There are those of us who advocate natural birth vs. those of us who promote routine medical interventions (e.g. elective cesareans, induction of labour etc). Of course no issue is really that black and white- and a blending of the two positions is perhaps the most sensible.

A scientific review published this month (International Journal of Gynecology and Obstetrics, Vol 102, Supplement 1 2009), was made public for the first time at the FIGO conference in Cape Town. This extensive study, which aims to understand the high rates of maternal and newborn deaths, might at first seem to have some relevance to this debate. It shows that 2 million mothers and newborns die every year during childbirth from preventable causes.

Is this evidence that the advocates of natural childbirth are wrong after all? Should mothers be delivering in hospital with medical supervision? Have we been putting babies at risk in defence of a myth of safe delivery at home?

I am pleased to report that the answer to these questions is No. A very firm No.

The 2 million mothers and children who die during birth do so far removed from any professional care- both antenatal and during labour. 58% of these women deliver with no skilled attendant at all. No GP, no midwife- sometimes without even a traditional doula. Of the life threatening complications that took babies lives at birth less than 1% required advanced level intervention. The other 99% of cases could have been handled by a trained birth attendant. It is primarily the health and social systems which have failed these women and their babies.

The 3 main barriers to safe childbirth in low income countries are money, distance from health care facilities and other socio-economic factors. We have to question a world in which not all lives are valued equally. And we have to ask ourselves- what can I do to help? Visit www.savethechildren.org [1] and www.gatesfoundation.org [2] for information on initiatives they drive to save newborns and their mothers. Both of these organisations supported the research and publication of this groundbreaking review on maternal and child health which, for the first time ever, has provided health professionals and the public with clear evidence on what the real causes of this health crisis are- and points the way to sustainable solutions across the globe.