Page last updated at 12:45 GMT, Monday, 26 October 2009
Maternal mortality across the world

By Jane Hughes
Health correspondent, BBC News

Patrick O'Brien: 'Most women in Uganda's villages deliver on their own'

Patrick O'Brien is used to seeing women struggling with the pain and exhaustion of a difficult childbirth.

As a consultant obstetrician at University College Hospital in London, it is part of his day-to-day life.

But even he was taken aback when he went to a hospital in Uganda, and saw lines of women in labour, all sitting on a hospital floor, waiting to take their turn on one of two delivery tables.

He was there to work with local doctors on improving the health of women giving birth.

Uganda has some of the worst maternal health in the world.

One in 25 women there die in childbirth. By comparison, the mortality rate in the UK is 1 in 8,200.

One of the biggest killers in developing countries is heavy bleeding after labour.

Reduced risk

Mr O'Brien helped develop a programme to reduce the problem.

He helped staff in Kampala roll out the use of a pill called misoprostol that significantly reduces the risk of haemorrhage.

Graph comparing global maternal mortality rates

Because it only costs a few pence, and does not need refrigerating, it is ideal for women in developing countries, unlike the injection that is usually given to women in the industrialised world.

The benefits of the drug were discovered by a colleague, Hazem el-Refaey, when the two men were working together in the 1990s.

"It was thrilling to see the research I had been involved in being used in Kampala - and even more so, to hear about it being used in the middle of nowhere, where traditional birth attendants were handing it out," Mr O'Brien told me.

"I felt I'd really helped make a difference."

One woman dies every minute during childbirth, yet almost all of these deaths are preventable.

In 2001, the UN set itself the goal of slashing maternal mortality by 75% by 2015, but it is nowhere near meeting that target.

Health ministers from around the world are meeting in Ethiopia to work out how to make up for lost ground.

The BBC is publishing a series of reports to mark the occasion.

Mr O'Brien is one of a number of staff from UCLH who have been to parts of Africa and India to work with local medical teams on improving mothers' health.

One project involved passing on better techniques for resuscitating new-born babies who were struggling to breathe, preventing them from becoming brain damaged.

Elsewhere, doctors and midwives have been shown a pioneering technique to cool the body temperature of babies who have been deprived of oxygen, again limiting their risk of brain damage.

Valuable lessons

The benefits do not all go one way.

"Some of our work in Africa enables us to refine the research we've been doing in this country," said Mr O'Brien.

People come back inspired and reinvigorated,
Patrick O'Brien
Consultant obstetrician, University College Hospital

But there are also advantages that are harder to measure.

"People come back inspired and reinvigorated," he told me.

"They are re-enthused by their work here in London."

And at an inner city hospital like UCLH that work includes seeing a big mixture of patients.

Research shows that women living in from more deprived backgrounds tend to have many more health problems during childbirth.

The hospital is working to encourage more women from minority communities to see midwives and doctors earlier in their pregnancies.

Staff know that the sooner they can see a woman with complications like diabetes, for example, the better their chance of ensuring she has a trouble-free labour.

And they also know that that level of care is still well out of the reach of the hospitals they have been working with in places like Uganda.

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