“Let us pray for our mothers…”

“Let us pray for our Mothers… Because sometimes they die giving birth.”

This. A simple prayer request. Jolting in it’s content. But even more so because it was spoken by a 10-year-old boy, in his clear and crisp Kenyan-English accent, standing up bravely before a large church congregation.

It was our first Sunday to attend church at Tenwek after we arrived last fall. Inquiring later, I learned that this young boy is not an orphan, not motherless… Just a child growing up in a place where pregnancy holds as much risk as promise.

Many have asked me, “What about OB? How is your work?” I haven’t shared about my experiences in “Maternity” because, frankly, I don’t even know where to start. How is it possible that my previous and current worlds of obstetrics and gynecology even exist on the same planet? How did a trip across the ocean take me from a practice where I discussed with my patients the risks and benefits of epidurals, explained the evidence behind prenatal screening tests and childhood vaccines, reviewed the merits of personal birth plans, met with privately hired doulas, and even assisted in planning gender-reveal parties…to a place where the children in my community literally fear for the lives of their mothers.

I knew the statistics…I had shared maps and numbers and percentages with many of you in our days of preparations to help flesh out the “whys” that motivated our move to Africa.

Statistics like this:

  • 800 women die EVERY DAY in the world due to pregnancy complications
  • Almost 2/3 of these deaths are in Sub Saharan Africa
  • The lifetime risk of dying due to pregnancy for a woman in Sub Saharan Africa is 100 times greater than for a woman in America (100 times!!!!)

And maps like this:

Cartogram of Maternal Mortality

Cartogram of Maternal Mortality (Size of country is made larger or smaller based on maternal mortality)

But beyond the staggering statistics and dramatic maps are real people.  These numbers now have names to me.  Dorcas.  Mercy.  Nellie.  Faith.  Evelyn.

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And they have families.  Children left without a mother… sometimes newborns who I brought into the world on the brink of their mother’s departure from it.

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Most maternal deaths are preventable, which makes the stark contrast between my two OB worlds even more difficult to reconcile. But too often, by the time mothers arrive to our facility, they have crossed a critical threshold beyond which our medical interventions have little chance of changing their outcome. Hemorrhage starting 24 hours prior to arrival with cardiovascular collapse already progressing too quickly. Infection setting in days ago, unrecognized or ignored, with septic shock already taking over.   Advanced stage cancer, untreated, with severe malnutrition, in a body unable to withstand the strains of pregnancy any longer. Preeclampsia, unrecognized in a village clinic, with convulsions and loss of consciousness beginning several hours before arriving to our facility.

The reasons behind this unacceptably high death rate in mothers worldwide are complex and multi-faceted… Inadequate numbers of skilled health workers (trained nurses, midwives, or doctors), long distances to health care centers, poverty, cultural practices, and lack of information. Improving maternal health was 1 of the 8 Millennial Development Goals adopted by the international community in 2000. Improvements worldwide are being made. Maternal death rates are decreasing, but much too slowly to reach the proposed benchmarks by the goal of 2015.   And there are still huge discrepancies between the rich and poor, and between those in urban and rural areas.

But my purpose here is not to fully expound on these reasons, or even to explore the many possible solutions, but rather to share about the beautiful and strong and brave women of my new home. They are remarkable…bearing incredible difficulties and sufferings with stoic grace. They love their children fiercely, dream expectantly, and persevere in amazing ways to care for their families. Their “barriers” to adequate health care are now the backdrop of my life. And it’s not OK.

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Frustrated. Perplexed. Discouraged. Heartbroken. Indignant. These emotions co-exist within me on a regular basis in my new “normal.” In 9 years of private practice in America, I never lost a patient. Our team here lost 9 mothers in the month of January alone…4 more in February. And it’s not OK.

God does not ignore these strong and conflicting emotions. He has much to say about death and discouragement and earthly pain in His Word, because these elements surround us in this world if we are willing to see them. He uses words like “groan” and “burdened” and “grieved” and “afflicted” to describe our time on earth. But He also gives us the assurance that this is not how He intends for things to be. Yes, we protest against death with every fiber in our bodies; because we are created for eternity, not for these weak and temporary earthly bodies. And while I may not be able to save the life of every mother brought into my care, I am given promises to which to cling.

…Promise of death defeated… “He will swallow up death forever; and the Lord God will wipe away tears from all faces,” (Isaiah 25:8)

…Promise of light overcoming darkness… “The light shines in the darkness, and the darkness has not overcome it.” (John 1:5)

…Promise of GOD with us… “For it is God who works in you,” (Philippians 2:13)

…Promise of eternity… “But our citizenship is in heaven, and from it we await a Savior, the Lord Jesus Christ, who will transform our lowly body to be like his glorious body,” (Philippians 3:20)

So let us pray for our mothers, and for us all, that we not lose heart.

“So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light and momentary affliction is preparing us for an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal.”   (2 Corinthians 4:16-18)

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