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Chapter 12 Mercy in Action Bringing Mother- and Baby-Friendly Birth Centers to the Philippines Vicki Penwell SYNOPSIS I studied the first 7,565 women admitted for labor and delivery in two charity birth centers that I established in the Philippines through Mercy in Action, the faith-based, nonprofit organization our family founded (see www.mercyinaction.org). The births in this study occurred between February 8, 1996 (the day the first woman delivered in our newly established birth center), and December 31, 2003 (when we ended the study to begin compiling data for my master’s thesis). All the women who were admitted for delivery are included in this reporting. (Women risked out prior to labor are not included in this study.) Midwives conducted all of the deliveries. These were certified professional midwives (CPMs)1 or licensed midwives (LMs)2 from the United States and the Philippines. In the vast majority of cases, student midwives under direct supervision helped “catch” the babies as they were born, and assisted in all aspects of maternity and newborn care. All students represented in this study were enrolled in Mercy in Action’s program for midwifery and primary health care training, and dual enrolled as candidates for an accredited associate of science in midwifery degree from the National College of Midwifery (see www.midwiferycollege.org and Chapter 9). The birthing women were at higher than average risk of a poor pregnancy outcome because of demographic factors: most were poor, often malnourished, and living in crowded urban slum conditions. In all, 92% of the women and 34% of their spouses were unemployed, and the average income was the equivalent of less than US$2 per day. Only a little over half were married. In spite of the poverty, 95% of these women had spontaneous vaginal births; 83% had blood loss less than 500 cc, with only 2% having blood loss 337 338 v. penwell greater than 1,000 cc. Eighty-five percent of the babies required no resuscitation effort; 67% of the labors were without fetal distress or meconium staining; and 90% of the babies were of normal birth weight. Transfers to a hospital after admission to the birth center occurred 7% of the time, with 3% of transports during first stage and 0.5% during second stage. Less than half of these transports resulted in cesarean section births. One and one-half percent of total deliveries transported occurred during the postpartum period, and 2% were referrals for the baby to be seen by a doctor. Neonatal mortality was 4.1/1,000, four times lower than the neonatal mortality rate of 18/1,000 for the Philippines as a whole. Maternal mortality was 53/100,000 births, compared with 200/100,000 births for the Philippines, also four times lower than the nation as a whole, and when adjusted for causes of death that were not directly related to the pregnancy or birth, that figure was halved, to 26/100,000 births (Penwell 2005a). When I conducted the research for my master’s thesis for the National College of Midwifery, my friend and mentor Elizabeth Gilmore suggested I write my null hypothesis stating that I expected our outcomes for these 7,565 births to be worse than the national average for the Philippines. My hypothesis read as follows: The null hypothesis is that all these women would have worse outcomes than a similar group of women, for the following reasons based on usual assumptions : because all deliveries were conducted by midwives and no deliveries were conducted by doctors; because the midwives conducting the deliveries were direct-entry-trained midwives at the Associate Degree level rather than nurse-midwives or physicians with advanced degrees; because the majority of patient care, including the “catching” of babies, also involved student midwives under supervision of Licensed Midwives or Certified Professional Midwives; because the deliveries were all conducted out of hospital; and because the staff had access to only simple technology—on site we did not have lab capability, ICU or NICU capability, or surgical capability. In addition to that, and maybe most important to this study being unique, the mothers were demographically high risk. (Penwell 2005b) Elizabeth said that such results would be expected based on the fairly universally held belief that doctor-attended hospital births would be safer than midwife-attended births in an out-of-hospital setting, especially for high-risk women living in poverty. By the time I finished this research and...

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