The birth of a baby is the real miracle at the core of Christmas. Giving birth is a universal experience but one that varies dramatically around the world.
Earlier this month, Princess Charlene of Monaco gave birth to twins in a private suite at the Princess Grace Hospital in the tiny but immensely rich principality on the Mediterranean. The arrival by Caesarean section of Princess Gabriella, Countess of Carledès, and Jacques, Hereditary Prince of Monaco, was heralded by 42 cannon shots. They are the princess’s first children.
She was attended by specialist consultants throughout her pregnancy. The boy was born second but will inherit the throne because traditionalist Monaco favours the male heir.
However, the countess has less to complain of than earlier offspring of her father, Prince Albert, who were never in line because they were born outside marriage. They can, however, inherit some of his considerable wealth. The twins and their mother are now back in the palace.
By contrast, out in the Jordanian desert, a young woman called Ayat is struggling to keep her newborn son, Noor, warm under a tarpaulin in vast Za’atarai refugee camp, where children in flip-flops play as the first snows of winter begin to fall and an icy wind whips through the makeshift tents.
Ayat and her husband are Syrian refugees. Noor is one of the 70 or so babies born in the camp every week. There are 80,000 refugees in Za’atarai; since October 2012, 27,000 babies have been born there.
Facilities are basic in the two maternity units – one doctor and two midwives offer 24-hour care. The units are in pre-fab buildings with intermittent electricity, but they have running water and painkillers, although not epidural anaesthetics.
Crucially, babies born there are inoculated and their births are registered, although this does not confer any citizenship rights on them. Rarely, mothers, including worrying numbers of girls as young as 14, are taken to hospital in Amman for delivery.
Since the birth of her baby, Ayat has stayed in the tent and Noor is wrapped up in blankets provided by Unicef, along with some baby clothes, nappies and soap. He is lucky compared with many – an unknown number of mothers and babies have died fleeing Syria while those inside the war-ravaged country are now facing, among all the other hazards, a resurgence of polio.
Wealth brings choice, in birth as in most situations. In the US, clinics like the Rose Medical Center in Denver regards childbirth as “beautiful and wondrous” and offers “the safest, most meaningful experience” to the mothers of the 4,000 or so babies it delivers each year.
Here there are birthing rooms with private bathrooms with jacuzzi tubes, birth balls, rocking chairs, squat bars and flat- screen TVs. Six luxury suites with private entrances offer the services of a private chef, fine linens and robes, space for overnight guests, windows with panoramic views and private bathrooms. There is also a “financial counselling service” for those contemplating this experience.
Poverty brings the opposite. The US, although it is one of the richest nations on the planet , is far below most industrialised nations for safety in childbirth, coming 30th in a global scale, well below some underdeveloped nations. The reason, according to Save the Children, is, largely, income inequality.
The most dangerous places in the world to give birth are also its poorest – most of them in sub-Saharan Africa. In Sierra Leone, 1,100 women die for every 100,000 who give birth, although progress was being made before the Ebola crisis.
Currently, one in seven women could die in pregnancy or childbirth, while stillbirths and newborn deaths are 50 per cent higher for mothers under 20. Schools have been closed and teenage pregnancy is rising, in many cases due to the rape of girls who are unprotected at home.
Ngadie, who is 16, will give birth at home, not out of choice but because clinics and hospitals are all geared towards dealing with the epidemic. She may get the assistance of a community health worker, but she may not.
She is “hungry all the time” and eats a small meal of rice or plantain just once a day. Plan Ireland is helping to run clinics in Sierra Leone and elsewhere for such young women.
Northern Europe is rated the safest place in the world for childbirth, especially Norway and Finland. Here in Ireland, approximately 6,000 mothers will give birth this month, mostly in the country’s 19 maternity hospitals.
“Every woman in Ireland has access to public healthcare, we have highly skilled professionals and the technology is fantastic,” says Jene Kelly, co-chair of the Association for Improvements in Maternity Services. “What we don’t have is choice – most women get a birth led by an obstetrician in a hospital, even though midwife-led births are better. Home births are practically extinct.”
Niall Behan, chief executive of the Irish Family Planning Association, agrees: “The woman’s voice isn’t listened to,” he said.
