World Pulse

Women Birth a New Vision for Maternity Care

Corine Milano
Posted May 13, 2013 from United States
© Gates Foundation

When it comes time for a woman to face the real dangers of delivering a child, she often finds herself at the mercy of her circumstances. Read five stories, each offering a potential solution, from the front lines of this global crisis.

Recommendation: Make Health Care Facilities Safe and Accessible

NIGERIA: Deliver to Decipher

When the time came for me to deliver my first daughter, my maternal grandmother took me aside and told me to sit down. “There is no pain as that of child birth,” she said. “It is indescribable. Delivery can only be done by God. Put your faith in him. As for the doctors—forget them.”

Her words made me deeply afraid for what I was to experience next, and my mother’s words only confirmed my fears.

“Has she explained everything to you?” she said. “It will be painful.”

True to their words, my labor was the most horrific experience of my life. My relatives prepared me for the physical pain, but I was not alerted to the conditions I would meet in Nigeria’s health care facilities.

I went to the hospital to deliver my daughter on April 25, 2002. Pain gushed out of me like the flow of a river. I screamed, expecting soothing medications to reduce my pain, or at least soothing words to help me through. Instead, one of the nurses shouted at me: "Shut up! It is time for you to know that a baby’s head is bigger than a man’s manhood."

At the hospital, there was not a single doctor. The room was crowded with women in various stages of delivery. We were forced to labor on benches, as there was only one bed. When the baby crowned at the birth canal, women would be transferred to the only available bed.

A nurse sternly warned me not to push, despite my baby’s insistence on coming into this world. When I could not take it any further, I screamed and the nurse almost hit me. "I told you not to push! No space for you to deliver!"

The pain of attempting to stop my labor made me cry out in more pain. I pulled my husband aside and gave him these instructions: "If I die, ensure that you take me back to my village for burial. I do not want to be buried in Lagos, or in your village." He responded with a hiss.

When my baby was finally delivered, she could not breathe. The nurse looked at me straight in the face and said, "Witch, you have killed your daughter." She handed the baby to my husband and said, "She is a still birth. Your wife killed your child."

I began to cry as my husband wrapped a scarf around the baby to prepare her for burial. But suddenly, a doctor who arrived just in time took the baby from his arms. I don’t know how, but by some miracle of God he was able to revive my daughter. Relieved, I fell asleep.

I woke in a pool of blood—the nurses had forgotten to stitch my vagina where the episiotomy had been performed. I recovered after eight days in intensive care.

These horrible experiences happened in one of the largest hospitals in Lagos. I was lucky to survive. My daughter, whom we named Oluwatobiloba meaning 'God is a Great King', was lucky to survive. Every day, women are sacrificed at the altars of medical negligence in Nigeria.

I could quote statistics of maternal deaths in my country, but they would be useless: official numbers do not represent the actual quantity of casualties we see daily. I call on our government to commit to proper funding and staffing for our health care system. We must all come together to reduce the number of women and infants buried in the graveyards of Nigeria.

Recommendation: Hold Healthcare Providers Accountable

CAMEROON: The Sour Taste of Pregnancy

As a young woman who has had three pregnancies and is now a mother to two children, I have had my share of the deplorable conditions expectant mothers in Cameroon face every day. I have also heard countless tales that echo my experience from other women in my community: unnecessary surgeries, unscrupulous medical personnel, lack of nurturing caregivers during pregnancy and delivery—there are so many sour experiences where maternal health is concerned.

Labor for my first child began at night so I was rushed to the hospital at about 10pm. The midwife in attendance was asleep when I got there. She was so unhappy because I interrupted her slumber. This made her very hostile towards me throughout that night, and if not for the timely intervention of more accommodating colleagues I wonder how that delivery would have ended.

My second pregnancy terminated in a miscarriage that could have been avoided if I had met committed health workers when I got to the hospital. Instead of getting me checked in immediately, I had to insist that my situation needed urgent attention. Finally, they offered to admit me as an in-patient but kept me waiting with no care whatsoever. That was how I bled until I finally lost my second baby.

With my third pregnancy, I had very poor prenatal care in the hospital where I registered: No lectures on my first visit, no essential tests, and an arrogant midwife who would not answer my simple questions. I eventually evaded this hospital to give birth in a private clinic where the workers were more hospitable. However, when I got my bill at the end, it had been consciously inflated.

More evils exist when it comes to maternal health care in Cameroon. Mothers are not given adequate information to sustain them throughout pregnancy. Some of them lose their premature babies because they were not incubated on time. Some get infections because their after-birth tears were not stitched. Some lose their babies right after they are born because midwives are too busy to attend to them. Some bleed to death because no medication is given to control abnormal bleeding. The list is just endless.

The truth is a lot of nurses, midwives, and medical doctors are not passionate about their jobs. They are more passionate about money. Pregnant women who need premium care continue to be their victims. According to a World Bank report published in 2012, as of 2010, 690 women in Cameroon died during pregnancy and childbirth per 100,000 live births. This number can be greatly reduced if the ills plaguing maternal health are curbed.

I call on my fellow women to study intensely when they are pregnant. We need to stand up for ourselves and put our health first. Let us empower ourselves with knowledge and choose the better health institutions over the bad ones. Pregnant women carry the future generation and we need appropriate care!

Recommendation: Bridge the Distance for Mothers

INDIA: The Story That Hasn’t Changed

Few people are aware that Mumtaz Mahal—for whom the Taj Mahal was built—passed away while giving birth to her 14th child. Nobody knows that the Taj Mahal is both a tribute to love and a tribute to motherhood. Did Shah Jahan, or any other emperor, give a thought to how they can improve childbirth conditions so that no other woman succumbs to death while bringing a new life into this world?

That was in 1631.

In 2011, in Madhya Pradesh, a state with one of the worst maternal mortality statistics, 22-year-old Sheena was rushed to the nearest government hospital with her husband. Her husband had to run from each corner of the hospital to get the attention of a doctor or nurse. Sheena had to wait 28 hours to get medical attention; she died while giving birth to her first child. Had she been given timely attention, Sheena would be alive today to care for her newborn girl.

Is India not a country for mothers? Here, a woman dies every eight minutes during childbirth. For every maternal death in India, 20 more women suffer from lifelong health impairments that result from complications during pregnancies. Approximately one quarter of all pregnancy and delivery related maternal deaths worldwide occur in India. In Uttar Pradesh, caste discrimination is an ingrained part of the medical system, and that contributes to rising maternal deaths.

"Upper-caste health workers refuse to visit Dalit communities," said Lenin Raghuvanshi, a rights activist. "Because of that pregnant Dalit women do not nutritional supplements and the majority of them are anemic."

It's not just mothers who die in my community. Babies are stillborn and many are premature. Those who survive are at risk because their mothers are not there to care for them.

There are three major reasons why women die during childbirth—

  1. Pregnant mothers or their families often fail to recognize and seek medical help quickly enough when a complication happens. This is due to illiteracy in families and communities. Women do not have adequate access to education, and many use ineffective home remedies due to traditional myths.
  2. Many mothers die at home or on their way to the hospital due to lack of preparedness for any complication, lack of access to transportation, or because they were referred from one hospital to another. More than half of childbirths in India still happen at home, and in many cases skilled attendants are not available. Thus, women seek medical attention when it is too late.
  3. Even if a mother gets to a hospital in time, there is no guarantee that her life is safe. The right medical facilities, trained professionals, medicines, and supplies are not available. According to the National Family Health Survey II, less than 30% of community health centers had an obstetrician available; less than 10% had an anesthetist.

But there are solutions. We must plan interventions at the community level to raise awareness of danger signs and improve access to information, communication, and transportation. And we must make quality care available to all pregnant women in India if we are to make any dent in maternal mortality rates.

Recommendation: Make Birth a Compassionate Experience

US: Coming Into The World In Violence

Arrive in pain. Sign papers. Strip down to a thin little gown. Hook you up to machines that beep loudly and irritatingly so. Stab you in the arm with a needle for an I.V. because you can’t eat for 8+ hours and they need to make sure they can give you drugs at a moment’s notice. Stay in bed. Do not get up unless you ask permission. Lay on your back. Open your legs. They push Pitocin because you’re not going fast enough; cue the intensity of your contractions skyrocketing. Person you’ve never met before is between your legs, giving you orders on how to deliver your child. The sound of scissors unnecessarily cutting a perineum. Push on command in a room full of spectators wishing you’d hurry up and give birth already. Pull baby out. Suction its mouth and nose upon arrival. Cut the cord prematurely. Show you what the baby looks like. Take the baby away to be weighed, poked, prodded. At some point, sign more paperwork while you’re trying to breastfeed.

Welcome to motherhood.

Currently, this scene is incredibly common in many hospitals across the world. From my experience, there are varying levels of how intensely this scenario plays out. After the five births I have attended as a doula, I made a decision to never give birth in a hospital unless it is a dire emergency. Why would I want my child to come into the world so violently?

It is hard to have 'birth' and 'violence' in the same sentence; and yet, in the US where it’s more dangerous to give birth than in 49 other countries, the violence and death is real. African-American women are at almost four times greater risk than Caucasian women. A safe pregnancy is a human right for every woman regardless of race or income. From my experience, this disproportional rate of risk for African-American women grows to include all and any marginalized women in my country. I often pose the question: What message are we sending future generations by bringing them into the world like this? What is happening around the world to birthing mothers is nothing short of mental and physical coercion and abuse.

We have been convinced that home birth is dangerous and that the only safe way to give birth is in a hospital—an idea that is younger than the history of women giving birth in the world. The secret to why many women end up feeling safer in a hospital is due to the underlying notion that a woman’s body is dangerous, and therefore, childbirth is dangerous. It too may as well be a sickness that should be monitored and controlled.

We are coming into the world violently, and this must end. We must find a way to make birth a compassionate, safe, and loving experience for women and their families.

Recommendation: Seek Support from Male Allies

NIGERIA: What I Learned From my Mother

I always wondered why my mother separated from my father. It took years for her to tell me why she had to leave. According to her, my father neither cared for her nor showed her love while she was pregnant. My mother lost three pregnancies before giving birth to me, and on those occasions my father was not around to give her the love, care, and support she needed to overcome the trauma of miscarriage. Instead, he always complained about the money he had to pay at the hospital.

She said the breaking point was when she gave birth to me, and she had complications that almost took her life after childbirth. Rather than focusing on how the doctors could help her to survive, he was busy questioning my paternity. This was because I was "very dark" in complexion and my father is very fair in complexion.

My mother’s story was a nightmare for me; I kept wondering why my father was displaying such gross irresponsibility at a time when she needed him most. I thought my father was the most wicked man on earth—until my mother tried having another husband. The man was very kind until my mother got pregnant. That was the last we saw of him.

As if this was not enough, my mother tried a third time at having a husband, which led to more tragedy. After impregnating my mom, the man took off again and my mother was left to raise all of us children alone.

The men in my mother’s life represent one category of men who do not value women and their childbearing roles in our society—but they are not representative of all men. I have been privileged to work with many male allies who value and care for women. They are remarkably different to the men in my mother’s life. They have love in their hearts and are able to feel the pains that women experience during pregnancy and childbirth.

All over Nigeria, the work of our male allies is making a difference for women. In Kano and Kaduna States, male members of the National Union of Road Transport Workers provide emergency transportation to health facilities for women in labor. This project has helped save the lives of many women who otherwise would have died as a result of pregnancy-related complications. The men who are involved in these activities have reported that they are increasingly more appreciative of the value of childbearing and the importance of their own supportive roles. They will likely not treat their pregnant wives the way the men in my mother’s life treated her.

Men’s active participation in caring for their wives, girlfriends, or mistresses during pregnancies is key to finding solutions to maternal mortality challenges in Nigeria. Men can and should play a role in addressing maternal mortality in Nigeria. Many a time, the lack of care and love exhibited by men towards the pregnant women in their lives makes childbearing a traumatic and risky venture for women.

No matter how well equipped our hospitals may be, if the care, love, and support of men is missing, efforts at reducing maternal death will continue to be a mirage.

Today, I celebrate my mother for her resilience and bravery, and I celebrate all women who labor to bring the next generation into the world. Moreover, I celebrate the men who stand with women to put an end to the deplorable conditions pregnant women face.

Comments 6

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May 22, 2013
May 22, 2013

Exactly. You are to the point

May 28, 2013
May 28, 2013

So, it happens too in Lagos. Even here in Abuja, in one of these Government hospitals, the story is horrible! I am still not sure if these nurses know the meaning of the name they are called- midwives, and the symbolism of the uniform they wear- white. Well, I am not here to preach. May God forgive them, all the same.

May 31, 2013
May 31, 2013

I must confess that I am sad reading this story to the point I ask my self does this really happen? I have given birth twice and I have never experienced any bad situation.

The hospital where I go to deliver is very clean and has very respectful staff and the price is well lets say friendly to the pocket(affordable).

I thank God for our country and the far we have come and PRAY that God will instil discipline in the hearts of midwives and nurses to always be careful of how they treat mothers to be and the babies to be born.

May 31, 2013
May 31, 2013

I did not mention my first two nights before the delivery date, I only started from the delivery room. The day I began to experience labour and the water burst was not the day I delivered, I slept at the back of a PICK UP PEUGEOT VEHICLE in the premises of the hospital. It was my first labour, I was afraid to go back home in case the baby decides to force her way our along the road and there was no bed for those who are yet to deliver their babies.

My husband sat down all night watching over me and scaring the mosquitoes away. My experience with Medical Center even after delivery, if narrated will be considered as tarnishing the image of my country. Government hospitals are cheaper, but then, I will never take such risk again.

My conclusion is just solution, not narrating heart-breaking experiences. transformation and not apportioning blames. I have experienced it, I survived, how other women and my daughters too, will not experience same is my concern.

Thank so much for the comments.

Betty B. Ackah
Jun 06, 2013
Jun 06, 2013

Heartrending story Olutosin. I applaud your ability to rise above this and actually use your life as a means to achieve social change!

This is and even more heartrending because it is the stark reality for so many women... I was speaking to a friend who gave a similar experience about having the nursing staff try to push back her baby into her because the staff and labour ward weren't ready yet!

We shall overcome

Jul 28, 2013
Jul 28, 2013

Hi Titi,

This is a wonderful write-up and recognition of the role that men play in creating a better world for women. To make any long-lasting and sustainable change, we need to have both men and women on board and working together.