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July 15th, 2008
Birth of a Surgeon
Video: Full Episode

With more than half a million women dying in pregnancy or childbirth worldwide, Mozambique’s surgical training programs are being hailed as a model solution in confronting the maternal health crisis facing developing countries. The film captures one woman’s story on the frontlines of improving maternal mortality but it also demonstrates how low-cost, community-based health initiatives are changing the face of public health in Africa.

The film Birth of a Surgeon follows Emilia Cumbane, one of the first midwives-in-training. She performs Cesareans and hysterectomies in makeshift operating rooms in rural Mozambique. We follow Cumbane from her home in the Mozambican capital Maputo, into intensive medical classes, through night shifts in the delivery wards, and watch as she fights for recognition of her surgical competence.

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  • adriana canas-polesel

    As an ObGyn practicing in the US, I was amazed by the conditions that these medical professionals face daily. I applaud the attempts the country is making to improve care for women and this episode was truly inspiring. It does sadden me when I see women in our country not appreciate the advances that medicine has made in improved maternal health in which maternal death is extremely rare. Thank you for having this and other stories on PBS.

  • carfour, Madochee

    Why it is always africa or a black country.If it is not jamaica it is Haiti, or some countries in south america.It is terrible to see how we spent money in war,in things that not even necessary.Thank you Wide Angle to bring these Stories to america. Great Great Great job.

  • Mary Rivera

    I applaud these women like Emilia that with the happiest face and the biggest smile wants to make a difference in her country. It is unbelievable the conditions they have to work in. How can we make a monetary donation to this cause?

  • AJB

    This is such an outstanding job.I applaud th women who endeavoured to take the chance to educate themselves and to help their fellow women during such critcal times. These countires need help. $1,000 for a working generator? We can help. Lets do it

  • Jennifer

    This was a wonderful film, and I am hopeful that the new program will make a difference for women in rural Mozambique. But the film showed so much more than that! The poverty and sexism (a woman needs her husband’s permission for sterilization?) stunned me. And the generator? Perhaps with future films you could provide links on the website or at the end of the film for ways that viewers could help. I would gladly contribute a generator to the hospital that needs it.

  • Phoebe

    We call ourselves civilized, “developed nations”. Yet while billions upon billions are spent to wage war for oil, issues critical to development such as maternal mortality remain totally underreported, to say nothing of underrepresented in the foreign policies of those countries in a position to do something about them.

    I leave any further moralizing to the individual citizen, but for those of you who are interested in issues of reproductive health in the developing world, start by browsing to learn more (and help financially as one commenter asked).

  • Eugenia Criss

    I’d like to say that Wide Angle did a wonderful job in giving us a deeper insight into whats really going on in our world. Thank you , I too applaud these brave midwives for the work and sacrifice that they have taken on as their life’s work. We hear about conditions that women face in other countries, but we really don’t understand the depth of the plight that exists in Africa, we really don’t understand the suffering and sacrifices that our fellow human beings are being subjected to. Can we once and for all agree that a change in the health care for all is paramount. How can I begin to advocate for this change? Who do I need to work with and take on this charge for change? We need more midwives taking on the charge of saving the lives of women and children. How can I help these midwives and the mothers? Can building birthing centers in Africa be a solution, equipped with working generators and medical supplies. Yes, Africa needs help, and I’m on my way!

  • kitty ernst

    Brava Dr. Chan and the midwives who have taken this courageous step. The discussion of women is especially important. Thank you for raising the consciousness of Americans.

  • Lee in CA

    I also would like to know how I can help. We can do this.

  • S.Zwiebach

    More should be done to publicize the work being done in this program to help women. $1,000 is a small price to pay for a generator, providing reliable electricity for hospitals. Thanks for bring this to our attention.

  • Toya

    Im not sure how I should feel about this video. I think it is dangerous to push Western practices onto African nations. Cesarean is not the ultimate solution to ending maternal and infant mortality. Infant and maternal mortality are low in in countries where there are fewer cesareans being performed (look at European countries like Denmark & Netherlands). Increasing cesarean sections will lead to a greater problem, infection. Infection is difficult to deal with in places where medical supplies are limited. Maternal mortality will actually either increase or not change at all. Cutting women open is not an improvement in maternal health because you have now put a healthy woman’s uterus in an unhealthy state.
    A more practical solution is improving prenatal care and nutrition of women during pregnancy. Learning techniques to assist women in turning babies who are not in optimal positions for birth, correcting nutritional deficiencies, and providing women with safe home environments to give birth in are all very practical non-invasive ways to improve birth outcomes. When you remove women from what is comfortable for them…you alter the natural course of labor and birth, therefore complicating it and creating needs for medical interventions like cesarean. Are we really looking to lead other countries like Mozambique to a 30% cesarean rate.

  • norma clark

    I watched the video, and was very impressed with the courage and braveness of these women, the love they have for midwifery, taking it to a whole new level, helping to save the lives of these mothers and their babies. I am a midwife here in the USA, how can I be of service?

  • REgine Marton CNM

    Dr Chan WHO Director says: we can measure the well being of the healthcare system of a nation by its perinatal mortality. The US have been ranking just besides CUBA ,at more or less the 25th rank for many years now… with a increasing rate of Cesareans and a increasing rate of perinatal morbidity for babies and mothers. American Midwives (CNM and CPM), due to lack of public awareness and others factors, are not really recognized for the wonderful work they are doing at home, birth centers and hospitals despite of the constant pressure of protocols and liability threats.

    On another hand we see Mozambique Mid levels providers pushed to practice emergency and routine procedures that should not be as frequent, as shown in this interesting movie, if the rate of non justified primary cesareans was not as high, if women had access to contraception, decent nutrition and decent life conditions.
    I can see some prominent leaders of the midwifery community have posted there , I wish our voice was more powerful to denounce the emergency of our health care system in the US.

  • donna jackson-kohlin

    We cannot possibly compare infant and maternal mortality in Denmark and the Netherlands with that of Africa! We have seen over and over that any baby in developing countries who can possibly come out vaginally, does, eventually, but that still leaves many infants and mothers to die from obstructed labor and complications of chronic diseases and malnutrition. Once again this video shows how anyone can be taught to do anything, given need, motivation,and appropriate level of training. Kudos to Wide Angle for making a wonderful video.

  • Marianne Moore

    As a CNM here in the US who has trained as a first-assist for C/S, I can agree with many of the viewpoints here. I think that the Mozambique midwives saw a need which isn’t being filled-there is a huge need in poor nations for skilled surgeons. Often surgeons and other physicians train and leave to come to the West for money.
    The WHO has established that up to about 15%, C/S improves infant and maternal outcomes. As Regina points out, the US section rate is well beyond that. Others note that caring for post-operative women in resource poor areas is a real challenge. Also true. I think we all have to remember that there are seldom simple answers to complicated issues. In many nations (including the US, where 47 million+ are not insured)basic access to health care on a regular basis, clean water and sanitation would be a huge improvement. I have a lot of respect for these women who are filling a need, but lets think about the inequities that got us to this place where health care is a privilege and not a right!

  • Helen de Pinho

    According to the Countdown 2015 figures, the caesarean section rate for Mozambique is 2%, a figure that is unacceptably low, given that the expected C-section rate is somewhere between 5 – 15% of all deliveries. In other words, women and babies are dying in Mozambique because of lack of access to skilled health professionals (surgical technicians, midwives or doctors) and the health facilities equipped to provide basic and comprehensive emergency obstetric care.

    All of the women in the training programme are experience midwives, who after some years of practice were selected to be part of this first training course to become surgical midwives. Ultimately their deployment in the services will expand access to emergency obstetric care for many more women and newborns. This must surely be a positive step forward?

  • Grace

    I agree that the ultimate goal should be to improve the health of women in general. But it is equally important to enable emergency solutions as well.

    From watching the video, I don’t see that they are pushing for a 30% c/s rate. That would be a financial and personnel impossibility. But, in any population there will be women and babies who would greatly benefit from the chance of a surgical birth. Norway and Japan both have high natural birth rates, yet, even they utilize surgery if indicated.

  • Amy MacDonald

    Thank you for an excellent report on midwife surgeons in Mozambique. It is clear to me as a CNM in the US that training more midwives around the world is the first step in improving the maternal and neonatal mortality rates in developing as well as more privileged nations. Midwives have the expertise to prevent many problems from occuring and are capable of performing life saving measures when necessary. I applaud the ministry of health in Mozambique for using midwives as frontline healthcare providers and Dr. Chan of the WHO who is focused on effective measures to improve the health of mothers and babies worldwide.

  • Donald Barford

    Congratulations and thanks to Wide Angle for bringing this aspect of womens health to a wider audience. For those who have practiced obstetrics in Africa as I have, the images presented will bring back many memories of the particular problems one encounters. One realises that it is often the small things (by our Western standards ) that can make such large impacts on outcome. What good is surgical technique if you cant operate in a reasonably sterile environment, particularly if you cant see for want of a $ 600 generator at Home Depot! Unless one has worked there and experienced the factors that affect these womens lives, one should be cautious in applying our Western ideals to their circumstances. A maternal death anywhere is a tragedy , in those circumstances it is that and more as the risk of death for her existing children is greatly increased. The health authorities in Maputo cannot do the “best” with the resources available however their efforts to try and do what is required are innovative and will doubtless save many mothers lives and for this they deserve nothing but praise. If three Jumbo Jets a day were to crash with all on board being killed, there would be world wide hand wringing, intensive investigation and prompt remedies . The fact that the equivalent number of women are in fact dying in childbirth sadly does not arouse a similar level of remedial response. Programmes like this will hopefully help. For a more global perspective one can visit WHO sites that address ” The Health of Women”

  • Mary Zwart

    I agree with Regine. I love that these midwives are able to help in emergency cases. But with good social circumstances, like good food, education, clean water and education the S.C. rate should not be over 15%. Prevention and education is very important every were

  • Gail V. johnson

    I agreed with Toya.
    Learning how to turn breeches, or posterior babies will save a lot of Moms and babies.
    definitely better prenatal care and education on birth control.
    Also this video does point out that a midwife can help more if training is given.
    In the USA with money and power so important, midwives are limited in the rural areas on how much they can help as well.

  • Ann Davenport

    Thank you PBS for this very wonderful documentary. Dr Chan is so right – if we can do something to save one woman or one baby, at least we are doing something! However, I agree with Regine Marton, in the comments section – surgical intervention is not always the answer. PREVENTION is always more cost effective. It all comes down to women’s rights, again, doesn’t it?

    This also shows that obstetricians really have no place in medicine. As a midwife and nurse, I have worked in many developing countries, and know from first hand experience that good midwifery care is 100 times more effective in saving lives than obstetrician intervention. Thank you for this and other PBS documentaries!

  • Maggie Traore

    What a wonderful initiative! Putting the skill of cesarean birth into the hands of health care workers at the nearest proximity to birthing women is a worthy gesture. This is not about encouraging cesarean birth, AT ALL! This is about teaching a much needed skill to health care workers who are willing and likely to be near women who would need this intervention.
    I admire the women who are willing to go to such great lengths to learn and who are willing to go where they are needed to put their hands to the task of helping their sisters. And those who are willing to see that they are trained and have the necessary resources.
    Maternity care is definitely a human resource issue (staff where they are most needed), a development issue (access to health care), and a social issue (education and awareness). But training midwives in cesarean birth, seeing they have the necessary supplies, and posting them where the need is greatest is a response that meets at least one need – – appropriate, accessible emergency obstetric care.
    Thank you PBS for sharing one country’s response to the global problem of maternal/infant mortality!

  • jacquelyn

    i agree with the comments, we can not superimpose
    over values and judgments we need to listen, observe
    and learn at the end of all of this: how can we help
    what do the midwives want us to do, what does the
    people of the villages want us to do, let ‘s do it
    be it a generator, nursing students internships,
    training in related areas, please let us know what
    we can do for a cost of less than jimmy choo shoes,
    a broadway play and dinner we can do something. this
    story has touched me at the core of my heart.
    one of my favorite scripture stories is Exodus 1:10 to
    end, Shiprah and Puah who were leaders of the guild
    of midwives, saved a nation . we have no idea what
    impact these women will have on future generations.
    peace- let me know if what we can do

  • Regine Marton

    Ms de Pinho says;”According to the Countdown 2015 figures, the caesarean section rate for Mozambique is 2%, a figure that is unacceptably low, given that the expected C-section rate is somewhere between 5 – 15% of all deliveries. In other words, women and babies are dying in Mozambique because of lack of access to skilled health professionals (surgical technicians, midwives or doctors) and the health facilities equipped to provide basic and comprehensive emergency obstetric care”
    Answer: although your reasonning and data is more than correct, I may be more subtle in the conclusion stating that women and babies are dying from lack of providers. This statement in my opinion reflects a paradigm obliterating some reasons why these women need access to medical care; Coming back on my first comment, lack of sanitations, chronic health problems such as anemia malaria etc… malnutrition, unemployement country destroyed by years of civil war, portuguese providers going back to main land for diverse reasons etc..
    So yes they are lacking providers but are we going to continue to form providers in order to get a “quick fix” or are we going to thing bigger and focus on the other problems?
    Dont take me wrong, I cried during most of the movie, and my heart was right there for these incredible warriors…

  • harriet donnelly

    this was an outstanding report on what is taking place to help such an enormous problem, but gives me faith in the human race that we can come together to be creative in solving problems. Margaret Chan was impressive in her efforts also. I work at one of the largest pediatric hospitals in the nation. Can you let me know how I can get our hospital involved to help these efforts? I know they would love the opportunity.

  • Jane Houston

    This is 2008, and maternal mortality in sub-Saharan Africa should concern us all. I worked as a midwife in rural Zimbabwe in the 1990’s and the situations were very similar to the ones encountered here. Good for these brave midwife surgeons, I hope they flourish.

  • Hilary

    It makes me sad that people comment on this story with their own agendas. No, mothers are not ungrateful when they ask for less unnecessary interventions in the United States. Can’t some of these resources wasted on non-emergency labors be spent better in poorer countries?

    And, on the other side of the same coin, as much as I am against unnecessary surgery, there is a serious need for access to cesarean in the developing world. Go visit if you need to learn about what cesarean sections could do to help mothers and babies.

    I do agree, however, that money could be spent better helping support medical centers like these than on war. Hear, hear.

  • Midwife

    Check out Earth Birth: A Global Women’s Health Collective. All donations go directly towards the training of traditional birth attendants in Northern Uganda and Sudan.

  • Jesica Dolin

    As a licensed midwife in the US, I was very impressed with this training program…until they got to the issue of women not having access to VBAC. At first I was enraged that it wasn’t an option, but upon looking closer, they had classical incisions! If these midwives are being trained to do Cesareans, why are they being trained in such an outdated style? It seems that the simple change of training them to do low transverse incisions could make a major impact on whether VBAC and a reasonable Cesarean rate (5-15%) are a part of those better outcomes, or whether that improvement in outcome is reduced due to a high Cesarean rate (as we see in the United States).

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