The place where babies see their first light of day should be the happiest room in the hospital, explains France Donnay on the origins of the Lab.our Ward project.
In almost every country, the risk of dying in childbirth is decreasing, compared to the year 2000, when the global community of leaders decided to address health challenges more forcefully than before. The death of women and babies during birth became one of the eight goals to be achieved by 2015. The results were at once striking – with nine countries achieving the goal – and disappointing – with many countries reducing maternal deaths by 50% or even 25%, against the 75% reduction that was proposed as a goal.
Why are 300,000 women still dying every year, or 800 women every day? Why do 10,000 newborns die every day? Why are countless women giving birth in dire circumstances, alone, on a rusty table, in a room with stained, filthy floors, bitterly cold in winter, unbearably hot in summer? Why are women suffering from infections and bleeding, why are many babies born small, weak or forever damaged by a birth trauma?
Now, you are probably thinking of a poor woman giving birth in her simple village house, or in a slum on the outskirts of a big city? Well, not at all, what is described here is a birth in a hospital in many poor – and not so poor – settings in low income countries.
Why are the midwives and nurses working in that hospital so stressed and tired that they insult their patients, slap them, or simply ignore them? Why are so many of them poorly trained, overworked, not motivated and not given adequate support while they have to work in such demanding conditions?
In my 40-year career as an obstetrician, first as a practitioner then as a public health “expert”, I have visited hundreds of birth centers and hospitals in many places, and time and again, I have been overwhelmed with feelings of surprise, anger, sadness, alongside the firm conviction that it does not need to be that way.
Over the last 20 years, the ecology of births has changed dramatically. Now globally, more and more women deliver in facilities, even if the distribution of facility and home births differ wildly between countries and regions – from 42% in South Asia, to 50 % in sub-Saharan Africa and 79 % in North Africa and West Asia. But in all regions, across all income levels, women and their families are voting with their feet, making clear their strong preference for delivering in hospitals. Moreover, they often go to large hospitals, bypassing smaller facilities. This choice is often made out of fear for unexpected complications that might not get adequately addressed in smaller places; because they are aware of the unavailability of a skilled birth attendant on duty 24 hours a day; or of the lack of even simple equipment and supplies for normal births.
So, why is the labor room, the place where babies see their first light of day, so often the filthiest place in the hospital?
With the ever increasing caseload in larger facilities come multiple technical and operational challenges, like
- Insufficient numbers of staff
- poorly trained and poorly supervised birth attendants
- outdated equipment
- drug and supplies stock-outs
These combined result in ineffective and poor quality care, and disappointing outcomes for mothers and babies.
The experience of birth should be a healthy, happy one, for women and their partners, and for the health providers. This is why we’ve embarked on the Lab.our Ward innovation project: to envision the labor room of tomorrow that is safer, more welcoming and provides options for the clients.
The objective is to redesign the labor ward, starting from architecture and space – from ventilation and lighting to privacy – then looking at sterilization, storage, products and finally improving services – starting with a welcoming reception and “precision care“ provided to each individual woman to efficient use of new technologies.
In 2015, the world leaders again set a goal for 2030 – reduce deaths in childbirth by about 75 % again of the 2015 results – for me, the work starts where every life begins: in the labor room.