Maternal Health

Maternal health is the health of women at the time of pregnancy, childbirth, and after childbirth, though it includes the concepts of reproductive health and family planning as well. Prenatal care and postnatal care are highly recommended by physicians to monitor the health of the mother and the unborn child to detect and prevent complications, ensuring a safer pregnancy. A safe pregnancy also involves good nutrition and a healthy lifestyle. Ideally, the positive outcome of a pregnancy is a full-term pregnancy, a safe delivery of a healthy baby, and a complication-free postpartum period.

However, limited access to health services contributes to maternal mortality. Decreasing maternal mortality has been identified as one of the eight Millennium Development Goals.

Monitoring Maternal Health

Prenatal Care

During pregnancy, women chose to use a midwife, traditional birth attendant, or a physician for their prenatal care. The health practitioner will teach the woman about pregnancy, suggest vitamins and supplements, perform physical exams, monitor the mother’s health, and run tests for the health of the baby. In general, the recommendation for a low-risk pregnancy is Weeks 4 to 28: 1 visit per month (every 4 weeks), Weeks 28 to 36: 2 visits per month (every 2 to 3 weeks), Weeks 36 to birth: 1 visit per week. If the pregnancy is considered high-risk, more visits are most likely required. The recommendations vary slightly between countries.

Postnatal Care

After childbirth, postnatal care serves to monitor the mother’s readjustment. Prenatal care monitors blood loss, breastfeeding, passing of urine and opening of bowels, uterine contraction, and overall healing.

Pregnancy-related Health Issues

Depression

Approximately 1 out of 10 women experience depression during pregnancy.^[1] It also increases the likelihood of developing postpartum depression. The symptoms of depression during or after pregnancy include: feeling restless or moody, feeling sad, hopeless, and overwhelmed, crying a lot, having no energy or motivation, eating too little or too much, sleeping too little or too much, having trouble focusing or making decisions, having memory problems, feeling worthless and guilty, losing interest or pleasure in activities you used to enjoy, withdrawing from friends and family , having headaches, aches and pains, or stomach problems that don’t go away.^[2]

Pregnancy-related Obesity

Obesity related to pregnancy is related to health complications such as cesarean delivery, macrosomia, gestational hypertension, preeclampsia, gestational diabetes mellitus, fetal death, and possible birth defects.

Hypertensive disorders in pregnancy

Pregnancy induced hypertension is a highly common disorder effecting pregnant women. There are four categories of hypertensive disorders in pregnant women: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension, and 4) gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy). ^[3]

Postpartum Hemorrhage

The medical definition of postpartum hemorrhage is blood loss exceeding 500 mL during a vaginal delivery or 1,000 mL with a cesarean delivery or a 10% drop in hemoglobin.^[4] 99% of the time, postpartum hemorrhage occurs within 24 hours of delivery but sometimes it can occur up to 6 weeks after delivery. It is the leading cause of maternal mortality in the world.

Infection

Infections during pregnancy aren’t always fatal but some can be transmitted to the fetus. Pregnant women become more susceptible to some such as a yeast infection because of hormonal changes. Some infections that pregnant women may encounter are: yeast infection (monilial vaginitis), listeriosis, Toxoplasmosis, urinary tract infection or cystitis, childbed fever, and STDS.

Ectopic Pregnancy

During fertilization in human reproduction, the sperm fertilizes the ovum in a fallopian tube and the zygote then travels down to implant in the uterine wall. Ectopic pregnancy occurs when the zygote implants outside of the uterus, most commonly in a fallopian tube. The pregnancy is rarely viable. Around half will resolve themselves and terminate the pregnancy while others will require medical intervention.

Obstructed Labor

Obstructed labor is a form of dystocia, or “difficult labor.” It is a failure for the delivery process to progress. It can be caused by a mismatch between fetal size, or more accurately, the size of the presenting part of the fetus, and the mother’s pelvis, malpresentations of the fetus, ineffective uterine contractions, and pathological enlargement of the fetal head. ^[5]

Unsafe Abortions

In many countries where safe and legal abortions are unavailable and/or illegal, many women turn to clandestine abortions. The practice results in several severe health complications. Anywhere from 10% to 50% women who undergo unsafe abortions need medical care afterwards.^[6] Complications include incomplete abortion, sepsis, hemorrhage, and intra-abdominal injury. If the woman survives the complications it increases her risk in future pregnancies or results in life-long disability.

Maternal Mortality

A woman dies from complications in childbirth every minute – about 529,000 each year -- the vast majority of them in developing countries. ^[7]

Maternal mortality is a reality for many mothers. The difference between maternal mortality rates among rich and poor countries demonstrates the most drastic divide of all health indicators.

Only 1% of global maternal death occurs in developed countries. The World Health Organization defines it as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” ^[8]

Maternal mortality is a major indicator of the health of a country. It is thought to be one of the more sensitive development indicators . Most of the causes of maternal mortality are entirely preventable. The incredible number of preventable maternal deaths is considered a human rights crisis .^[9] Furthermore, maternal mortality leaves many children motherless every year.

Statistics

The maternal mortality rate (MMR) is the number of maternal deaths per 100, 000 live births. The worst maternal mortality rates are found in Africa. The worst MMRs are as follows: Sierra Leone (2100), Niger (1800), Afghanistan (1800), Chad (1500), Somalia (1400), Angola (1400), Rwanda (1300), Liberia (1200), Guinea Bissau (1100), Burundi (1100), the Democratic Republic of the Congo (1100), Nigeria (1100), Malawi (1100), and Cameroon (1000). By contrast, Ireland had an MMR of 1.^[10]

For every woman that dies, 20 more suffer some disease, injury, or infection from pregnancy.^[11]

Causes

Maternal mortality is a result of complications during pregnancy and childbirth. The major medical causes include hemorrhage, infections, unsafe abortions, hypertensive disorders from pregnancy, obstructed labor, sepsis, embolism, unsafe abortions as well as indirect causes such as malaria and HIV.

The reason it is more prevalent in poor countries than in rich countries has to do with the lack of adequate healthcare for these women. Health care services that would save their lives are often too expensive, too far, of poor quality, or non-existent. An estimated 74 per cent of maternal deaths could be averted if all women had access to the interventions for preventing or treating pregnancy and birth complications, in particular emergency obstetric care.^[12] Poverty, gender and racial inequalities, lack of political will and commitment, misinformation or lack of information, and weak health systems all contribute to the problem.

Solutions

Increased prenatal care, postnatal care, and emergency obstetric care is the most obvious solution to maternal mortality. Research indicates that increasing the number of births with skilled birth attendants is an effective intervention in improving pregnancy outcomes. In addition, many women that die have no prenatal care whatsoever. This allows for conditions like anemia, hypertension, and other complications to go undetected. In resource-constrained settings traditional birth attendants can provide basic emergency obstetric and prenatal care when adequately trained.

Yves Bergevin, Coordinator of the Maternal Health Thematic Fund’s Reproductive Health Branch at the United Nations Population Fund (UNPF), says, “Increasing financing of health systems is important in reducing maternal mortality. National health plans must be adequately funded so that quality reproductive health services can be scaled up to ensure universal access. This often requires a significant amount of leadership and governance to make sure that reproductive health is a strong component of the national health plan, adequate resources are allocated, and progress effectively monitored through the routine collection of quality data.” ^[13]

In addition, accessibility to health services is a major problem. Women who live in rural areas cannot easily access hospitals or clinics in urban locations. Creating health centers for every 100,000 people in rural areas would health eliminate this barrier.

Improved family planning services and reproductive health information would help prevent unwanted pregnancies. The legalization of abortion would decrease the amount of maternal deaths that result from botched abortions.

Many human rights lawyers, doctors, and activists champion the human rights approach to decreasing maternal mortality. They argue that maternal mortality is connected to many human rights such as the right to the highest attainable standard of health, which is protected by the Convention for the Eliminations of All Forms of Discrimination Against Women (CEDAW) and the International Covenant of Economic, Social, and Cultural Rights (ICESCR). International human rights law provides a basis to hold states accountable for reducing maternal mortality.

Considerations

The evidence base on organizing, delivering, and paying for effective and equitable health services in any resource-constrained setting is very weak.^[14] Issues of bad government and related community and development issues must be addressed to see a great improvement in some settings. The lower social status of women in different countries and lack of legal/political power both prove to be obstacles in decreasing maternal mortality

References

1. ↑ “Maternal and Infant Health Research”, Centers for Disease Control and Prevention, http://www.cdc.gov/reproductivehealth/maternalinfanthealth/index.htm
2. ↑ “Depression in Pregnancy”. The National Women’s Health Information Center. http://www.womenshealth.gov/FAQ/depression-pregnancy.cfm
3. ↑ “Hypertension and Pregnancy”. Paul Gibson, MD http://emedicine.medscape.com/article/261435-overview
4. ↑ “Pregnancy, Postpartum Hemorrhage”. Maame Yaa A B Yiadom, MPH, MD <http://emedicine.medscape.com/article/796785-overview>
5. ↑ Obstructed Labour”. JP Neilson. British Medical Bulletin 67:191-204 (2003) http://bmb.oxfordjournals.org/cgi/content/full/67/1/191
6. ↑ WORLD HEALTH ORGANIZATION (WHO). MATERNAL HEALTH AND SAFE MOTHERHOOD PROGRAMME. Abortion: A tabulation of available data on the frequency and mortality of unsafe abortion. 2nd ed. Geneva, WHO, 1994. 117 p.
7. ↑ “Improve Maternal Health”. Millenium Development Goals. http://www.unicef.org/mdg/maternal.html
8. ↑ Maternal Mortality in 2005” WHO, UNICEF, UNFPA, and the World Bank. http://www.who.int/whosis/mme_2005.pdf
9. ↑ Sadhwani, Gouri. “Facing the Crisis of Maternal Mortality.” Amnesty International. http://blog.amnestyusa.org/escr/sierra-leone-is-not-alone-in-facing-this-crisis-a-human-rights-crisis/
10. ↑ “Maternal Mortality in 2005” WHO, UNICEF, UNFPA, and the World Bank. http://www.who.int/whosis/mme_2005.pdf
11. ↑ “Why do so many women still die in pregnancy and childbirth?” World Health Organization http://www.who.int/features/qa/12/en/index.html
12. ↑ A. Wagstaff and M. Claeson, The Millenium Development Goals for Health: Rising to the Challenges, World Bank, 2004.
13. ↑ Haddad, Alina. “Problems and solutions of maternal mortality in the developing world”. MediaGlobal. http://www.mediaglobal.org/article/2008-10-09/problems-and-solutions-of-maternal-mortality-in-the-developing-world>>
14. ↑ Walraven G, Manaseki-Holland S, Hussain A, Tomaro JB (2009) Improving Maternal and Child Health in Difficult Environments: The Case For “Cross-Border” Health Care. PLoS Med 6(1): e1000005. doi:10.1371/journal.pmed.1000005