Film: "Birth of a Surgeon"

Just today, I watched this film produced by PBS's Wide Angle. "Birth of a Surgeon" tells the story of one woman, a midwife, in Maputo, Mozambique, and her training to become one of the world's first midwife surgeons. The film is good. It showcases a part of the world many of us in North America fail to consider. Personally, I had little knowledge of the state of affairs in Mozambique or Sub-Saharan Africa at all. The film does well in demonstrating the state of maternal health care in Mozambique, both urban and rural, while also humanizing it. These are not just sad faces in dusty lands: these are people, these are women and children, whose lives are critically affected by the lack of health care. The initiative on which the film focuses is interesting as well. Midwives with little more than very basic education - the woman featured completed only grade 10 - many of whom are illiterate, are training to not only catch babies and deal with simple maternal and infant complications, but to perform ceasarean sections and hysterectomies. Given the lack of education and the minimal resources, this is huge. The initiative was begun in an effort to quell the staggering maternal and infant mortality rate in Mozambique. More than a million women will die every year from complications in childbirth. Ten percent of all infants will die within their first year of life. Hemorrhages due to placenta problems are a very real concern, as surgery is the most certain way to stem the bleeding and save both mother and child, and there simply are not enough doctors to save those lives. But here is my concern with this initiative. Several of the mother's whose deliveries are featured in the film have had multiple ceasareans before the deliveries filmed. The doctors and nurses and midwives express concern for these mothers, stating that they are concerned that their uterus may rupture. The only safe option is to forgo a natural labour and deliver surgically. When these surgeries are filmed, the cause for their concern becomes obvious: the scars from previous sections, and the new incision filmed are all classical, vertical incisions. Rather than using the newer, safer, low transverse incision which does not render the uterus far weaker after it is healed, they have been trained to use a technique which greatly increases the risk of rupture for every future pregnancy. I think what Mozambique is trying to do - save women and children by elevating midwives to a position of greater power and ability - is admirable. I do, however, think it could be done better. The fact is, surgery is risky in even the most developed country, in even the most sterile environment. In the developing world, in an environment where surgical gloves must be washed and reused, and where electricity is unreliable (both are issues presented in the film) surgery is far, far riskier. The fact is, better healthcare pre-pregnancy, better education and better nutrition would likely go farther to save more women's lives, and more women's fertility. Hopefully, Mozambique is making that a concern as well.