Addressing Critical Knowledge Gaps in Newborn Health

My Son’s Birth Day – life, near miss and loss

 

“The act of giving life should not cause death” – Graça Machel, Global Newborn Health Conference

 
This statement by Madame Machel on Sunday at the Global Newborn Health Conference brought me back 10 weeks ago when I spent the day in a maternity and labor ward in South Africa. Like most days in any hospital across the world, there were stories of life, near miss, and loss.
 
At 41 weeks pregnant, I delivered a healthy baby boy after an uncomplicated labor. However two hours later, I began to hemorrhage and within minutes passed out from blood loss. I survived thanks to a husband with a loud voice to shout for help, the skills and timely response from midwives, and ready access to drugs - oxytocin and misoprostol. Had I been without access to this care, my children may have lost their mother that day. Sadly every hour, 34 women die from complications of childbirth globally.
 
As I recovered, another woman was rushed into the labor ward. She had lost her baby at 29 weeks gestation. Her screams of pain from an early labor and cries of sorrow still pierce my ears. Each hour, there are over 300 stillbirths and their mothers and families are left to grieve, often silently, after the loss of an expected life. Nearly 50% of all stillbirths are full term babies who die during childbirth. Many of these are preventable.
 
My husband and I also met the father of a baby who on that day was born too soon. His wife had gone into labor at 32 weeks. At the hospital, skilled workers recognized signs of preterm labor and administered antenatal corticosteroids to strengthen the baby’s lungs and tocolytics to delay labor. Even with the best neonatal care, this little baby was still struggling to survive, as his mother was cup feeding the tiny baby with expressed breast milk. This story is all too familiar for families of the 15 million babies born prematurely each year. Complications from preterm birth are the leading cause of newborn deaths, resulting in 123 deaths by the hour.
 
As I reflect on the events on this one day – where there was new life, near miss, and loss – it is a reminder that maternal and newborn care are intrinsically linked. What is a mother without her child? How can a baby live without his or her mother? Evidence shows that a baby’s chances of survival lessen with the loss of their mother especially if the baby is vulnerable from prematurity or infection.
 
Happening this week is the Global Newborn Health Conference, the first-ever conference dedicated to newborn health. Nearly every discussion has highlighted the need to link actions for newborn health to maternal health.
 
At the conference, Professor Joy Lawn presented the startling statistics of how many mothers and babies die needlessly each year (see box). There are highly effective, lost-cost, and agreed upon solutions that can save mothers and newborns, and save many intrapartum stillbirths. But these solutions are not reaching every mother and every child. As Dr. Gary Darmstadt asked at the Opening Ceremony “we know what to do to save the lives of mothers and babies, so what are we waiting for?”
 
In an effort to advance action for newborn health, global partners, together with countries, are developing “The Global Newborn Action Plan” with the first consultations occurring at this conference. This plan will be the first high-level roadmap for change on newborn health setting out clear actions for countries and other actors. A major component of this plan will focus on improving care at the time of birth. Investing in care at birth is not necessarily cheap but it does provide a triple return on investment by saving mothers and newborns and preventing stillbirths, making it very cost effective.
 
My son and I survived one of the riskiest days of our lives. We were privileged to have access to skilled care and life-saving commodities. Had we been one of the 54 million home births each year, our story would be different. Had we delivered in a rural health center without access to the necessary drugs, our story would be different.
 
It is time we take concrete action to prevent needless deaths during childbirth. To quote Professor Lawn, everyone deserves a “Happy BIRTH Day”. Visit the Global Newborn Action website and raise your voice for change.
 
No woman should die while giving birth – 287,000 mothers die each year globally
Many mothers die unnecessarily due to lack of skilled care or access to drugs. Oxytocin and misoprostol have been included as essential medications identified by United Nations Commission on Life Saving Commodities for Women and Children.
 
No baby stillborn – 2,600,000 stillbirths each year (46% occur from complications during childbirth) globally
As demonstrated in a comprehensive analysis in The Lancet Stillbirth series, many of the solutions for intrapartum stillbirths would also save mothers and newborns.
 
No baby born to die – 3,000,000 newborns die each year globally
Nearly a quarter of all newborn deaths occur from complications during childbirth. Helping Babies Breathe is an initiative to improve health worker skills and access to commodities for neonatal resuscitation. Resuscitation devices have also been identified by the UN Commission on Life Saving Commodities for Women and Children.