MGH Global OB-GYN Newsletter

From Academics to Advocacy and Action

February 2019

Massachusetts General Hospital                    Vincent Program in Global OB/GYN

Welcome to the February newsletter! Our goal is to share with you stories from our work around the world, important new publications from academia and the media on global women’s health, a few fun facts, and tips on how to stay safe while traveling. We’d love your input, so if you have a story, or wish to share a tip, send them our way at

From the Editors: AK Goodman, Adeline Boatin, Tom Randall

Nearly one-third of childbirths in the US involve a cesarean section. The overall global trend of cesarean section has surged at an alarming rate, and experts suggest a good proportion of the procedures are unwarranted, that they put mothers and babies at unnecessary risk. In this newsletter, let's find out about its history, the reasons for c-section, and its health impact. 

                                                                                  Notes from the Field
                                                                                                By Hannah Bergbower, MSN, MPH, CNM

                                               Pic: Hannah and other midwives conducting a newborn examination at Hope Foundation's clinic, Bangladesh 

                                                    Pic: Hannah and a midwife attending an antenatal visit at Hope Foundation's birth center, Bangladesh

On the days in the labor ward when a patient arrives fully dilated and shortly after has a vaginal delivery, there is a sense of ease that reminds us of how beautifully simple this process can be for some. Then there are patients that leave us with questions that remind us of the fears we silently carry as we enter every room, from that day forward. 

That is why we like boundaries. They help us to feel safe. But labor and birth are not accompanied by a rule book. Even knowing that no two labors will be the same, we still approach it with a hopeful lens and the awareness that devastation can occur if we aren’t watching closely. Even when we are constantly present and watchful, sometimes this devastation still creeps upon us. 

In Bangladesh, where I live and work, over half of the births taking place are still at home. Most often with family or friends or a traditional birth attendant. As for the births taking place in healthcare facilities, there is a struggle between the operating theater and delivery suite. On a regular Tuesday, I had been accompanying a woman during her labor for several hours. From my perspective, she had just recently moved into active labor and her dilation pattern was currently still safe. The obstetrician I was working with was of a different opinion. He felt she had been active for many hours and that her progress was obstructed. I stepped out of the ward for 10 minutes, to return and find that she had been moved to the operating theater for a cesarean. 

Cesarean rates are astronomically high in many areas. Providers are pushed into a corner and due to the constraints of back-up support and such a long history of bad outcomes, physicians are often quick to decide surgery is the right path. This is where midwife-led birth centers have become the key to balance. The birth center concept is new so the representation of each end of the pendulum is strong. Rightfully so, for often valid reasons. Some of the reasons may be grounded in fear of the other, but it generally seems they are due to lived experience that justifies the decision made. So this leaves us with the question, “Is birth normal?”

Author's Biography:
Hannah is a nurse-midwife, women's health nurse practitioner and public health specialist who currently works in Cox's Bazar, Bangladesh with Hope Foundation for Women and Children of Bangladesh. She has been working in global health and development since 2014, originally living in sub-Sahara for several years, with a focus on sustainability and capacity building, SRH and maternal and newborn health. She trained as a nurse at Lakeview College of Nursing, completed a Masters in Public Health at Indiana University, a two-year fellowship in Global Clinical Education at MGH while serving as a Peace Corps volunteer in Tanzania with the Global Health Service Partnership, and a Master of Science in Nurse at the University of Pennsylvania. She has taught nursing, midwifery and public health courses domestically and globally and holds an appointment as an Associate Scholar at the University of Pennsylvania School of Medicine Center for Global Health and as an Adjunct Associate Professor at Tufts University School of Medicine.

Interesting fact
Reasons why mothers worldwide underwent cesarean section in 2017:
Maternal Health Care in Cox’s Bazar, Bangladesh: A Survey of Midwifery Experience at Hope Foundation and a Review of the Literature:

Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation May Address Quality And Cost Issues:

Unequal Motherhood: Racial-Ethnic and Socioeconomic Disparities in Cesarean Sections in the United States:
News Bulletin
How the C-Section Went From Last Resort to Overused:

Exploring a Possible Link Between C-Sections and Autism:

This Mom of 4 Died after Childbirth and Donated 12 of Her Organs to Save Other People’s Lives:

Due to an ongoing outbreak of novel coronavirus, as of February 4, 2020, the Center for Disease Control and Prevention recommends avoiding non-essential travel to China.
Announcements and Events

Do you have knowledge of, have previously researched, or witnessed obstetrical violence? The Center Against Gender-Based Violence is working on defining the prevalence and scope of violence against women in the context of childbirth and would like to collaborate with anyone interested in the topic.  For more information or to take part in this project, please contact Violette Perrotte at 

Want to help the Center Against Gender-Based Violence design a Word Cloud? Email us three words that you think define the global effort against GBV or that uplift and heal GBV survivors (


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