baby are much improved. In fact, only .7% of cases of obstructed labor end in death, however untreated cases that do not end in death can leave the mother suffering with long term or chronic health problems. In developing countries, obstructed labor is not always caused by fetal position. A common cause is malnutrition, especially in childhood, which prevents proper formation of the pelvis. Unfortunately, it is in these same developing countries where access to surgical birth for poor women is almost non-existent. It is more the result of poverty and lack of healthcare that kills these women than pregnancy or childbirth.

Infection

Infections account for 15% of maternal deaths. This is most unfortunate since majority of these occur among the poor in areas with little or no healthcare. It is not that the poor are unclean people, they simply do not have access to bacteria and virus free water. Without understanding the causes for infection, caring individuals can unintentionally do harm as was done in developed nations when childbirth moved to hospitals in the late 19th century. When an infection occurs, access to medical care is important for treatment. But again, the poorest of the poor do not have access to basic health care.

Understanding the causes of death, we begin to see three things. First, our lifestyle has a strong impact on our pregnancy outcomes. Good nutrition, adequate exercise and a safe environment can prevent many of the problems with pregnancy and childbirth. Secondly, most maternal deaths could be prevented with trained care providers treating illness and infection. Finally, even among the deaths caused by giving birth, most could be handled effectively with positive outcomes for mother and baby by a trained midwife. Being pregnant and giving birth are very safe when the mother has good access to high quality nutrition, access to basic health care and access to a hospital when it is needed.

Source: World Health Report 2005 Make Every Mother and Child Count World Health Organization

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