Planned pregnancies: The best gift a mother could give
“DOC, I am in trouble,” she said, her glossy stare like grey clouds heralding the coming downpour of rain. “I didn’t plan to end up in this situation. What am I going to do?”
An unplanned pregnancy can be devastating to a woman with often adverse implications for families and relationships. The effects of such an event, however, stretch far beyond the scope of the social into one of the most complex, concerning medical challenges in this country today. The problem of maternal mortality is immense, with rates locally being as much as 10 times that reported in the USA and the UK. Of greater concern is that these figures have increased by over 20 per cent in the last two decades. While policymakers and medical professionals bear the responsibility for solving this most ghastly and tragic riddle, the greatest power perhaps to stem this scourge lies not in the hands of policymakers, or even in the hands of medical professionals, but in the hands of the women who die.
In many cases, a woman faced with the dilemma of an unintended pregnancy views her social and economic situation as untenable and unsuitable to deal with the demands of pregnancy, and as a result she is unwilling to continue the pregnancy. Not uncommonly, women resort to radical solutions such as abortions with often dire and lethal consequences. Complications of abortions are the fourth leading direct cause of maternal death in Jamaica and the seventh overall.
Pregnancy imposes tremendous physiological stress on the human body. The demands on the heart may increase by up to 80 per cent throughout pregnancy, labour and delivery. The kidneys perform with greater efficiency, having to cleanse 50 per cent more blood per minute. In the space of a few small months, critical organs such as the heart undergo adaptations that take elite athletes such as Usain Bolt years of training to achieve. While the demands are great, a healthy young woman will tolerate pregnancy with little ill effect. The implications, however, for a woman with underlying disease can be catastrophic.
Complications of chronic non-communicable diseases such as cardiovascular disease and obesity are the leading contributors to the current epidemiological trend of increasing maternal deaths. Women with sickle-cell disease are 10 times more likely to die consequent to pregnancy than other women, and hypertensive disorders have contributed to the death of more women over the last 20 years than any other condition.
It is estimated that reducing the number of unintended pregnancies could avert as much as 60 per cent of maternal deaths. Often the general thrust of national family planning campaigns seems to be geared towards the number of children being born with tag lines such as “two is better than too many”. But while we have been effective at reducing the birth rate, the maternal mortality rate continues to rise. Perhaps the most pertinent message is not simply a doctrine of numbers, but rather exhortation to the correct timing and preparation for pregnancy.
Perhaps the message should be pregnancy positive — geared towards encouraging planned pregnancy. In planned pregnancy a woman consciously decides to pursue pregnancy only when she has achieved the optimal physical, psychological and, most importantly, medical condition to handle the demands of pregnancy. If we as a nation embrace the concept of planned pregnancy, not only will we reduce unintended pregnancy, but we are more likely to curb the scourge of maternal death that has plagued and is plaguing our country.
History demonstrates that the most effective solution to a problem is to empower those most affected. In the context of maternal deaths, the power must be placed in the hands of the women themselves, for they are the ones who die. Every woman of childbearing age should be encouraged to seek medical care and set targets for her health. She should insist on receiving an appropriate birth control method suited to her needs and comfort, and ensure that this is maintained until she is in the best-possible condition before trying to conceive.
Pregnancy is the wonderful process by which the gift of motherhood is given, by which the world is replenished, and the strength of our nation is established. Mother’s Day, celebrated recently, represents the ultimate celebration of this gift when the world pauses to salute the sacrifice of those who have borne the pains of the process. Unfortunately, too many of our women have made the ultimate sacrifice. While we are still in the spirit of Mother’s Day, it is my hope that our women will resolve to invest in the best gift a mother could give to herself — the gift of life. After all, what benefit is there to a celebration if one is not alive to enjoy it?
Dr Campbell is a consultant obstetrician-gynaecologist at Victoria Jubilee Hospital. He wrote this piece for the Programme for the Reduction of Maternal and Child Mortality (PROMAC) project at the National Family Planning Board (NFPB).
