‘Many women refuse to come to hospital to give birth because they are not respected by the midwives’. I was working on a maternal health proposal in Ghana when this little bombshell dropped. More than half of Ghanaian women choose to stay at home to give birth. Too many of their newborns die. Without due care, new mothers suffer complications in their recovery and endure injury or even death.
The improvement in maternal and newborn health were Millennium Development Goals that missed the mark. These continue to be priorities for global health agencies, largely on the basis that women should come to hospital to give birth under medical supervision. Obnoxious midwives make this aspiration that bit harder.
Strangely enough, in countries with highly developed health services, women are also asking why they have to go to hospital to give birth. Not because of bolshie staff, but because they want the experience of birth to be more natural and less clinical.
The solution we sought in Ghana was to provide skilled birth attendants closer to home, perhaps with small compounds to oversee the births. Transport to the nearest hospital was also a feature of the plan in case of emergency.
Many midwives in developed health systems argue for much the same, with local birth centres becoming increasingly popular with the middle classes. Naturally, all concerned are wary of risk. Hospitals are assumed to offer the most skilled care in the face of complications. But they also tend to practice too much medicine in the process, and women whose second or third child looks set to enjoy a routine birth find this medicalised environment unsatisfying.
Giving birth requires skilled care and attention in an environment that can enhance and not detract from the joy of bringing a new life into the world. We should not assume that hospitals are always the ideal setting.