So......
To play devil's advocate and to look at both sides of the story there are also other reasons that the majority of maternal deaths occur in the public hospital....
- Usually women who have the ability to birth in a private hospital have insurance and/or money. They usually have adquate or excellent preventative care. The women arriving at the public hospital mostly do not see a doctor unless they are pregnant. Lots have undiagnosed conditions such as diabetes, hypertension, cardiac disease, etc.
- The public hospitals receive the haitians who just show up not having had any prenatal care. Pre-Eclamptic, HIV positive, with a multitude of other co-morbitities.
- The public hospitals do not have enough staff and there staff are not well-educated.
- The public hospitals receive the majority of pregnant adolescents who in themselves come with an array of issues.
Now that we've estableshed that there are some reasons WHY you are more likely to die giving birth in a public hospital that has nothing to do with the above causes. Some of these things are proven while others are my personal observations.
- There is a non-chalant attitude among the staff. Some really could care less. This is my personal observation. Women are treated as if they are nothing. So if they are nothing, who cares if they die, right?
- The quality of care in public hospitals is lacking. They have no money for continuing education, alot of the doctors do not keep up with new studies and standards of practice which we know that especially in OB, is paramount to good care. In OB the standards change all of the time with new evidence, studies, etc. If you do not keep up with it, as most doctors in pubic hospitals don't, you may actually be giving care that was ok before but at present is actually harmful. This is proven (not my opinion). I saw in one hospital where there big rate of death was postpartum hemorrhage that after vaginal delivery the women are put into a 6 bed "recovery room" where they recover for 1-2 hours before going to a postpartum room. They lay in the bed for 2 hours then go to their room. The first hour after delivery is critical for Postpartum hemorrhage, the fundus and vital signs should be checked every 15 minutes. In this first hour, a woman can be left alone and if not checked, she could fal asleep and bleed to death. This happens alot in DR. I teach my ladies to check their own fundi and bleeding. I tell them to try not to sleep the first hour, they can go to sleep once they get into their postpartum room. I educate them on what are the signs that they are bleeding to much and how to advocate for themselves if no one is taking them seriously. One girl told me that after delivery, NO ONE checked her fundus until the next day when the doctor came to see her. She said luckily she was doing it herself!
- The hygiene in the public hospitals is lacking. This is fact, not my opinion. And it is self explanatory. Especially for C-section patients, catching an infection in the hospital and not being diagnosed before you are discharged (because the nursing care is so poor) can be a death sentence.
- Patient education in the public hospitals is lacking. Fact, not my opinion. If patients are not educated on how to take care of themselves once at home, with vaginal or C-section and not educated on the signs and symptoms that there could be an issue and not told when to return to the hospital then your job as a provider was not complete. Many women leave the hospital not knowing simple education facts that could save their life postpartum.
- C-sections make money but are not the safest option for the patient. The C-section rate in DR is an embarrassment. The WHO states that the rate should not exceed 15%, and ours (DR) is between 40%-45%, even MORE in private clinics. Women are women are women, and our bodies have NOT changed so significantly in the last 100 years that almost half of women now need a C-section.
Hopefully the DR will come around, there ARE strides being made. Doulas are now all the rage, more patients are being educated so that they can stand up for themselves. We just need to make enough stink so that instead of just talking about it, they DO something about it.
SHALENA
P.S. I have been named by DONA International as their Regional Representative for the Dominican Republic so I will be overseeing DONA's activities in the country. If you don't know about DONA here is an excerpt from the website.
"DONA International: We are the world's premiere doula organization
Pardon us for bragging, but we are the oldest, largest and most respected doula association in the world. Our founders are among the foremost experts on doula care, and DONA International certification is a widely respected measure of quality and professionalism. We are an international, non-profit organization of doulas that strives to have every doula trained and educated to provide the highest quality and standards for birth and/or postpartum support to birthing women and their families. To that end, we promote continuing education for doulas and provide a strong communication link among doulas and between doulas, families and the medical birthing community.
We are an amazing community with a shared passion for families that reaches around the world. DONA International doulas and the families they serve are in more than 20 countries."