Home birth geography quiz!

Quick! Name the country where:

  • Maternity care is provided in hospitals by obstetricians, and at home by medically-trained midwives and traditional midwives.
  • Obstetricians don’t trust midwives.
  • Midwifery groups don’t trust each other, and none of them trust obstetricians.
  • Midwives feel obstetricians are often insulting and disrespectful to them.
  • Obstetricians, in fact, are often insulting and disrespectful to midwives.
  • Timely transfer from home to hospital during labor is often hampered by delays in deciding to seek care, by slow transport to the hospital, and by delays in receiving care on arrival.
  • Women seeking home births are afraid of hospitals, which they see as cesarean mills.
  • Obstetricians are viewed primarily as surgeons, their motives mainly financial.
  • Economic and ethnic disparities are rife; those with money get care when and where they want it.
  • Despite years of progress, maternal mortality rates remain stubbornly high.

I know what you’re thinking: Hey! I live there, right?

Wrong. It’s Iran.

Specifically, it’s Zahedan, the capital of Sistan and Baluchestan province in eastern Iran, home to 600,000 people on the border with Pakistan.

A recent study of maternity care in Zahedan revealed a very fractured, and fractious, obstetrical world. What with battles over where and when midwives can legally practice, how best to deal with a flood of undocumented and uninsured immigrants, layers of professional suspicion, accusation, intrigue and infighting…you start to get the idea that maternity care is a mess the whole world ’round.

Granted, there are differences between Zahedan and the U.S. It’s unlikely, for example, that an American woman would have to have her eclamptic seizures exorcised by a faith healer before her family would allow her to go to the hospital (a not-uncommon practice in Zahedan). Too, an American family would probably not be required to drive their very angry midwife home before heading to the local maternity ward. And an Iranian midwife’s trump card–the threat to “go outside the home and shout and bring disgrace” on a woman and her family for seeking hospital care–probably doesn’t strike a lot of fear in American hearts.

Still…

Hospitals in Zahedan have begun a two-pronged outreach effort of sorts, aimed at convincing mothers and their relatives that a) traditional midwives may be lacking the kind of training needed in real emergencies, and b) hospitals aren’t simply scary cash-machines for doctors:

“Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give appropriate consideration to the ethical and cultural concerns of the women.”

Maybe we have more in common with Iran than we thought…

 

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