Safe Motherhood

Essay written by: Dorothy Bauman, CPM – September 2026

Women around the world are dying from childbirth-related complications at astounding rates. While Western Europe has the lowest rate of maternal mortality, other countries are not faring so well. In fact, the USA is about the twentieth down on the list in maternal mortality.

In the US, the white educated populations are generally treated better than the black, indigenous, or undergraduate populations. This is resulting in over twice the mortality rate among women of color than that of their white counterparts. Even with the advanced technology, training, education and endless resources in America, women are still suffering unnecessarily, and mortality rates are not improving. As medicine advances, cesarean sections are becoming much more widely available, "safe", and the preferred route of delivery. With cesarean section rates on the rise, we are seeing a greater percentage of other complications such as placenta acreta, placenta previa, uterine rupture, postpartum post-traumatic syndrome disorder leading to greater incidences of postpartum depression and postpartum psychosis, and many other negative outcomes. There is still a lack of skilled health care, adequate labor and delivery availability in hospitals, and a lack of access and availability to skilled midwifery care.

Midwives are statistically shown to have the highest rates of success in keeping motherhood safe and in lowering the rates of maternal mortality, both in America and in all other places in the world. Appropriate training and education for midwives is vital to achieving safe motherhood. In many places, midwives are under-recognized, under-appreciated, under-paid, are frequently bullied, and in some places are discriminated against. Midwives have suffered much persecution since the beginning of time, while the hospital systems and insurance companies ruling them dominate. Though hospitals are supposed to be more equipped for every kind of birth emergency possible, they are often lacking in compassionate, respectful mother-baby friendly care to the natural physiologic process of giving birth. Pregnancy and birth are treated as a disease rather than a natural normal process of the female body as part of a whole family event. This in turn leads to unnecessary interventions which lead to more adverse and unsatisfying outcomes. But this is not the only thing that this perspective and approach lead to – it creates distrust and disrespect of the body's natural processes, turning it into a problem that they don't want to, or don't have the time to deal with. Neglect occurs, and safe motherhood dwindles, mortality rates climbing.

This is not acceptable. Why, in a world of escalating knowledge and technology at our fingertips, is motherhood suffering?

As the quote goes, "Women are not dying because of disease we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving."

The hand that rocks the cradle, rules the world. Mothers are the ones that are raising the next world leaders. Why are they so thoughtlessly discarded of?

While we stand here analyzing the sad state of America's lack of improvement of safe motherhood, we need to consider that there is yet a much greater need in the underdeveloped world. No, America should not use this as an excuse, but let us not ignore the needs of our fellow humans in the rest of the world.

Taking a look into the country of Tanzania, located on the Eastern shores of Africa, we learn that their maternity rates are at their best so far, yet are still showing us that about 104 women are dying in childbirth per 100,000. To compare, America is looking at about 18 deaths of mothers per 100,000 births. The Sustainable Development Goal (SDG) target for Tanzania's maternal mortality rate is to bring these numbers down to 70 maternal deaths per 100,000 births by the year of 2030. In order to meet this goal, the country needs to continue to recognize their need and to make a way to be training more hospital staff and midwives. Midwives need supported and educated well. Midwives need financial compensation for their work. Midwives need proper equipment and supplies. Midwives need appropriate support in their work and ability to work alongside doctors, making transfer of care accessible and timely. Hospital staff also need to be financially compensated for their work and well supported and trained.

There are many facets to making motherhood safe. From governmental policies to the daily mundane traditional life of villagers, many steps must be taken by all parties to see an improvement happen. Governments need to recognize the need for improvement and organize laws and policies to protect the education and work of midwives and health care providers. Schools need to make it possible for women to be educated in health care and there needs to be accessible and affordable programs to train midwives. Women who find an interest in the work need encouragement and support to pursue it. Men need to honour the need for safe motherhood by supporting their wives and daughters in training and serving. Fathers and husbands also need to provide for their families and support their wives in seeking out Midwifery care. Safe motherhood and the need for improvement must be proclaimed publicly, and societies must be continuously made aware. More awareness and education lead to more motivation to change. I need to be a voice. You need to be a voice. We all need to be a voice to make motherhood safer for ourselves and our neighbors.

There are a lot of traditions and misunderstandings that warp our efforts to achieve safe motherhood. For example, in cultures that believe feeding infant formula is going to make their babies grow faster and stronger, women reject breastfeeding or may quit much sooner than they should. This in turn leads to many more sick babies that, without a lot of medical help, will lead to a much greater rate of infant death since breastmilk is much more protective to the immature immune system of the young child.

Another example is that in cultures that do not use a latrine or toilet and no soap to wash with, there is a much greater rate of parasitical and bacterial outbreak of deadly diseases. Simple hygiene and proper setup of living quarters can make all the difference in family health. Dangerous practices such as putting unsafe or unsanitary things on the umbilical cord after birth can lead to tetanus or sepsis. In some cultures, it is believed that dung must be put on the cord stump for good luck. This may cause fever and sickness and may even lead to death.

It is important that every pregnant woman can access professional care in a timely fashion. We understand that the greatest cause of death during pregnancy, childbirth, the postpartum period and infancy is DELAY of appropriate care. The three primary delays that occur leading to high rates of maternal and infant mortality and morbidity are: 1.) Delay to recognize the need; 2.) Delay in transportation to reach appropriate health care; and 3.) Delay of healthcare providers and hospital staff to provide the appropriate care. If these delays could be shortened or eliminated altogether, many more mothers would be saved, and many more families would thrive.

Considering these three delays, why do they occur and what could be done to eliminate them?

Let us first consider the first delay afore mentioned: delay to recognize the need. Without first understanding that there is a problem, the problem cannot be resolved. Is it normal to have fever? Is it normal to always feel ill? Is it normal to bleed heavily after birth? Is it normal for a baby to not want to eat? If we do not first understand what is normal, we will not as quickly recognize what is not normal. It is important that communities and families are taught about health, the human body, pregnancy and birth, breastfeeding, and good hygiene and healthy diet. Families and mothers need to understand what germs are, learning to change their daily habits to simplistic rituals of clean living such as handwashing after using the bathroom and before working with food, washing dishes with soap, and safe food practice and storage. They also must understand that routine prenatal and birth care with a trained provider is important to prevent unnecessary death. The family must save up money when pregnancy occurs for in the case they may need emergency medical services. Caregivers and midwives should be affordable and accessible to all families both to teach healthy practices and to provide care when needed. In the case of a birth emergency, midwives and birth attendants must be trained to recognize deviations from the normal, and be ready and equipped to deal with complications.

The second delay brings us to the transportation to receive higher-level care. In cultures that do not own or drive a car, it may be very hard to get a ride at any given time, especially in the middle of the night. It is important that those attending births in rural settings have the equipment to transfer a birthing mother as well as have the equipment to sustain life until higher-level care is reached. Adequate vehicle transportation must be available at all times as well as fuel to keep the vehicle running. Phone service is also important to reach the driver or the ambulance emergency services. A phone can also be used to alert hospital staff to be prepared and ready upon the arrival of the emergency.

The third delay brings us to the final step for emergency help. Sadly, if the first two delays have not been eliminated, the third step may still fail. The sooner a problem is recognized, the more successfully life can be preserved. If one waits until signs of death begin to occur, it is often too late by the time care is actually reached. Even though the healthcare team may do everything right to save the dying person, the body may be too much in shock to respond to the emergency care. Early action saves lives!

Healthcare providers and midwives must have appropriate training, support, and equipment to give life-saving care. They must be trained to not just prevent disease but to also treat disease. Surgery and anesthesia must be accessible in a sterile environment at any given time of the day or night. Medications to reverse life-threatening disease must always be available. Birth attendants and midwives must be trained in newborn resuscitation, how to stop a postpartum hemorrhage, and in other birth emergency skills. They must also understand and have professional skills in resolving a shoulder dystocia, breech birth delivery, and how to suture a perineum. Healthcare providers also need to understand the importance of breastfeeding and mother kangaroo baby care, and how to appropriately care for the premature infant. Basic concepts of sanitation, warmth and nutrition are some of the big vital life-savers for babies and must be understood, taught and practiced.

When cultures and communities begin to understand these things in a greater way, improvement happens.

Looking into a country such as Tanzania, how can we encourage and strengthen safe motherhood? Though, as mentioned above, Tanzania has made improvements in maternity care, we still cannot be content when we see even one preventable maternal death occur. One preventable maternal death is one too many. It is not okay that mothers are dying unnecessarily. Almost ALL of these deaths are preventable!

In Tanzania, women believe they must work and not rest in pregnancy so that their child will be strong and not lazy. They also believe that they cannot drink too much water because their child might be born with edema, especially in the eyes. These beliefs may strongly influence their health since water and rest are very important to keep the mother and the baby healthy during pregnancy and childbirth.

Another thing they are taught is that women are strong if they birth at home. While birthing at home can be a good thing with a skilled attendant, these women will choose home birth even without skilled care because of what the other women in the community are telling them. It is considered weakness to go to the hospital. This in turn hinders appropriate and timely transfer. All women should have access to skilled hospital care in the case of a high-risk pregnancy or birth without being made to feel shamed and guilty. Communities need to be taught and understand that hospitals are there for when we need them, not just to take your money and to put a status on you.

There needs to be a greater effort made to bridge the gaps between traditional birth attendants (who attend the majority of births in rural areas) and the urban hospital staff. Hospital staff should treat every woman with respect and dignity, and advocate for her human rights. Hospital staff and doctors should also seek to collaborate with midwives working in the field and transferring care, making transfers as smooth and quick as possible.