Protecting Perinatal Health
Essay written by Dorothy Bauman, CPM – July 2025,
Campeche, Mexico
The term perinatal is commonly defined as the period of time from conception and up to a year after giving birth. "The perinatal period, broadly defined, encompasses the time frame from one year before to 18 to 24 months after the birth of the child. This period constitutes a window of opportunity through which parent-infant interaction may be reinforced, offering the possibility of decreasing the risk of family dysfunction." (National Library of Medicine)
As mentioned above, the perinatal period is a special time, one that can be shaped and molded, that can be damaged or protected. It is a time when the mother and baby's health is at an increased risk. The delicate health of the perinatal period must be guarded, must be protected and guided.
Midwives are a vital part of perinatal health. Midwives have a tremendous influence over the care that women receive during their pregnancy, birth, and in the period after the birth. Because trained midwives provide a more holistic type of approach to care, which includes both the medical and the natural processes, they follow both low-risk and high-risk women, working where doctors cannot, while referring patients that require higher care to specialists. Midwives are primary healthcare providers, attending to women through continuity of care beginning in the prenatal period, and extending through the birth into the "4th trimester", providing care over the time of the entire childbearing year. Midwives mentor mothers, empowering them to own their body, their birth, and their baby. Midwives hold skills for medical emergency care, as well as skills in breastfeeding and well-woman care. All in all, midwives improve outcomes, decreasing maternal and neonatal mortality. With more midwives, the world would see many more lives saved, many more women empowered, many more happy and thriving families, and less trauma in birth. It is imperative that the world recognize midwives as an integral part of humanity (as they have been since the beginning of time), giving them a place to function both in maternal healthcare and in teaching future midwives safely and legally. Midwives should have access legally to training in pharmacology and in use of medications for a life-saving measure. Doctors should recognize the important place of the midwife, not viewing midwives as a threat, but rather another link in the chain to protect perinatal health.
Pregnancy and childbirth are not inherently pathological, meaning they do not always require medical intervention. In fact, pregnancy and childbirth are a natural, physiologic process of the body and its reproductive cycles, and must be guarded to help prevent unnecessary pathology, interventions, and complications. Maternal and child health services have long been seen as inseparable partners. The two are so intertwined that to separate one from the other is to not acknowledge the core essence of their origin, creating a setup for more iatrogenic complications and unnecessary interventions. Safe Motherhood Initiative has brought positive change to the medical system…
"The launch of the Safe Motherhood Initiative in the late 1980s, for example, brought heightened attention to maternal mortality, whereas the International Conference on Population and Development (ICPD) broadened the focus to reproductive health and, more recently, to reproductive rights (Germain 2000). Those shifts can be linked with international programmatic responses and terminology—with the preventive emphasis of, for instance, prenatal care being lowered as a priority relative to the treatment focus of emergency obstetric care. For the child, integrated management of childhood illnesses has brought renewed emphasis to maintaining a balance between preventive and curative care. The particular needs of the newborn, however, have only started to receive significant attention in the past three or four years (Foege 2001)." (National Library of Medicine)
It is imperative that we recognize the intertwining of the mother-infant relationship, prioritizing and emphasizing preventative measures in the perinatal period through high-quality prenatal, intrapartum, postnatal and newborn care. While there is a great need for providers to have life-saving skills and that trained medical personnel be readily available for curative care for all critical cases in maternal and neonatal care, there also must be a recognition of the need for preventative care. Midwives specialize in preventative care and ideally should be available for every pregnant woman.
An estimated 210 million women become pregnant each year, and close to 60 million of these pregnancies end with the death of the mother (≈500,000) or the baby, or as abortions. More than 60 percent of perinatal deaths involve the following conditions: For the mother, these conditions are hemorrhage, sepsis, hypertensive disorders of pregnancy, obstructed labor, and unsafe abortion. For the baby, low birthweight, birth asphyxia, and infection.
It is estimated that by investing in the training and availability of midwives around the world, 4,300,000 lives could be saved by the year 2035. It is stated that 88 to 98 percent of maternal deaths are avoidable with moderate levels of health care (WHO 1986). "Maintaining an effective balance, however, between preserving normality and ensuring a state of readiness to deal with abnormality represents a fundamental challenge to health systems and a tension in safe motherhood programming. The principle of 'first, do no harm' has particular significance in this area, because many preventive practices related to pregnancy and childbirth can readily become harmful in unskilled hands—for example, inappropriately early induction of labor or poor forceps technique. The iatrogenic burden of maternal and perinatal conditions is rarely factored into assessments of intervention effectiveness." (National Library of Medicine, Chapter 26, Maternal and Perinatal Conditions)
The statement above speaks of the difficulty to find that fine balance between the natural physiologic approach and the place for interventions to save lives and improve outcomes in childbirth.
The first 1,000 days of a child's life involve life from the day of conception (first day of pregnancy) until the day the child turns 2 years old. During this time is when the perinatal period takes place. It is during this period that the health of mother and baby are at greatest stake, holding great delicacy. This is an important time for maternal and neonatal providers to give their best to protect this delicate period, to nourish it, and guide it by educating those responsible for their own health decisions: the parent(s). It is a time to be monitored closely, to be guarded as a sacred space. The first 1,000 days of a child's life are both the most impactful and influential as well as the most dangerous of all. This is when the most (untimely) deaths occur; many, many that could be prevented.
Because the mother-infant relationship is so closely intertwined, both the health and bonding of mother and baby must particularly be guarded closely. Protecting this period largely includes the establishment and promotion of breastfeeding beginning with early initiation of breastfeeding at the time of birth and exclusive breastfeeding up until 6 months of age.
Protecting the perinatal period goes beyond the care that clinicians provide… it must be taught and implemented by society as a whole, by communities, and by each individual adult. Fathers must recognize the critical delicacy of the woman and the child's health, and honor the perinatal period. Women should be educated and empowered to make decisions regarding them and their baby's care. Males and females should be treated with equal value in all sects of life, and childbirth should be honored and protected by all.
One of main killers in the perinatal period is… Delay. Delay in recognition of a problem, delay in transportation for proper care, and delay on the clinician's part to act quickly enough. These three delays are considered to be the three deadly delays. So, what are some ways we can help eliminate some of these deadly delays?
First off, society must recognize these delays as a main problem for the health and mortality of the perinatal period and within the first 1,000 days of life. Action must be taken on everyone's part to help decrease these delays. Teaching the public through media and programs about the danger signs of pregnancy and labor, and how to prevent basic complications through clean water and good hygiene, how to avoid accidents and disasters, and how to respond when a health need arises, is imperative to improve maternal and neonatal outcomes.
Let's look at a few of these life-threatening complications:
Preterm birth is defined as the birth of a live infant from the twentieth week of gestation up until the thirty-seventh week of gestation. Preterm birth is one of the number-one causes of neonatal mortality and morbidity. Yet, preterm birth is happening all around us all the time. Even in the USA where there are the latest technologies in medicine, preterm birth is still a leading factor of mortality, causing many more complications that are draining millions of dollars of resources unnecessarily every year. But then when we look over into Africa, the rates of preterm birth sky-rocket. Why? Why could this not be prevented? The answer is that it primarily can be prevented with good quality care. But when women don't recognize the early signs of preterm birth, can't pay for good care, or can't access quality care easily, preterm birth continues to be a real issue we deal with daily in the world. Malnutrition is another huge factor in the epidemic of preterm birth. Besides, many of those women that do come for some kind of prenatal care are often still very limited from receiving the critical care needed to prevent and treat preterm birth. Thus, preterm birth is still a big problem.
Another one is postpartum hemorrhage. If a woman is giving birth alone, or with a birth attendant that is not specifically trained to manage childbirth complications, she may die from postpartum hemorrhage. Hemorrhage is a leading cause of maternal death. It usually occurs immediately after childbirth, but occasionally up until the 6th week postpartum. Heavy bleeding during or after birth should not be looked at lightly, but should be handled by a trained healthcare professional in an educated and skillful manner. Delay to recognize the problem, delay to activate and access help, and delay to treat the hemorrhage complication are factors what kill women in childbirth. I personally know of a couple of women in a nearby area here in Mexico that died from postpartum hemorrhage only a few weeks apart from each other. The one had been seeing a traditional (under-trained) midwife, and from her previous pregnancies had a very unhealthy blood count at the time of birth. She bled out shortly after giving birth and the birth attended could not get it stopped. Had she gotten proper care, she would've been able to build her blood count up in time, and the birth could've been managed a lot more carefully and precisely to avoid this hemorrhage. The other woman that died had received very poor care in a government hospital including a cesarean delivery, and had lost so much blood during the delivery that she needed blood transfusions. But the hospital did not have blood. The woman went home, but she grew weaker. They went to another hospital to try and get blood, but by then it was much too late, and she died soon after reaching that hospital. This could've easily been prevented had the hospital managed the delivery safer and had a blood store on hand for occasions like this.
Another woman I am seeing in my care as a current patient, expecting her 4th, had her first in a government hospital. Her husband was not allowed in with her, and she could not communicate with the staff because she spoke a different language then they did. While laboring alone, flat on her back on a hard bed, she felt something wet on her elbow. She looked down to see that it was blood flowing everywhere and off the bed. She called for help. The doctor finally came in and said she would need to have a C-section. Then he walked out and no one came in to check up on her until three hours later when the baby was ready to be born. Amazingly, the baby was born alive, but both mother and baby nearly died. She now gets very emotional when talking about that birth. Since then, she has had beautiful natural births without complications with trained professional midwives. She, along with many others with similar stories, is now a firm believer in quality professional midwifery care.
Protecting the perinatal period is vital for greater success in positive, empowering outcomes and achievements. To decrease the excessive number of maternal and neonatal mortality, attention must be focused on the first 1,000 days of life, the 1,000 days that will make it or break it for the health, well-being, and success of an individual life, an individual family, and of the entire world.
If it was your mother at stake, your daughter, your child, your wife… would it matter?
References:
National Library of Medicine, Disease Control Priorities in Developing Countries. 2nd edition. Chapter 26, Maternal and Perinatal Conditions; Wendy J. Graham, John Cairns, Sohinee Bhattacharya, Colin H. W. Bullough, Zahidul Quayyum, and Khama Rogo.
The World Health Organization
The First 1,000 Days: A Crucial Time for Mothers and Children -- And the World – May 3, 2016 by Roger Thurow
UNICEF For Every Child; Ensuring a Healthy Start: The First 1,000 Days
Facts For Life, Fourth edition.
Genesis 24:59, 35:8, 17, 38:28; Exodus 1:15-21.
Safe Motherhood Initiative, and International Conference on Population and Development (ICPD), Germain 2000, Foege 2001.
Mercy In Action, Vickie Penwell on Maternal Mortality
Save The Mothers; Where Have All the Mothers Gone? by Dr Jean Chamberlain Froese, MD