After a harrowing 36 hours delivering her daughter, Michelle Thompson faced yet another complication. Her cervix tightened so much that she suffered a retained placenta. It was a potentially life-threatening development as the tissue, if left untreated, could have become infected and led to haemorrhage. After discussing the options with her doctor, Thompson decided on surgery to remove the placenta.
"I was very relieved to be in a hospital that had the facilities to deal with my condition," Thompson says of her experience at the Matilda International Hospital four years ago. Thompson's sentiments echo those of former supermodel Christy Turlington Burns, who suffered post-partum haemorrhage after giving birth to her first child in 2003.
"While frightening and totally unexpected, my complication was managed throughout by a midwife, and eventually the obstetrician who backed her," says Turlington Burns. "I later discovered that thousands of girls and women around the world die from the same cause, because they don't have access to the services that could save their lives."
That discovery prompted Turlington Burns to research issues of global maternal health. She went on to make the documentary No Woman, No Cry, which tells the stories of mothers from Bangladesh to Tanzania and the US. The two-year film project led her to found Every Mother Counts (EMC), a non-profit organisation that aims to promote education about maternal health, and to support efforts in reducing maternal mortality around the world.
According to the World Health Organisation (WHO), 287,000 women died in childbirth in 2010, the overwhelming majority of them (99 per cent) in developing countries. About 80 per cent of maternal deaths are due to post-partum haemorrhage, infections, high blood pressure during pregnancy, and unsafe abortions.
Post-partum haemorrhage - defined as loss of greater than 500ml of blood following vaginal delivery, or 1,000ml of blood following a caesarean section - can occur up to six weeks after birth, says Dr Alex Doo, an obstetrics and gynaecology specialist at Matilda. But if recognised early, the problem can be managed by blood transfusion and aggressively reversing the impaired ability to clot.
Post-partum infections are mostly diagnosed after discharge from hospital, Doo says. So women should contact their doctor if they suffer abdominal pain, high fever, sudden onset of severe bleeding, foul smelling discharge and swelling, and redness of the breast, as these are signs of infection. The chances of recovery from infection are good with prompt treatment.
Disorders related to high blood pressure, pre-eclampsia and eclampsia, can develop at any time from 20 weeks into the pregnancy up to six weeks post-delivery. Signs of pre-eclampsia include high blood pressure, protein in the urine and, often, swelling of the hands, face and feet. Severe cases can result in convulsions known as eclampsia.
"Delivering the placenta is the only cure and all other measures such as antihypertensive drugs are only to buy time until the fetus is mature enough to be safely delivered. But in early pregnancies with severe cases, termination may be the only means of curing the disease," says Doo.
According to WHO statistics, some 42 million women have abortions worldwide and 20 million of these procedures are unsafe. While legalising abortion can reduce the incidence of unsafe abortion, providing easily accessible and safe contraception is the most efficient way to eliminate this practice.
"Even if the woman survives, there is a high risk of complications. These can include incomplete abortion, infection, haemorrhage, and internal injury," Doo says.
EMC estimates that about 215 million women worldwide lack access to modern contraceptives although they want to delay or avoid pregnancy. Meeting this need would prevent 53 million unintended pregnancies and 150,000 maternal deaths.
"The barriers to care that pregnant women [in poor countries] commonly face are access to emergency services, quality healthcare, post-partum care, stronger healthcare systems and policies, education on family planning, and reproductive health," Turlington Burns says. Women often don't have the power, economic or individually, to get this care at the right time.
EMC is primarily focused on advocacy, she says, working with NGOs and health leaders around the world. So it actively supports programmes that help achieve the United Nations' eight millennium development goals to end extreme poverty.
Little progress has been made on the objective to reduce maternal mortality. WHO figures show the rate declined at an annual rate of 3.1 per cent from 1990 to 2005 compared to the millennium goal of reducing mortality by 75 per cent by 2015.
It may seem a distant problem to residents in affluent, fast-paced Hong Kong, where deaths during pregnancy and childbirth are relatively rare. The maternal mortality rate has fluctuated between one and 11.2 per 100,000 live births in the past 31 years.
But the deaths of two mothers from post-partum haemorrhage in 2008 led senior doctors to call for urgent action to improve private hospitals' handling of emergency care.
All women should have access to professional care during labour, given by trained medical staff who respect their wishes, says Hulda Thorey, director of maternity consultancy Annerley.
"To have access to such support when needed, but not to use it beyond what is medically necessary, makes the pregnancy and birth safer for women and their babies. Being supported during this phase in your life is essential," Thorey says.
But inadequate pre- and post-natal care is a problem that affects women everywhere, including developed countries like the US. For instance, a 2011 Save the Children report found the US to have the worst maternal death rate of any industrialised nation.
"Disparities exist in many countries, and that translates into the message that not every woman counts," Turlington Burns says.
To raise awareness of the challenges in maternal health, EMC also engages businesses in product partnerships. These support frontline programmes such as transport vouchers for mothers in Uganda so they can reach health facilities for delivery and training new midwives for Haiti. A collaboration with US company Ergobaby to produce a limited-edition series of carriers, bags and waist packs, using Turlington Burns' designs. The limited edition series will be available here from next month, with a portion of the proceeds benefitting EMC.
Turlington Burns says the idea is to highlight how thousands of women continue to die each year due to complications of pregnancy and childbirth. Up to 90 per cent of those deaths can be prevented: "Through partnerships, we hopefully inspire people to take action on this issue. Together we can make a difference," she says.