I'll like to restate some of my posts but briefly as I can't answer every issue raised but will try to clarify a couple things.
Hospitals are a place for sick people. The vast majority of pregnancies are normal and therefore not necessarily the best place for hospitals. When something goes clinically wrong with a pregnancy, a hospital should be a safe place for women to receive the medical attention they require.
in my own experience in the UK, the lack of treatment I received in a hospital put my own life and my child's in grave danger. It should have been the safest place for me to have been and while we both left without injury, the trauma we suffered over 8 days of hospitalisation should never had occurred but for a human being who would have listened to what I was trying to communicate. I was therefore dangled over a precipice only to be rescued from it. Had I been listened to, I would not have blocked up an HDU suite.
This sort of truama (physical and mental) is the kind of butchery that should not occur in a maternity unit.
Women in the developing world by and large do not need HDU units to improve vastly improve the outcomes for themselves and their babies. By and large they need comparatively cheap services and medical care. Of course all over the world medical emergencies occur and no one would like to not have the care available for them. But incidences like placental abruption are v infrequent and no bush village in Africa can evacuate a woman in this circumstance in time to save her life or that of her baby. OTOH, pre-eclampsia is much more common and very cheap to treat, even in the bush in Africa. I would rather see 200 women treated successfully for PE and at a fraction of the cost of saving one life from placental abruption, any where in the world. Even if it was me or my baby dying from placental abruption.
You can google the morbidity and mortality from eclampsia in this country. I and maybe even my daughter were almost dead in a major teaching hospital in the UK, not because I did not have help or medicine or the latest equipment available. it was because no human being would listen.
unfortunately, this sort of nightmare scenario is not uncommon in medical units in the US or the UK. Midwives and obstetricians often times rely too heavily on listening to machines rather than to the woman. Unfortunately many people like standanddeliver cannot see that the problems were created by not listening to the pregnant woman and her body.
Women in the developing world may view hospitals as a panaecea and in many cases hospitals save lives. They also have also created some bad practices over time which damage lives. That is what I am trying to say. There is no point trading in all the good things about traditional birth attendants who are cheap and in many instances are providing a good service for people who can never afford the financial cost of getting into a hospital or logistically get to one frequently enough for regular antenatal checks or delivery when the alternative would be to train TBAs into best practice in areas where they lack knowledge.
I come from a country where TBAs still practice. Ina May Gaskin learnt the now named '[http://www.inamay.com/?page_id=30 Gaskin Maneouvre]]' from a TBA/midwife who is from my country. She learnt it from TBA in the Guatemalan Highlands from Mayan TBAs. The midwives from The Farm have gone to Central America to share best practice with TBAs there because that is what knowledge is good for: for sharing - and maybe it is a way of paying back what they have learnt. There is will be no other viable alternative for millions of poor women in Guatemala, El Salvador, Belize or Guatemala in my lifetime. I am eternally grateful on their behalf for travelling to my country to enhance the skills of TBAs there at their own cost.
TBAs all over the world have good practice which we can learn from and not so good practice which they can learn for us. Things as simple as cutting the cord with a clean instrument to prevent neonatal tetanus. no vaccination needed. cheap for us but expensive to transport and keep in the forests of northern Laos. (pampers are sponsoring vaccinations against neonatal tetanus to sell pampers - a good thing but ultimately they are only doing it because pampers benefit) passing on the knowledge to midwives in a region is not as glam but it is cheaper and by far more sustainable.
pandora when I tantrummed complained and demanded my choice for a home birth. I can tell you that it was measured, well thought out, articulate and was delivered by hand to the hospital at 28 weeks or so pregnant. Not at the end of a phone, screaming like a banshee to some poor receptionist at 3am when I was actually in labour.
I should think that is the sort of thing women and their partners ought to do when they are denied their choice with that nasty little fob off. Nasty because it is manipulating the very primal urge to protect an unborn child at a time when a mother and her partner are at their most vulnerable. It is a disgusting tactic in my humble opinion.
I am taking my dd1 to bed.
I hope you got to the end of this mammoth post and taht it makes sense. I don't have time to preview it.