By Maana Lindqvist*
300,000 women die around the world as a result of complications of pregnancy and childbirth, every year.
That is 1 woman every 2 minutes.
Almost all of these deaths are preventable.
Global maternal health is in crisis. Each year millions of women all over the world face death, serious illness and permanent disability because of complications relating to pregnancy and childbirth. At the root, inequality and discrimination lead to around 303,000 women – 1 woman every 2 minutes – dying due to complications. 99 percent of these deaths occur in low-resource settings, and most of them could have been prevented.
Health professionals have long known what it takes to ensure that women and girls survive pregnancy and childbirth in good health. But preventing maternal mortality and morbidity is not simply a fact of medical know-how. It requires the elimination of barriers affecting antenatal care, delivery and postpartum care. It requires the elimination of societal barriers. It requires the elimination of overlooking and disregarding the feelings, emotions, and experiences of a woman. It requires the annihilation of the ‘gender health gap’, born of disregard of women in science. We know what needs to be done.
As Gill Walton, the chief executive of the Royal College of Midwives, said:
’We know that placing women at the centre of their own care not only improves outcomes in pregnancy, but also improves a woman’s experience of birth and maternity care.’
Not everyone has a poor experience during pregnancy or childbirth. If your memories of expecting and delivering a healthy baby are beautiful, happy and full of wonder, I am so happy for you. It should have been just like that. You had it right. Do not let anyone take that away from you. But too often things go wrong. Too often a mama is faced with sadness, pain or injury. Not every birth is the joyous event it deserves to be, despite advancements in medicine or access to healthcare. Too many mums face motherhood on a battlefield.
Maternal health is in a serious global crisis
Many women around the world experience roadblocks when trying to get the care and support they need. According to Every Mother Counts, the reason for a poor outcome of pregnancy is usually in one of the following four:
- - Disrespectful treatment;
- - Discrimination;
- - Harmful practices; or
- - Shortages.
You are not crazy for thinking something is wrong
Were you disrespected during your antenatal consultations, during delivery? Do you feel something should not have happened, or it should have happened differently? Were you able to advocate for yourself? I’m sorry if you had to be one of our warrior mums before even meeting your little one. But I am also immensely proud of you.
Disrespect is more than belittling, overlooking, and disregarding. It is not being thorough, or acting outside guidelines, or cutting corners. It is more than the event; it’s the sum of all events, physical and mental. It is what the mother feels like after the appointment, after the delivery, even thinking back on her pregnancy years later. During pregnancy, it has no discernible name. In childbirth, it has a name: obstetric violence. A Finnish newspaper reported on January 24, 2021 that a third of 1-child parents identified an earlier maternal trauma as the reason for not wanting more children. Disrespect has real consequences.
Leah McLaren, a mother of two and an award-winning journalist, fought for treatment and support during the neonatal days of her second son who was born unresponsive following a traumatising birth by forceps. She had to deal with disinterest of medical staff regarding her newborn son’s health, as well as the aftereffects of bad tearing and episiotomy. But she lived and her son lived, thus creating the official narrative of a ‘successful’ birth. Her postpartum struggle was not recorded as part of the birth despite being clearly associated with it. While given the all-clear by the medical professionals to mark complete healing, dark thoughts and flashbacks haunted her. She suffered from stress incontinence. Normal, even expected side effects of postpartum? I guess so. I mean, women often do get those baby blues after childbirth, right?
After self-referral to the GP and a following gynaecologist appointment, Leah was diagnosed with a prolapse of the bladder, an uncomfortable, but treatable injury related directly to her vagina’s damaged walls during childbirth. Her delivery literally broke her body. And Leah is not the only one. The Birth Trauma Association, a peer-to-peer support group, estimates that 10,000 women in Britain are treated for post-traumatic stress disorder as a result of birth each year. The British Journal of Obstetrics and Gynaecology found in 2015 that 24 percent of women experienced pain during sex 18 months postpartum. Other studies have found fractured pubic bones, severe damage in pelvic floor muscles, back pain, and incontinence among women who had been medically cleared from childbirth. Baby blues, right?
(Dis)respectful treatment has a huge impact on mother’s health and wellbeing. Overlooking a mother’s worry, perhaps even describing her a ‘crazy woman’ when she tries to advocate for herself is unforgivable in any medical system. Motherhood ought to be about thriving, not merely surviving. Keep reading to find out why we care, and what our Co-Founder Laura’s experiences with disrespectful treatment were.
Discrimination still happens, and even celebrity mums face it
Substantial inequities’ a woman faces based on their gender, race, ethnicity, language, socio-economic, or indigenous status have a huge impact on their health. Death is the ultimate outcome of systemic discrimination against women and girls throughout their lives. Experts have noted that the racial disparity in maternal deaths in the United States remains, regardless of the mother's income and education level. If it is so in one place, I believe it is safe to assume it happens elsewhere too.
Prominent black celebrities like Beyoncé and Serena Williams have spotlighted issues in pregnancy care by sharing their own experiences. Both women faced severe, nearly fatal complications during and after delivery due to being overlooked by their medical personnel. Beyoncé opened up to Vogue about her experience of toxaemia and spending weeks in the NICU following the delivery of her twins, Rumi and Sir. Williams, with demonstrated medical history of blood clots, was refused a CT-scan and heparin drip following her Caesarean section. After persistently advocating for herself, the medical team finally found blood clots forming in her lungs.
These women have money, they have influence, and yet they were not listened to by their medical professionals. Both complications could have been caught early on and avoided completely. It is no surprise to read statistics of POC women’s experience with pregnancy and childbirth: Black women in England are four times more likely to die in pregnancy or within the first six weeks of childbirth than their White counterparts. Asian women face death twice, and mixed-race women three times more likely than their White counterparts.
Harmful practices on young women and girls
Women subjected to harmful practices such as female genital mutilation (FGM) or child, early and forced marriages, are closely associated with having negative pregnancy and childbirth outcomes.
Despite being recognised internationally as a human rights violation, at least 200 million girls and women in 31 countries across three continents face genital mutilation. In the UK, it is punishable by law to fail to protect a girl against this practice that has no medical necessity. Girls of Egyptian, Ethiopian, and Indonesian descent are especially vulnerable.
Before the COVID-19 pandemic, more than 100 million girls worldwide were expected to marry before their eighteenth birthday in the next decade. Now, up to 10 million more girls will be at risk of becoming child brides as a result of the pandemic. Globally, child marriage among boys accounts for just a sixth of all child marriages. Most of wedded children are child brides, girls, often expected to carry children shortly after and facing the consequences of childbearing when they are but children themselves.
Staff and resource shortages
Even when a woman can gain admission to a medical facility in time to give birth, their health and survival depend on the quality of the care they receive. Generally, healthcare systems that fail to provide adequate care have several recurrent issues: inadequate health infrastructure, poor working conditions, lack of trained personnel, lack of skilled birth attendants, lack of emergency obstetric care, blood shortages, delays in referrals to specialist care, and shortages of medicines and other supplies.
Even well-oiled machines such as the NHS in the UK face many of these issues. Staffing problems, lack of clear support systems for medical professionals, blood shortages, and delays in referral decisions are problems faced daily even among the health systems in industrialised countries. Because of inadequate infrastructure to deal with potential complications, many mums face a long journey to the hospital all over the world.
Everyone Deserves High-Quality Maternity Care
With the risk of repeating myself, the quality of care a mum receives during pregnancy, delivery, and postpartum affects her health, the health of her child, and the likelihood that she will seek care in the future. Increasing access to and utilisation of healthcare services alone are not sufficient for improving maternal health outcomes.
Instead, according to the WHO vision for high quality maternal healthcare, it should be:
- Safe – delivering healthcare which minimises risks and harm to its’ user, including avoiding preventable injuries and reducing medical errors.
- Effective – providing services based on scientific knowledge and evidence-based guidelines.
- Timely – reducing delays in providing and receiving healthcare.
- Efficient – delivering healthcare in a manner that maximises resource use and avoids waste.
- Equitable – delivering healthcare that does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status.
- People-centred – providing care which considers the preferences and aspirations of individual service users and the cultures of their communities.
Did Leah McLaren get high-quality care, or did she face obstetric violence? The Finnish newspaper describes obstetric violence as the established practices not considering the mother or hearing her needs during birth. During birth. What about the consequences of the birth, events that take place after the birth because of something that took place during delivery? During pregnancy? What about the events that take place before birth, complications that may lead to a premature birth?
Rebecca Schiller, the chair of BirthRights, says that institutional denial of women’s experience is a huge problem in post-natal care, condensing the issue as “Your experience does not matter, all that matters is a healthy baby.” According to Leah McLaren, diagnosing a birth-injured or traumatised mother with postpartum depression is the healthcare equivalent of asking a justifiably irate woman if maybe, just maybe, she’s about to get her period? And it happens all the time.
In the words of Dr Mahmoud Fathalla, the former president of the International Federation of Obstetricians and Gynaecologists:
‘Women are not dying of diseases we can’t treat. … They are dying because societies have yet to make the decision that their lives are worth saving.’
But, dear reader, the first steps to recognising the female experience have been taken: The British society has finally begun that process which aims to improve health services for women. Fertility, maternity, and even menopause are finally on the table with women’s voices in the centre. From Monday 8 March 2021, the Women's Health Strategy will spend 12 weeks speaking to female patients about a wide range of issues including maternity care and mental health. Our voices are finally listened to – in theory. What happens once the results of those talks are published after the Summer holidays will remain to be seen.
We care because we are mothers too
We at Lola&Lykke care because we care about women. The personal experiences of our founders, the interest towards women’s health we share among our team, and the love we have for women all over the world inspire us to do our best to get their voices heard. Your voice deserves to be heard.
Shortcomings relating to maternity care persist even in countries like Finland, where maternity care is considered world leading. Even here, the physical and mental health of new mothers has become secondary, and our maternity system ignores a lot of suffering. Lola&Lykke´s Co-Founder Laura experienced severe complications during and after her first child´s birth that were nearly fatal due to the medical team not listening to her nor giving her the care she urgently needed. At one point she was even discharged from hospital whilst suffering from severe sepsis and multiple organ failure with her heart and lungs. The previous day, Laura had been complaining of confusion, disorientation, and a feeling of being detached from reality, but the hospital sent her home regardless without even a simple blood pressure test. The symptoms were put down to being just a part of the normal bewilderment one feels as a new mother.
The multiple organ failure and emergency hypertensive crisis was only diagnosed the following day after Laura returned to the hospital´s A&E due to breathing problems in a life-threatening condition. Despite the traumatic birth experience Laura went through, she considers herself one of the lucky ones, just like Leah McLaren, as both her and her baby son escaped the severe complications without any permanent health issues, even if the recovery process took several months. Several clinical trials have demonstrated a mortality ranging from 40% to 75% in patients with multiple organ failure arising from sepsis. Unfortunately, not everyone is so lucky. For instance, the UK has one of the highest infant mortality rates in western Europe and, according to the NHS litigation authority, pays out hundreds of millions in maternity negligence claims each year.
Read more about motherhood and the birth of Lola&Lykke in Laura’s own words here.
What we do to prevent unnecessary trauma
We here at Lola&Lykke care about mums. From the start, we teamed up with Every Mother Counts to aid their efforts in making pregnancy and childbirth safe for every mother, everywhere. Their initiatives in countries where mums struggle the most are worth our support. Every mum deserves the best, caring and empathetic health care they can get during pregnancy and childbirth.
As we see it, a huge part of the problem is that pregnant women are not properly informed of the risks of birth trauma and injury in advance. That is why we designed our The Pregnancy, Birth, & Beyond series, an online antenatal course where we equip you with the knowledge and confidence to approach birth without fear and to help you navigate the first few weeks as a new parent. We teamed up with medical experts and maternity physiotherapists to provide you with all the expert clinical knowledge you need to feel empowered as you near childbirth and postpartum.
Read more: The Pregnancy, Birth & Beyond series
What you – a mother, a spouse, a supporter – can do to help
As a mum-to-be or as one with experience, the best you can do for yourself and for your baby is educate yourself. Knowledge is power. Learn as much as you can, especially about how things look like when everything goes right. And learn what could go wrong so you don’t get caught off guard if something unexpected happens.
If you, dear reader, are the spouse, family member, or a friend of a pregnant woman, do the same studying. Talk with your mama-to-be, and make sure she has an ear to express her fears, hopes and wishes to. Because if the worst happens, which I sincerely hope it won’t, but if it does, and she cannot advocate for herself, it’s up to you. You are the shield on the battlefield keeping her safe. Do your research, listen to the professionals, and question what you don’t understand.
To help you all with the excitement, our Motherhood Starter Kit, including full access to the Pregnancy, Birth & Beyond series, as well as organic pregnancy tea and a thermos mug, is launching later this Spring! A perfect gift for a baby shower or just to treat your mum-to-be with a bit of luxury and knowledge.
As part of our commitment to the Pregnancy, Birth & Childhood series and the Motherhood Starter Kit, we have partnered up with Every Mother Counts to bring essential care to women and their babies globally from the United States to Bangladesh to Guatemala and more. We are part of something bigger than just ourselves.
For every friend or loved one our clients refer to Lola&Lykke, we will make a 10€ donation to Every Mother Counts. Find the referral link below.
With this money, we can provide:
- - Clean, safe birth kits for mums in Bangladesh,
- - Medical equipment for student midwives in Guatemala,
- - Essential antenatal and delivery supplies for mums in Tanzania...
- ... And much more!
*Maana is Lola&Lykke's Content Administrator. After studying Politics and International Relations in Scotland, she moved to London to attend the prestigious London School of Hygiene and Tropical Medicine where she studied Reproductive and Sexual Health Research.