The other day I wrote about a Youtube mom who recently gave birth to her son and then recognized that her blood pressure was too high after she was released from the hospital. She immediately visited her OBGYN and then ultimately was hospitalized due to the severity of her condition, preeclampsia. You can follow her journey at R & L Life. She, her husband, and sister have updated viewers about how she is doing. Watching her videos shows how difficult it is for her doctors to get her blood pressure down after several days. It is all to show that warning signs during and after pregnancy are important to listen to and act upon as she did.
As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.
Earlier this month I wrote about Uganda’s move to use misoprostol for women who experience postpartum hemorrhage (PPH) during childbirth or immediately after delivery. PPH is the leading cause of maternal mortality for women around the world. 800 women die every day from complications during pregnancy and delivery; that is two mothers a minute.
Misoprostol, it has been found, is effective because it will stop a woman’s bleeding, can be taken in pill form and can be stored at hotter temperatures. Oxytocin, which is the gold standard for stopping PPH must be stored in cold temperatures to be effective. However, in low-resource settings electricity can be touch and go or altogether nonexistent.
Last year Merck announced that they have partnered with the World Health Organization as well as Ferring Pharmaceuticals to test the efficacy in clinical trials of using carbetocin, another medication that can stop PPH, but can be stored in hot and tropical environments.
The clinical trials began this year in 12 countries that included 29,000 women. Through its Merck for Mothers initiative, Merck has partnered with organizations in the United States and abroad to reduce maternal mortality around the world.
In low- and middle-income countries women continue to die each day during and immediately after childbirth mainly due to postpartum hemorrhaging (PPH). In fact, most maternal deaths in sub-Saharan Africa (440 every day) are caused by PPH. The World Health Organization’s strong recommendation to save mothers who experience PPH is to administer oxytocin, the most effective drug to stop hemorrhaging. The problem, however, is oxytocin must be kept refrigerated. … Continue reading Uganda Moves Closer to Using Misoprostol to Curb Postpartum Hemorrhage
You have probably heard the story of Tashonna Ward, the 25-year-old Milwaukee woman who recently spent hours in the emergency room due to shortness of breath and died after waiting too long. Ward was told that she would spend between two to six hours in wait time at the ER according to distressing posts on her Facebook page. Preliminary tests were performed on Ward and showed she had cardiomegaly, an enlarged heart, but she was never admitted despite having chest pains and tightness of breath.
After waiting 2 hours and 29 minutes in the ER, Tashonna Ward and her sister decided to go to urgent care. She never made it. She passed out en route and collapsed and died in the urgent care parking lot. The cause of death: hypertensive cardiovascular disease.
While many reports mentioned the emergency room wait times that led to Ward’s death, a few have reported that she developed cardiomegaly due to pregnancy complications from a miscarriage in March of 2019. In fact, the Milwaukee County Medical Examiner’s Report states that the “decedent did develop cardiomegaly during pregnancy.”
Every day 800 women die during childbirth or from pregnancy complications. This startling statistic represents women who not only live in sub-Saharan Africa where most maternal deaths occur but also throughout the world. In order to reduce the number of maternal deaths in low- and middle-income countries across the globe design teams, social entrepreneurs, innovators, and NGOs are creating innovative ways in which to save more … Continue reading 5 Maternal Health Interventions That Save Mothers’ Lives
The more technology improves in low-and-middle income countries the quicker mobile apps will be invented and scaled to better people’s live. We already know that banking apps have transformed the exchange of money and have helped economies like Kenya’s thrive. Now, innovators are looking to create more and more mobile apps to transform health care and save more lives. Sub-Saharan Africa has some of the … Continue reading New Maternal Health Mobile App for Tanzanian Women Seeks Crowdfunding
We are very pleased and excited to announce our new weekly chats all about maternal health with some of the leading maternal health experts, researchers, practitioners, and organizations in the world under the #maternalhealthchat hashtag. Starting on Tuesday, November 8 at 1 PM EST with Jacaranda Health we will host 30-minute chats each week all about maternal and reproductive health as well as the health of newborns. We will dig … Continue reading Announcing #MaternalHealthChat Starting November 8 With Jacaranda Health
Christy Turlington Burns is a mother, social entrepreneur, model, and founder of Every Mother Counts. As a result of her global advocacy work she was named one of Time’s 100 Most Influential People in 2014, Glamour Magazine’s Woman of The Year in 2013, and one of Fast Company’s Most Creative Minds in 2013. Christy is a member of the Harvard Medical School Global Health Council, an advisor to the Harvard School of Public Health Board of Dean’s Advisors and on the advisory Board of New York University’s Nursing School. She holds a BA from NYU’s Gallatin School of Individualized Studies and has studied Public Health at Columbia University’s Mailman School of Public Health. A four-time marathon finisher, Christy resides in New York City where she lives with her husband, filmmaker Edward Burns, and their two children.
Jennifer James: We are impressed that you are helping to spread the word about maternal health and mortality in the Unites States. When did it occur to you that there is a maternal health crisis in America?
Christy Turlington Burns: Soon after experiencing a childbirth complication following the delivery of my first child, I learned that hundreds of thousands of pregnancy and childbirth-related deaths occur around the world every year. Yet, up to 98 percent of those deaths are preventable. Once I knew about these shocking statistics, I had to know why this was happening. This led me to make a documentary film, “No Woman, No Cry,” which examines the state of maternal health in four countries Tanzania, Guatemala, Bangladesh and the United States. While making the film, I learned that while 99% of these global deaths occur in developing countries, we lose three women per day in the U.S. too.
The morning I spoke to Dr. Jean Chamberlain Froese she had just come off of a late shift delivering babies at St. Joseph’s Hospital in Hamilton, Ontario. Two of the expectant mothers in her care during the night were African. One expectant mother hemorrhaged directly after delivery and the other who had undergone female genital mutilation (FGM) needed it to be wholly reversed before she could deliver her baby. Dr. Chamberlain Froese was able to successfully reverse the FGM and saved both mothers’ and babies’ lives during delivery.
Just another day at the office.
Given each of the mothers’ obstetric complications if they still lived in Africa, the probability is they would not have survived their deliveries. In fact, 800 women around the world, particularly those who live in low- and middle-income countries, die every day during childbirth from largely preventable causes like postpartum hemorrhaging or obstructed labor. In Canada, both women survived and delivered healthy newborns. In Africa, that likely would not have been the case. After caring for these women, the lingering question arose again for Chamberlain Froese: Why is it that women who deliver in the West are more valuable than other mothers? Continue reading “Maternal Health Heroes: Interview With Dr. Jean Chamberlain Froese #MHHSS”
Speaking with Dr. Priya Agrawal, Executive Director of Merck for Mothers, for this latest interview in our Maternal Health Heroes Summer Series, I instinctively realized that she is not only a gifted communicator with a passion for women’s health, but also an infectious advocate for safe motherhood both in the United States and worldwide.
Merck for Mothers, a 10-year, $500 million initiative aimed at reducing maternal mortality, was launched in 2011 and initially set robust goals to reduce women’s deaths during childbirth in low- and middle-income countries. Like many in America, Merck for Mothers failed to initially realize at the time that maternal mortality in the United States is a persistent problem that is steadily worsening. In fact, that line of thinking is quite understandable given most of the 800 women who die every day during childbirth live in sub-Saharan Africa and Southeast Asia.
The good news for women living in low- and middle-income countries, however, is maternal mortality has drastically been reduced by 45 percent since 1990, a marked change despite the future reductions that still need to occur during the Sustainable Development Goals era. Sadly, in the United States the numbers are not improving. “The United States is the forgotten child when it comes to maternal mortality,” Agrawal mentions. “We learned very quickly that even in our backyards we had to do something. Maternal mortality has more than doubled in the United States. The trend is going in the wrong direction.” Given the amount of money spent on health care in the United States, we experience the highest maternal mortality ratio than any other developed country in the world.
I have often focused on maternal health and mortality around the globe especially where the deaths rates are the largest, but there is much-needed sustained discussion about maternal mortality in the United States. I have detailed the problem in several previous posts here including:
Periodically I will share news and updates about what is happening in the maternal health space in the United States including the successes and failures to save more women’s lives as well as the key players who are making a difference.
Michelle Hartney has been an artist and activist for maternal health and obstetrics since the birth of her daughter and son: Shine and Seamus. While she says both of her deliveries were empowering, they were also very troubling prompting Hartney to create awareness through art about the high maternal mortality rate in the United States as well as obstetric abuse that she says is all too common for women across the country.
“I was shocked to discover that the way American women give birth now is rooted in a past that is riddled with misogyny, racism, and abuse. As I was reading as much as I could about the history of obstetrics in America, I was filling up my sketchbook with ideas and was flooded with visuals and topics that I wanted to make work about.”
For Hartney’s second delivery with her son, her doctor did not deliver her daughter, but she was instead assisted by a resident who wasn’t going into the field of obstetrics. She ended up fighting with the resident and a nurse about wanting to deliver her baby on her side; an option previously agreed upon by she and her doctor. Instead, they forcefully told her to “lie on her back” to deliver. Since Hartney had a doula who advocated for her during childbirth she was able to deliver on her side in four pushes, but the experience was difficult for her to handle.
Maternal health remains one of the most elusive Millennium Development Goal to achieve. While maternal deaths worldwide have been nearly halved since 1990, there is still a long way to go to ensure that more women’s lives are saved during childbirth. Currently 800 women lose their lives during childbirth due to largely preventable reasons. According to the new report, Strategies Towards Ending Preventable Maternal Mortality, by 2030 the maternal mortality ratio should be no larger than 70 deaths/100,000 live births and no country should have a MMR of 140 deaths/100,000 live births.
How can this be achieved?
The new report calls for more wellness-focused healthcare as opposed to emergency-focused care for expectant mothers despite available resources. Most importantly, the post 2015 maternal health framework is rooted in human rights for women and girls. In order to save more women’s lives, there needs to be a cross-sectional system of integrated care. According to the report, more women, girls, and communities need to be empowered to recognize gender equality and empowerment. Mothers and newborns must have integrated care as opposed to caring for both independently.