Which Orthodox Christian is not familiar with the words from the litany of petition about “the Christian end of our life, painless, shameless, peaceful...”? They indicate that a person’s dying can occur in different ways: in agony and terrible torment or peacefully, painlessly, and shamelessly. You can die young, unexpectedly and unexpectedly, having been involved in a random accident, or you can die seriously and for a long time, await your death, having confessed and received communion. You can die saving the life of another person, or you can die from heart failure while intoxicated. There are different types of death...
Which of them refers to the death of a mother during childbirth? What to do when it is known in advance that the pregnancy threatens the life of the mother herself?
Today in our society it is not yet possible to find a clear answer to this question. This ambiguity has its own reasons, its own history and logic. There are two opposing positions in this logic. The movement from one of them to the other contains the history of the formation of the correct answer to the question that concerns us.
The first position was expressed back in the 5th century BC. in the Hippocratic Oath. Among numerous medical manipulations, Hippocrates specifically singles out fetal expulsion and promises: “I will not give any woman an abortifacient pessary.” This doctor’s judgment is all the more important because it runs counter to the opinion of many great moralists and legislators of Ancient Greece, for example Aristotle, about the fundamental admissibility and practical expediency of abortion. Hippocrates clearly and unambiguously expresses the position of the medical class on the ethical inadmissibility of a doctor’s participation in the production of an artificial miscarriage.
The opposite position is most clearly expressed in the principle of the Jewish physician and theologian Maimonides: “The attacker should not be spared.” He almost literally transfers the well-known maxim of Old Testament morality to the relationship between mother and child - "an eye for an eye a tooth for a tooth"(Lev. 24:20). Already from the 13th century, this rule began to be interpreted as a permission to kill a child in the mother’s womb, which was carried out by a doctor to save the life of the mother. Today, such manipulation is defined by the term “therapeutic abortion.” Therapeutic abortion is the destruction of a child in the event of a conflict between the life of the mother and the fetus; it is an abortion during which the child is destroyed in order to save the life of the mother.
Recognition of therapeutic abortion is a break not only with the moral position of Hippocrates, but also a challenge to the Christian moral tradition, for which, as is known, " immortal life a child is more valuable than the temporary life of the mother."
Since the beginning of the twentieth century in Russia, the indisputable Christian ethical traditions of the medical community have begun to come under criticism. On the pages of Russian medical journals and newspapers there is a very intense discussion of the ethical and medical problems of induced abortion. Thus, in 1911, Dr. T. Shabad was almost one of the first to raise the question of “the mother’s right to control the function of her body,” especially in the event of a threat to her life. In fact, Shabad is at the origins of the liberal approach to induced abortion, trying to find arguments against the prevailing moral tradition in the “testaments” of Dr. Maimonides.
After 1917 in Russia, discussions about therapeutic abortion completely ceased, due to the complete legalization of abortion, based on the official ideology’s declaration of “the mother’s right to control the function of her body” and the absolute availability of abortion operations. artificial interruption pregnancy not only medical indications, but also simply at the request of the woman. An act such as abortion has not been a crime since 1917. On the contrary, abortion was considered a socially significant achievement, because, as Lenin assured everyone, “there is not a grain of ethics in Marxism.”
What to do today, when such Leninist “truth”, which turned Russia into a country of mass infanticide, still dominates the minds of medical specialists? How to free yourself from the grip of the arbitrariness of a fallen man who has come to believe in the legitimacy of the violence of his will and passions?
It is impossible to agree with the recognition and justification of therapeutic abortions. It contradicts conscience as the internal ability to experience and recognize evil. It contradicts mind as the ability to understand and explain the inadmissibility of therapeutic abortion. The grounds for such inadmissibility for an Orthodox person include the following:
A) Therapeutic abortion is a form conscious killing a child, which conflicts with the 2nd and 8th Rules Orthodox faith Saint Basil the Great, according to whom “Whoever intentionally destroyed a fetus conceived in the womb is subject to conviction as for murder”. At the same time, Bishop Nicodemus specifically emphasizes the difference between the Orthodox and Old Testament attitudes towards human life, the beginning of which in the Old Testament tradition is associated only with the emergence of humanoid traits in the fetus, while Orthodox anthropology does not make such distinctions. It connects the beginning of human life with the very moment of conception, as evidenced by the Annunciation of the Archangel Gabriel and the glorified Orthodox Church conception of the holy righteous Anna Holy Mother of God and the conception of John the Baptist.
b) Saint John Chrysostom claims that exile is “something worse than murder,” for it represents a violation of the “first and greatest commandment” - the commandment of love. The conscious killing of her child by a mother in order to save her life is an action that not only violates the commandment of love, but is also the opposite of fundamental Christian ideas:
- firstly, about the deep moral essence of motherhood,
- secondly, about a shameless and worthy Christian death,
- thirdly, about the role of sacrificial love in human relationships.
V) Christian veneration of the military and the socially significant status of a soldier are determined by his conscious readiness to lay down his life for children, women, and the elderly: “Greater love has no one than this, that a man lay down his life for his friends.”(John 13:15). Justifying the conscious refusal of a sacrificial attitude towards her child on the part of the mother is an action that is flagrant in its anti-Christian essence. Archpriest Dimitry Smirnov in the book “Save and Preserve” writes: “After all, extending one’s life at the cost of killing one’s own child is tantamount to a mother eating her baby - such cases happened in besieged Leningrad. When a mother wants to save her life at the expense of her child, this is cannibalism.” .
G) Today, as a result of the development of medical science, which has successfully overcome previously difficult-to-treat diseases, cases in which there really is a need to terminate a pregnancy for medical reasons occur. rarely. But the failure to recognize the moral unacceptability of therapeutic abortion gives rise to the widespread practice eugenic abortion, produced in order to prevent the birth of defective or sick children. Today, due to the powerful development prenatal diagnostics the production of eugenic abortions is gaining momentum.
In conclusion, one cannot help but recall the ancient principle, which directly relates to therapeutic abortion: “Non sunt facienda mala ut veniant bona” (you cannot create evil from which good would come). Without accepting a natural “shameless, peaceful” death in childbirth, modern medicine produces, produces the most terrible kind death - eternal spiritual death.
For any family, the death of a woman during childbirth is a colossal tragedy. This is orphanhood for children, grief for the spouse and all loved ones. The causes of death during childbirth can be any, but the result is the same: the person cannot be brought back. Record low level maternal mortality in Russia over the past two years perfectly illustrates the “law of large numbers”: there is no need to be afraid of getting pregnant, because the chances of dying under the wheels of a car are several dozen times higher for Russians. Fear of death before or during childbirth should not be the reason for childlessness!
First, some statistics regarding maternal mortality and how it is compiled. According to the accepted methodology, statistics on maternal mortality include not only death during childbirth, the causes of which can be very diverse - they will be discussed below. The data includes deaths that occurred throughout pregnancy and up to 42 days after birth. Abroad, the statistics include cases of maternal death after an abortion, but in Russia they do not.
The number of deaths of women per 100,000 births is considered the most important indicator that directly characterizes the level of development of medicine and obstetric care in a particular country, and in large states such as Russia - and its regions. According to the Ministry of Health, in 2017 this rate was 7.3 per 100,000 births, which is quite comparable to the rates in the most developed countries on the planet.
In region 33 Russian Federation zero maternal mortality was recorded: this means that in 2017 there was not a single tragic case of death during childbirth.
The most common cause of death during childbirth is hemorrhage
Bleeding can occur both during pregnancy and during childbirth or after its completion. According to statistics, almost every fourth death during childbirth is associated with obstetric hemorrhage. The causes of acute anemia may be the following:
- Placental abruption can cause fetal and maternal death.
- Uterine rupture, which occurs as a result of several reasons: a large fetus or a too small pelvis of the woman in labor, neoplasms of the uterus or ovaries, transverse position of the fetus.
- Birth bleeding can begin with non-standard separation of the placenta and injuries (ruptures) of the birth canal. Serious blood loss is possible in very short time and, if blood and plasma are not available for transfusion, death may occur as a result of blood loss.
- Bleeding disorders, congenital and acquired.
The risk of death due to postpartum hemorrhage remains for a month after birth. The happy mother and baby have already been discharged home, but bleeding can open in a few weeks and lead to death. It is very important for the woman in labor and her loved ones to monitor blood pressure, vaginal discharge, painful sensations in a stomach. If a woman’s general condition worsens for no apparent reason, she urgently needs to sound the alarm and seek help from doctors.
Obstetric sepsis
Most often occurs in the postpartum period. These are infections of birth wounds and tracts caused by the penetration of penicillin-resistant staphylococcus and various bacteria into them. But is it really difficult to maintain the minimum level of safety during manipulations and interventions during childbirth, and to sterilize instruments? Even if the medical staff fulfills all the requirements, the cause of septic infection can be the natural microflora of the vagina, which under certain conditions turns into pathogenic.
The trouble is that doctors are faced with microbes that quickly adapt to the action of modern antibiotics. Sepsis is a serious infectious disease, and it is not easy to fight. How to reduce risks? A pregnant woman should strengthen the strength of her body in every possible way, which is facilitated by balanced diet and taking vitamins. When or in water, you should carefully observe all hygiene requirements, disinfect linen, clothing, and bedding.
Preeclampsia is the cause of almost 20% of deaths during childbirth
About 18% of all pregnancies are last weeks before childbirth are accompanied by so-called “late toxicosis”. The occurrence of gestosis is associated with disturbances in the hormonal regulation of organs and systems, neuroses and even a genetic factor.
The development of gestosis leads to serious disruptions in the functioning of a woman’s cardiovascular system, the kidneys may fail, and tissue necrosis occurs in the liver. The placenta undergoes changes, which can cause oxygen starvation of the fetus with unpredictable consequences, including intrauterine death.
Severe gestosis leads to eclampsia, when severe convulsive attacks occur. A woman in labor can fall into a coma, seizures provoke hemorrhages, and in the worst case, eclampsia leads to the death of the woman.
Diseases “outside” pregnancy
These are “ordinary” and well-known diseases, but this does not make them any less dangerous and can cause the death of a woman in labor. These are diseases not related to the reproductive function of a woman; they are called extragenital. These causes include diseases of cardio-vascular system(heart defects, hypertension and hypotension, thrombosis and thromboembolism), diseases of the respiratory system (asthma, pneumonia), tuberculosis, kidney disease, acute appendicitis, acute pancreatitis, diabetes, epilepsy. Blood diseases can also threaten the health of a woman in labor.
According to statistics, extragenital diseases of women in acute form lead to death during childbirth in 15% of fatal cases.
A cunning killer. HELLP syndrome
A very complex pathology that usually occurs in the last weeks of pregnancy (very rarely in the first days after birth) and is closely related to late toxicosis. The causes of HELLP syndrome have not been reliably established; there are several dozen hypotheses, but none is recognized as the main one. They are called autoimmune diseases, genetic predisposition, taking drugs and substances that interfere with the activity of a woman’s liver.
The pathology is complex: red blood cells are destroyed, the amount of liver enzymes increases, the level of platelets decreases, which causes a violation of blood clotting and thickening. The mother's liver tissue is destroyed (hepatosis), pain symptoms are observed in the hypochondrium, severe jaundice skin. A sure symptom of this disease is swelling, vomiting, and fatigue.
If measures are not taken in time, the woman in labor may fall into a coma and die: with this disease, the probability of a favorable outcome is no more than 25-35%, because it is not for nothing that HELLP was nicknamed “an obstetrician’s nightmare.” Death occurs as a result of complications: cerebral hemorrhages, thrombosis, acute liver failure...
Diagnosis of the syndrome is made based on laboratory tests blood, ultrasound, urine analysis, computed tomography. After emergency hospitalization, if the diagnosis is established, immediate induction of labor or emergency caesarean section is required if natural childbirth are impossible in time or the mother’s condition is worsening every hour.
A boy came into a toy store and asked to wrap a car for him. Then he handed the cashier some toy money. The cashier laughed.
- Why are you laughing? - the kid didn’t understand. — The car isn’t real either!
Why do doctors call HELLP syndrome a “nightmare”? Because on early stages it is difficult to diagnose, especially if the doctor has little experience or is inattentive. The disease progresses quickly and it can be very difficult to cope with it in the later stages.
If measures are taken in time, the life of the mother and baby is not in danger, but you will have to undergo long-term treatment in a hospital, stabilize the mother’s blood counts, and restore the functioning of the liver and kidneys. Blood and plasma transfusions are indicated, and various medications are prescribed.
Death during childbirth as a result of HELLP occurs in approximately 4% of the total number of deaths of women in childbirth.
Death due to complications after surgery
We are talking mainly about caesarean section. Like any surgical operation, cesarean carries risks for the woman in labor. Sometimes a caesarean section is resorted to when a woman’s health condition has deteriorated significantly, or natural childbirth is beyond her capabilities.
Important advice from anesthesiologists, on which your life may depend: before a caesarean operation, 8 hours before it begins, it is strictly forbidden to eat or even drink anything. Pay close attention to your doctor's recommendations!
The operation itself is not too complicated, even for an inexperienced surgeon. Blood and plasma are always ready for transfusion, the patient’s condition is monitored using instruments, and in extreme cases, there is an intensive care unit nearby. During the operation, death of a woman in labor occurs extremely rarely; most cases occur in the postpartum period. Internal bleeding and complications are frequent, the slightest negligence or oversight of personnel leads to tragedy, and resuscitators no longer have time to save the woman.
Death of a mother in labor as a result of medical error
All causes of death during childbirth as a result of unprofessionalism or medical negligence can be divided into two groups:
- The causes of death of a woman in labor are the responsibility of gynecologists and obstetricians. Lack of experience and skills on the part of an obstetrician can lead to injuries to a woman’s organs. There are belated decisions about the need for surgical intervention, untimely and incomplete medical care provided during childbirth and in the postpartum period.
- Anesthesiologists and resuscitators are responsible for deaths during childbirth. There are errors during epidural anesthesia, overdose during infusion therapy, injuries and complications during resuscitation measures, and death can occur as a result of anaphylactic shock. According to statistics, about 7% of deaths during childbirth occur for reasons related to anesthesia.
Sometimes the death of a woman is accompanied by circumstances that are not entirely clear, and doctors, while respecting corporate interests, are not always ready to admit mistakes - after all, this entails criminal liability under Article 109 of the Criminal Code of the Russian Federation! Criminal cases involving the death of a woman in a maternity hospital or the death of a child during childbirth usually become public knowledge; these sad topics are actively covered in the press and are difficult to hush up.
The husband or immediate relatives are obliged to file a statement with the police or prosecutor's office and achieve a fair investigation. It’s hard to do this after such grief, but it’s necessary. A special commission will be appointed, an independent examination will be carried out, and the court will determine the perpetrators and impose punishment, or acquit them if guilt in the woman’s death is not proven.
How to reduce the risk of death?
It is impossible to insure yourself 100%, but there are still simple recommendations. First of all, during pregnancy you need to undergo all the required examinations, take regular tests, and see a doctor at the antenatal clinic. If a doctor prescribes or recommends something, you need to trust him and follow it conscientiously. Regular examinations will help identify hidden diseases and diagnose deviations from the normal course of pregnancy. You need to carefully monitor your health, eat well, avoid stress: even if these are not the most important factors, but still.
Little Petya asks little Marina:
- When we grow up, will you marry me?
- No.
- Why?
- You see, in our family everyone marries their own. For example, my grandfather married my grandmother. My dad is on my mom, my uncle is on my aunt...
The cause of death during childbirth can be untimely medical care if a woman gives birth at home. The ambulance may be late or stuck in city traffic jams if something goes wrong. Delay in emergency care is the main argument of opponents of home birth, but according to statistics, death during childbirth at home is no more common than in the most modern maternity hospital with highly qualified doctors, midwives, and resuscitators.
I have always been against cesarean sections. And now, remembering my birth, I think - it would be better if they “caesareated” it! Now I understand that not every woman can get such pleasure as natural childbirth...
The pregnancy was long-awaited. I flew with happiness every day, enjoying my condition. Fortunately, I did not experience such “joys” as toxicosis and swelling. The test results were similar to those of an astronaut, with the exception of high blood glucose levels and low hemoglobin.
So, myth first - increased level only people with a sweet tooth and overweight people have sugar. I have an average build, and I don’t like sweets. But genetics decided everything for me. My father also has a tendency to high sugar. And my grandmother actually has diabetes. Everyone told me that all this was nonsense, and there was no threat from it. But I, knowing first-hand what high sugar is like, immediately went on a diet. I had to give up potatoes, flour products, some sweet fruits and berries (grapes, watermelon, dates). The basis of nutrition became dairy products, vegetables, boiled meat and fish, sometimes boiled buckwheat porridge. I ate in small portions. Loving relatives, of course, they tried to feed me “something tasty,” complaining that with such nutrition the child would be born small and frail, but I rarely succumbed to their persuasion.
It follows from this the second myth is “fed the child!” My husband is quite large. His weight at birth was 4100 kg. You can't argue with genetics - our baby, despite his mother's diet, was born weighing almost 4 kg! At the same time, during pregnancy the total weight gain is 5.5 kg. After childbirth - minus 16 kg!
Myth three – vitamin complexes only provide benefits .
I'm certainly not against vitamins. But! You shouldn't get carried away with them. In the 3rd trimester, the gynecologist strictly forbade me to take vitamins. It turns out that they can also cause a large fetus. In addition, excessive calcium intake can promote intrauterine fontanelle fusion, and taking vitamin A in the first trimester can cause fetal malformations. Therefore, in the first weeks of pregnancy I drank Femibion, and in the second trimester only one pack of “Alphabet Mom’s Health”.
Myth four - if nothing bothers you, then there is no need to go to the doctor .
At my next appointment with the gynecologist, the nurse noticed my low blood pressure (this has always been the norm for me) and recommended doing a cardiogram. The doctor said that if there are no complaints of pain in the heart, then there is nothing to worry about. Accordingly, I didn’t do anything. As it turned out later, it was in vain. My heart is really weak.
Myth number five: Ultrasound is harmful. Three scheduled inspections are enough.
The last ultrasound in the antenatal clinic is done at 30 weeks. I would recommend going through it yourself before giving birth. So, before giving birth, my baby got tangled in the umbilical cord and had a tight coil around his neck. How I now regret that I was greedy for money and did not go and see how things were. Besides, good specialist will be able to determine the estimated weight of the child at birth. Thank God, everything is fine with the baby. But if we talk about the consequences that could occur, then the harmfulness of ultrasound, if any, becomes secondary.
Myth number six: Perineal massage will prevent ruptures.
I did this massage for about 15 weeks. The result was an episiotomy + numerous internal ruptures. I also tried to do Kegel exercises, but they caused tone, so I had to give up on this matter.
Myth seventh – a wide pelvis is the key to an easy birth.
I'm the happy owner wide pelvis, but what's the point? The birth canal turned out to be narrow for my baby. Appearances are deceptive!
When the baby was born, the doctors began to fuss and urgently called an anesthesiologist. The midwife urged everyone on, shouting not to delay, since my entire crotch had turned black. After the episiotomy, a crack appeared in the vagina and bleeding began. The loss was 2 liters of blood! Half of the total volume... The heart stopped... Many people wonder if there is life after death. I'll tell you what I saw (maybe, of course, it was all about the anesthesia). It's very difficult to describe in words, but I'll try. The feelings, of course, are indescribable: it seems that you have no body, as if you are flying out of it, like a stream of light at incredible speed, it becomes easy and good. It seems that I have entered another dimension, more voluminous. If you compare life with a movie theater, then I’ll say this – it’s like after an ordinary movie you find yourself in 5D. A lot of bright colors It was like being inside a rainbow. At some point I remembered that I had given birth to a child, and I wanted to return. And I got stuck... I began to rush around, as if in a color maze (very similar to a children's kaleidoscope), looking for a way out, fighting like a fly against glass. There were many colors, but I intuitively went with yellow. Oh miracle! I opened my eyes! A large medical lamp hung above me yellow color. I saw poorly, as if under water. It seemed that all the doctors at the maternity hospital were in the room, they were bustling around. I passed out again... Deep coma. I was connected to an artificial life support machine because I couldn’t even breathe on my own. rib cage didn't get up. I stayed like that for a day. It’s strange, but sometimes I remember fragments of what happened in the ward. And the view from above, as if I was looking from the ceiling. There was practically no chance of survival. And then I started hearing voices. The voices of those who were nearby. But I couldn’t show any signs of life. My body felt like it was separated from me. It's very hard! Giving birth is much easier than lying in a coma! Coming out of a coma is a colossal effort! I gathered my will into a fist and tried to do everything so that my body began to obey, I prayed, I spoke mentally to myself, so as not to switch off, to live. And I did it - my first breath after giving birth! I had to learn to do everything again - open my eyes, speak, walk, etc. The first thing the doctor who operated on me told me was that the doctors saved my uterus! But I could have lost it. After giving birth, I was in intensive care. I didn’t see the child for almost two weeks. After giving birth, I was on a drip with antibiotics for a long time. It took about two months to recover. I couldn’t breastfeed – despite everything I had been through, my milk simply didn’t come in. Neither teas, nor lactation pills, nor frequent feeding of the baby to the breast helped. I can't give birth now. Only caesarean section provided that at least 3 years have passed. After giving birth, a bend of the uterus appeared, but this is not the worst thing that could happen...
I thank fate for keeping me and my child alive; for the fact that I now experience the joy of motherhood, for the fact that good doctors are nearby.
- Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth.
- 99% of all maternal deaths occur in developing countries.
- Higher maternal mortality rates are observed among women living in rural areas and poorer communities.
- Girls adolescence are at higher risk of complications and death from pregnancy than older women.
- Thanks to qualified care before, during and after childbirth, the lives of women and newborns can be saved.
- For the period 1990-2015. maternal mortality worldwide has decreased by almost 44%.
- Between 2016 and 2030, in accordance with the Sustainable Development Agenda, the goal is to reduce the global maternal mortality rate to less than 70 per 100,000 live births.
Maternal mortality is unacceptably high. About 830 women worldwide die every day from complications related to pregnancy or childbirth. In 2015, an estimated 303,000 women died during and after pregnancy and childbirth. Almost all of these deaths occur in low-income countries, and most are preventable.
In several countries in sub-Saharan Africa, maternal mortality rates have halved since 1990. Other regions, including Asia and North Africa, have made even greater progress. Between 1990-2015 The global maternal mortality rate (that is, the number of maternal deaths per 100,000 live births) fell by only 2.3% per year. However, since 2000, there has been a higher rate of accelerated decline in maternal mortality. In some countries, maternal mortality fell annually between 2000 and 2010. was above 5.5%, the level required to achieve the MDGs.
Sustainable Development Goals and the Global Strategy for Women's and Children's Health
Convinced that it is possible to accelerate this decline, countries are now united around a new goal - to further reduce maternal mortality. One of the targets of Sustainable Development Goal Three is to reduce the global maternal mortality rate to less than 70 per 100,000 births, with no country having a maternal mortality rate more than twice the global average.
Where do maternal deaths occur?
High maternal mortality rates in some parts of the world reflect inequities in access to health services and highlight the huge gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these cases occur in sub-Saharan Africa and almost one third in South Asia. More than half of maternal deaths occur in places with fragile conditions and humanitarian problems.
The maternal mortality rate in developing countries was 239 per 100,000 live births in 2015, compared with 12 per 100,000 in developed countries. There are significant differences in rates between countries. There are also large disparities within countries between high- and low-income women and between women living in rural and urban areas.
The highest risk of maternal death is among adolescent girls under 15 years of age. Complications during pregnancy and childbirth are the leading cause of death among adolescent girls in most developing countries. 2.3
Women in developing countries have, on average, many more pregnancies than women in developed countries, and face a higher risk of pregnancy-related death throughout their lifetime: a 15-year-old girl is about to die from a maternity-related cause. 1 in 4,900 in developed countries compared to 1 in 180 in developing countries. In countries designated as fragile states, the risk is 1 in 54; this is a testament to the consequences of collapsing health systems.
Why do women die?
Women die as a result of complications during and after pregnancy and childbirth. Most of these complications develop during pregnancy and are preventable. Other complications may exist before pregnancy but become worse during pregnancy, especially if they are not monitored. The main complications that lead to 75% of all maternal deaths are: 4
- heavy bleeding (mostly postpartum hemorrhage);
- infections (usually after childbirth);
- high blood pressure during pregnancy (preeclampsia and eclampsia);
- postpartum complications;
- unsafe abortion.
In other cases, diseases such as malaria and HIV/AIDS during pregnancy or related problems are the causes.
How can mothers' lives be saved?
Most maternal deaths are preventable because medical methods to prevent or manage complications are well established. All women need access to antenatal care during pregnancy, skilled care during labour, and care and support in the weeks after birth. Maternal health and newborn health are closely linked. An estimated 2.7 million newborn infants died in 2015 5 and an additional 2.6 million were stillborn 6 . It is especially important that all births are attended by trained health professionals, as timely care and treatment can make the difference between life and death for both mother and baby. It is especially important to ensure that qualified health professionals are present during all births, as timely assistance and treatment may depend on life.
Heavy postpartum bleeding: healthy woman could die within 2 hours if she does not receive medical attention. An injection of oxytocin given immediately after birth is effective in reducing the risk of bleeding.
Infection: After childbirth, infection can be ruled out by maintaining proper hygiene and identifying it. early signs and timely treatment.
Preeclampsia: must be identified and managed appropriately before seizures (eclampsia) and other life-threatening complications occur. By administering medications such as magnesium sulfate, the risk of women developing eclampsia can be reduced.
To prevent maternal deaths, preventing unwanted and too early pregnancies is also vital. All women, including adolescent girls, need access to contraceptive methods, as well as safe abortion services to the fullest extent permitted by law, and quality care after an abortion.
Why aren't mothers getting the help they need?
Poor women in remote areas are least likely to receive adequate health care. This is especially true in regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. Despite increasing levels of antenatal care in many parts of the world over the years last decade, only 51% of women in low-income countries receive skilled care during childbirth. This means that millions of births occur without a midwife, doctor or trained nurse.
In countries with high level income, almost all women attend antenatal clinics at least four times during the prenatal period, receive help from a qualified medical worker during childbirth and postpartum care. In 2015, in low-income countries, only 40% of all pregnant women attended at least four antenatal clinics.
Other factors preventing women from applying for medical care during pregnancy and childbirth are the following:
- poverty;
- distance;
- lack of information;
- inadequate services;
- cultural characteristics.
To improve maternal health care, it is necessary to identify barriers to access to quality maternal health services and take action to eliminate them at all levels of the health system.
WHO activities
Improving maternal health is one of WHO's main priorities. WHO works to reduce maternal mortality by providing evidence-based clinical and programmatic guidance, setting global standards and providing technical support to Member States. In addition, WHO is promoting more affordable and effective methods treatment, develops educational materials and guidelines for health workers, and supports countries in implementing policies and programs and monitoring progress.
In addition, WHO promotes more affordable and effective treatments, develops training materials and guidelines for health workers, and supports countries in implementing policies and programs and monitoring progress.
During the 2015 United Nations General Assembly in New York, UN Secretary-General Ban Ki-moon launched the Global Strategy on Women, Children and Adolescents' Health 2016–2030. 7 This strategy is a roadmap for the post-2015 agenda, as described in the Sustainable Development Goals, and aims to end all preventable deaths of women, children and adolescents, and to create an environment in which these groups not only survive , but also successfully develop and see changes in the environment, health and well-being.
The content of the article:Mortality during childbirth is not only a sad statistic, but also a huge tragedy for relatives. Most often, women in labor die due to prenatal diseases, complicated childbirth, medical error or postpartum infections. The death of a child can be caused by various diseases and the condition of the mother or the fetus itself. In addition, a newborn may die due to improper obstetric care.
Deaths during childbirth in Russia are 22 per 100,000, compared to 6–10 in Europe, and from 400 to 800 in Africa and Asia. Why do deaths occur and how to prevent them? This will be discussed in this material.
Causes of maternal mortality
Maternal mortality is the death of a woman during pregnancy, childbirth, or 42 days after its end.
Causes of death during childbirth:
Obstetric hemorrhages account for 23% of all deaths - this is the most common reason deaths of women in labor. A woman dies as a result of uterine bleeding during pregnancy, during or after the birth process.
Causes of bleeding during pregnancy - detachment or presentation " children's place"(placenta), rupture of the uterus along the suture in multipartum women.
Hemorrhage during childbirth can be caused by a large fetus, incorrect insertion of the head, or transverse presentation of the child. Other reasons: clinically narrow pelvis in a woman in labor, hypertensive dysfunction of uterine contractility, tumor of the genital organs, cicatricial deformation of the cervix, exostoses in the pelvis.
Causes of bleeding after childbirth: blood clotting disorders, impaired separation of the placenta and placenta, internal and external ruptures of the tissues of the birth canal, atony and hypotension of the uterus.
Late toxicosis (gestosis) accounts for 18% of the total number of deaths of mothers. Dropsy in pregnancy, nephropathy (swelling, protein in urine, high blood pressure), and preeclampsia pose a high risk. But the most dangerous complication late toxicosis- This is eclampsia, which provokes convulsions, respiratory arrest, coma or even death.
Extragenital pathologies account for 15% of the total maternal mortality rate. These are diseases of the cardiovascular, nervous, digestive, respiratory and other systems. Such diseases lead to severe obstetric complications and often provoke the death of a woman during childbirth.
Purulent-septic diseases constitute the same percentage of mortality as the previous point. The inflammatory process after childbirth, especially after cesarean section, provokes an increase in temperature up to 40°, purulent vaginal discharge, weakness, fever, and loss of appetite.
Complications during anesthesia account for about 7% of all deaths. This means that the mother died during childbirth due to aspiration pneumonitis, complications of catheterization, hypersensitivity to painkillers (anaphylaxis), violation of the rules for infusion therapy, epidural and spinal anesthesia.
Penetration amniotic fluid into the mother's bloodstream accounts for 6% of the total mortality rate. This complication occurs as a result of a significant excess of amniotic fluid pressure over venous pressure or when veins gape. The main reasons for increased amniotic pressure are rapid labor, breech presentation child, diabetes mellitus, heart defects, preeclampsia, induction of labor. Gaping of the uterine veins occurs due to placenta previa or abruption, caesarean section, decreased uterine tone, traumatic non-penetrating violation of the integrity of the uterus.
Uterine rupture provokes the death of a woman in labor in 5% of cases. When the uterus begins to rupture, the woman experiences frequent and painful contractions, and the fetal heart rate increases. It occurs more often in first-time mothers.
These are the leading preventable causes of death during childbirth.
Preventing maternal death
Late toxicosis most often occurs in women under 20 years of age and after 35 years of age, due to genetic predisposition, chronic diseases, excessive physical exertion or hormonal imbalance. When swelling occurs, speed dial weight, you should limit the daily volume of liquid to 1 liter and the amount of salt. Doctors recommend switching to a dairy diet.
In case of severe edema and nephropathy, the pregnant woman is hospitalized, transferred to a salt-free diet, and the amount of fluid consumed is monitored. If there is a risk of preeclampsia and eclampsia, medications are prescribed: diuretics, sedatives and antispasmodics. The woman is in hospital until her condition stabilizes.
Eclampsia is a very dangerous condition that requires intensive treatment to normalize the functioning of important organs. If the woman’s condition does not improve within 3-12 hours, then a caesarean section is performed.
To avoid such complications, you should follow a diet. Allowed products: fermented milk products, cereals (buckwheat and oatmeal), herbs, vegetables, fruits. You should avoid smoked products, fried, salty foods, and chocolate. Doctors recommend swimming, avoiding stress and excessive physical activity.
High risk of mortality during childbirth in women over 35 years of age with high blood pressure, fibroids, diabetes mellitus or overweight. Such pregnant women should be under the supervision of a doctor, follow a diet, healthy image life.
To prevent a woman from dying due to infectious diseases Doctors prescribe antibacterial drugs. To prevent severe bleeding, it is important to diagnose in time, identify the causes and eliminate them.
To stop bleeding after childbirth, a woman is given an injection of Oxytocin or the placenta is removed manually. If necessary, the woman in labor is hospitalized for a blood transfusion or surgery.
The death rate of women during childbirth is common when there is an obstacle to the passage of the fetus ( incorrect position, narrow pelvis in a woman). A qualified doctor will quickly assess the situation and perform emergency surgery.
Thus, it is important to find an experienced and conscientious doctor who will manage pregnancy, childbirth and monitor the woman’s condition after childbirth. After all, the risk of death after childbirth is also quite high. A woman must strictly follow the doctor’s recommendations, lead a healthy lifestyle, be attentive to her health, and avoid stress.
Infant mortality - causes, statistics
Recently, the mortality rate during childbirth has been decreasing; in 2016 it was 5.8 cases per 1000 births. Infant mortality has decreased thanks to the federal program “Children of Russia” and the work of modern perinatal centers in 30 regions of the Russian Federation.
Statistics of mortality during childbirth in Russia:
2008 – 11 deaths per 1000 births;
2009 – 10 cases for the same number of births;
2010 – 9.3 cases per 1000 births;
2011 – 8.4 deaths;
2012 – 8 cases;
2013 – 7.4 deaths.
As can be seen from the figures, infant mortality is gradually decreasing.
Perinatal death (death between 22 weeks of pregnancy and 7 days after birth) occurs in 35% of cases due to disorders intrauterine development(various defects of fetal organs). High mortality rate in premature babies weighing about 1.5 kg. But the death of a full-term, fully formed child is considered the most unfavorable.
There are many causes of death as a result of childbirth, which are divided into 2 groups:
Conditions and illnesses of the mother that cause the death of the fetus. Causes: premature placental abruption or discharge of amniotic fluid, gestosis, rapid labor or weak labor activity etc.
Conditions and diseases of the fetus that cause its death. Causes: malformations of organs (heart disease), diseases of the respiratory system (pneumonia in an infant), hypoxia or asphyxia, various infections (purulent infections).
It often happens that a child dies during childbirth due to poor quality medical care. In addition, home births under the supervision of unskilled midwives have recently become popular.
Preventing the death of a child
It is possible to reduce the likelihood of a child’s death, but to do this you must follow the following rules:
Mother and father must give up bad habits(smoking, alcohol, drugs) even before conception.
It is important to treat somatic diseases, chronic diseases, and urogenital infections before pregnancy.
It is necessary to establish correct mode sleep and wakefulness, create comfortable conditions for work and rest.
Expectant parents should eat right.
It is important to avoid stress.
Having become pregnant, a woman continues to lead a healthy lifestyle, and her husband must support her in every possible way.
It is important to undergo regular diagnostic studies in order to identify defects in time and take the necessary measures.
Future parents must find a qualified and trusted specialist who will manage pregnancy, childbirth and monitor the condition of the mother and child.
Only by following these rules can death be avoided.
How to survive a tragedy?
The death of a child is a huge grief for parents and relatives. Those who have encountered a tragedy are interested in the question of how children who die during childbirth are buried. A child from the 28th week of pregnancy has the same rights as an adult; he is allocated a place in the cemetery and is provided with funeral services.
The funeral rite is no different from the usual one, that is, the body is cremated or buried in a small coffin. Parents can arrange the funeral themselves after the cause of death has been determined. If they do not have the funds to organize a funeral, they can turn to a special service for help.
Can take charge of organizing the funeral medical institution after parental consent. Cremation or burial is carried out by the city service 3 days after the cause of death is determined.
If parents are painfully experiencing the death of a baby, then they should seek help from a psychologist. Relatives are obliged to support them at this moment!
In addition, it is important for a woman to restore her body after loss. During this period, she begins to experience discharge similar to menstrual discharge and appears slight pain in a stomach. This is how the uterus is cleansed. If the discharge becomes profuse, smells unpleasant, or the abdominal pain intensifies, you should consult a doctor.
To suppress lactation, you can use special drugs. If milk in the breast does not interfere, then you can wait until it disappears on its own or consult a doctor on how to speed up this process.
After 6 weeks, the woman must visit a gynecologist for an examination. The doctor will answer questions about possible reasons death of the child and advise how to avoid this during the next pregnancy.
Physical exercise will not only restore strength and strengthen muscles, but also improve morale. It is important to accept emotional support from your spouse and family.
Thus, in order to protect yourself and your child from death, you should take a responsible approach to pregnancy planning. You should give up bad habits, lead a healthy lifestyle, treat diseases in a timely manner, and follow the instructions of a qualified gynecologist. This is the only way you will experience all the joys of motherhood.
