Thursday, May 26, 2011

Looking to the Future: Mother-Centered Maternity Care in Kuwait

Expecting mothers in Kuwait have fairly easy access to the best the world has to offer in maternity clothes, nursery furniture, strollers, or infant toys—something you would expect in a country that has the third highest GNP in the world. And while there is a limited supply of pregnancy support services (doulas, childbirth educators, lactation specialists, prenatal fitness instructors etc.) if you can’t find one here in Kuwait, you would have the option to pay for private services and fly one in from a neighboring country. However, if you want to stay in your home country and give birth in Kuwait, the one thing money can’t buy is a mother-centered maternity system. You can’t find it here, and you can’t import it in from someplace else. 

Kuwait is not unique to this situation. I am sure that the mothers I teach are not the only ones who look at their antenatal instructor during class and ask, “But why do hospitals continue to use routine interventions (such as continuous external fetal monitoring, routine episiotomies for first time mothers, or IV fluids) when they have been shown to be ineffective and sometimes harmful to the mother?” Likewise, I know my clients are not the only ones to ever say, “I don’t know if my doctor will allow me to do that,” when discussing their own personal comfort during labor—such as eating and drinking, moving around, having emotional and physical support, or laboring in water—or when discussing what position they want to be in for pushing out their own baby.  At what point did women have to start asking permission to respond to the needs of their own bodies? The fact is, many hospital and medical care practices and maternity system policies are based on fear of litigation, convenience for the doctor and other staff, political alliances, and the potential for financial profits rather than scientific study and sound reflection. As a result, they do not always serve the best interest of mothers and their babies.


In contrast, recent studies have named Sweden the best place in the world to give birth (right up there with Norway, Finland, Japan, and the UK- all midwifery based maternity systems I might add) A research centered organization—Childbirth Connection, based in the US—created a team of experts to look at countries like Sweden and others with excellent maternity and infant care, to identify the key elements that go into making a great maternity system and create a road map for getting there. According to the Childbirth Connection’s Transforming Maternity Care project, “A high-quality, high-value maternity care system means care is consistently and reliably woman-centered, safe, effective, timely, efficient and equitable.”

How does that translate into real practice? What would a maternity system like this look like? For the purposes of this article I am going to paraphrase a great deal from the Transforming Maternity Care Vision for 2020. The key elements include the following:

During pregnancy, mothers are engaged as partners in their own care. Their wishes are known and respected. Mothers receive practical support from their care providers, including access to complete, accurate, up-to-date, high-quality information, decision support, health promotion services, and antenatal education.

During the time of birth, mothers continue to be engaged as partners in their own care, have the freedom to choose the place of their birth—including home, birth centers, and hospitals. Each woman is attended in labor and birth in the manner that is most appropriate for her level of need and that of her baby and experiences only interventions that are medically indicated, supported by sound evidence of benefit, with least risk of harm compared with effective alternatives. Each woman has access to a full-range of evidence-based, non-pharmacologic and pharmacologic strategies for pain management and relief as appropriate to each birth setting.

Immediately after the birth, mothers and babies routinely stay together, skin to skin, receiving evidence-based care, support, and minimal disruption in the minutes and hours after birth to promote early attachment and the initiation of breastfeeding, whenever neither requires specialized care at this time.

Mural at AIS

Recently, I was walking through the hallway of my children’s school—the American International School of Kuwait—and I was moved by a mural on the wall depicting the Kuwait skyline and the values taught by the school: knowledge, innovation, reflection, care for others, critical thinking, risk-taking, and empowerment. If these are the values that we expect our children to learn at school, maybe we should start modeling them first. What we need to truly change maternity care here in Kuwait are well-informed and empowered mothers, doctors and nurses dedicated to the Hippocratic oath and the scientific method—the systematic study of effective care—and innovative politicians truly dedicated to being servants of the public good rather than their own self-interest. We all contribute to the problem, and so we must all contribute to the solution. Let's take a lesson from our children. Together, we can help transform maternity care in Kuwait, because there’s no place like home when it comes to having your baby.

No comments:

Post a Comment