112 • Midwifery practice 4

Figure 7.1 Case history supplied by Sister Anne Thompsorf, from her experience of working
in The Cameroon

Mara was moribund when she was lifted down from the lorry which
brought her to the district hospital. Her village was many miles away and
the men had carried her in a hammock made from a blanket and slung on
a pole, right through the forest and across the river until they found a lorry
at the crossroads. She was lean and would have been elegant once, but
now her skin was dry and rough, hot to the touch and putty coloured. Her
mouth was dry and sore and her eyes rolled in unconsciousness. A
greeny-black discharge poured from her vagina and it was hard not to
recoil from the foul smell. The journey had been long, but they hadn't
even started on the road until last night, three days after Mara had given
birth to twins, with great difficulty-and with no one trained to help.
In Mara's village, twins are not welcome - perhaps too often the problems
which accompany their birth are interpreted as the power of evil spirits
which come to harm the mother. Whatever the reason, tradition
maintained that the old women, straight after the birth, counteract the
work of the spirits by packing the birth canal with a paste made from an
assortment of herbs, plants and, probably, less savoury substances. We
had the story, bit by bit, over the next two days as we watched Mara die,
from a young woman who had stayed with her. She did die, of course,
despite our best efforts, our drips and antibiotics. And her death would
only drive deeper the conviction of the older women that the birth of twins
spells disaster. .;'-^:";;\ A ^; .< ' :

world's live births but a massive 42,6 per cent and 38.4 per cent respectively of the maternal
deaths. In comparison, Latin America's 9 per cent of the live births and 3.9 per cent of the
materna! deaths appears favourable (Acsadi & Johnson-Acsadi 1990). By comparing the
statistics of maternal deaths per 100000 live births, however, the picture is made more clear.
This is because people usually find it easier to visualise specific numbers rather than
percentages. The figures also express the risk of death among women once they are
pregnant. They can also be used for the planning of maternal and childbirth services
(Royston & Armstrong 1989; Maine 1990). Figures 7.3 and 7.4 show the contrasts between
1983 and 1988 for maternal deaths per 100000 live births. This latest information shows that
pregnancy and childbirth has in fact become slightly safer for women in most of Asia and
parts of Latin America. In contrast in most parts of sub-Saharan Africa the situation has not
changed greatly for women where an increase in the number of births has led to a parallel
increase in the number of maternal deaths. However results need to be interpreted with
caution as it is not known which of the changes are real and which are due to better informa-