While I was reading the maternal and child health chapter about Haiti about healthcare services and costs. The chapter pointed out that women in Haiti felt healthcare services (including those pertaining to birth) should be free of charge. Conversely, the healthcare workers had the notion that payment is important because the services would be rendered worthless (179). This was a really striking statement and I personally do not really understand it. If you provide a service for free, especially one as beneficial as healthcare or maternal care I do not see that as detracting from its value. If one thinks about the terrible rates of mortality Haiti has for health issues brought on by poverty its interesting that free services making things worth less is the mindset of health workers. These health care workers are in direct contact  with poverty and see the effects of it as well as insufficient maternal care everyday. This also speaks to a bigger issue, which relates to infrastructure. This ideal must be something that is being taught among healthcare professionals  or a conclusions drawn sparked by misconception and a break in communication between workers and mothers. Whatever it is something that needs further consideration outside of this project. I say this because this project sponsor made sure to have pre-natal services and the like provided for free, which is nice for those in Torbeck Plain but what about those living in other areas with the same fee for value system? Finding some common ground on maternal care costs and needs are essential. The progress of women being able to properly take their children to term, survive the birth, and raise the child into adulthood are dependent on things like healthcare workers and fees in rural areas.

Deciding where to give birth is very personal decision, but it is dictated by societal influences, such as socioeconomic status, availability to different types of care, and geographic location. Oftentimes, women don’t have the freedom to choose where to give birth. For example, women in rural or low-income areas may not have access to hospital birth. On the other hand, many women in places where birth is largely medicalized- such as the United States- do not know that they have options outside of hospital births or do not have access to alternative birth locations. Women should be provided with multiple options during their pregnancy, so they can decide what may be best for them. There are advantages and disadvantages for each birth setting, and because each woman and experience is different, we should not generalize and state that one birth setting is best for all women.

Home birth

Advantages: comfort in one’s own home, ability to eat, drink, and move freely, ability to choose in what room and position to give birth, often more affordable than hospital birth, fewer interventions (http://www.cdc.gov/nchs/data/databriefs/db84.htm)

Disadvantages: possible delay of emergency medical care, limited access to pain-relieving drugs, may not be covered by insurance, not available to women deemed “at risk”

Hospital birth

Advantages: close access to medical care, full staff available to attend the birth, open to patients of all medical backgrounds

Disadvantages: no drinking or eating, movements limited, labor is often rushed, likeliness of intervention increases, standard birth position on back, lack of informed consent, requires travel, expensive

Birth center birth

Advantages: freedom to eat, drink, and move, rooms designed for specific types of birth (water birth, etc.), multiple trained staff available, ability to choose position, fewer interventions, more drugs and technologies on hand than home birth

Disadvantages: requires travel, possibly delay of emergency medical care

Note that many of these disadvantages and advantages depend on the individual birth setting and caregivers and that this is a general composition.

There should not be laws that dictate where women give birth. Instead, women should be trusted to make their own medical decisions based on what is best for them. However, there should be laws (or lack thereof) that ensure that women have access to a variety of types of care during birth. Thus, hospitals should be regulated to ensure that women of all income and geographic settings could access them. Also, currently, 28 states prohibit the practice of Certified Professional Midwives, who most often attend homebirths (http://mana.org/about-midwives/legal-status-of-us-midwives). In addition to legal advocacy, it is important to advocate for a larger change to the system that tells women that 1) they are not competent enough to choose where and how to give birth and 2) medicalized (hospital) birth is the only way to give birth.

Sources and additional information:

http://www.cdc.gov/nchs/data/databriefs/db84.htm

Summary and statistics about home birth in the US

http://mana.org/about-midwives/legal-status-of-us-midwives

An explication of the legal status of midwives in the US

http://www.theatlantic.com/health/archive/2014/10/why-american-babies-die/381008/

I recently read this article and found it very pertinent to our class, and to what I want to use in presentation. The article states how the United States is ranked 56 in the world in infant mortality and sandwiched between Serbia and Poland, which I personally found surprising as I figured the US would be lower, but I didn’t think that low.

The article states however that the US has lower neonatal death rates than Finland and Austria (two countries with low infant mortality rates) but relatively high postneonatal rates. So the problem is not when a child is born and is in the hospital and when they immediately get home, but later on.

But the one paragraph I found most interesting was this:

“The effects of socioeconomic status on health have been well-documented, and infant mortality is no exception: Unsurprisingly, the states with the highest rates are also among the poorest. “IfAlabama were a country, its rate of 8.7 infant deaths per 1,000 would place it slightly behind Lebanon in the world rankings,” Christopher Ingraham recentlynoted in The Washington Post, while “Mississippi, with its 9.6 deaths, would be somewhere between Botswana and Bahrain.””

The comparison to Botswana and Bahrain really puts the global problem of infant mortality in perspective in that it is a global problem which includes the United States. This article ultimately suggest how one must look critically at health statistics, but certainly for something as complex infant mortality.