Section Member Karel R. Amaranth offers this poignant reminder of why our work matters.

I didn’t really need a manicure and yet I knew I would need one by the end of the week when I had a date to go to the Whitney Museum. I had to stop in the town I used to live in, the town where I had lived when I was married, the town where my youngest daughter grew up and still lives with her father. Being in this town is now always a little surreal; it is home, but it is not. It is where I still do my banking and where I have my photos printed. It is a town where I sometimes uncomfortably run into ex-neighbors, now my ex’s neighbors, and where I sometimes happily re-connect with friends who live there.

I didn’t really need the manicure and yet the idea of my hands in hot paraffin and silky hand cream being massaged by a sweet Korean woman on a cold January night was appealing. I had spent most of the afternoon at my office at Montefiore Medical Center doing research for my thesis on global maternal mortality, specifically the impact of clean delivery kits to reduce deaths due to sepsis. I had a specific research task that day: learning about the off-label effects of misoprostol to prevent post partum hemorrhage.  I had met the day before with the director of an international program advocating third stage of labor treatment to address complications leading to death during childbirth. She told me that the paradigm of preventing maternal deaths had shifted from prevention programs, like the one I was researching, to programs that developed resources to provide emergency obstetric care. Her work and the strategies employed by her organization were quite opposed to prevention, viewing it as a distraction from the medical treatment needed to save lives. Although I was somewhat intimidated, I was grateful to her for her insights and her expertise with an approach very different from the preventive model that was not only the basis of my thesis but of most public health approaches. One strategy she said that would be a preventive model would be the distribution of misoprostol, which could be taken by the mother if there was uncontrolled bleeding after the birth. Perhaps birthing kits could be distributed that would include this inexpensive drug which could save lives. So there I was the next day trying to find out whatever I could about misoprostol.

Misoprostol as it turns out was not developed to be used in childbirth. It is an anti-inflammatory drug used to treat ulcers, but off-label it is used to induce abortion, to induce labor, and to treat postpartum hemorrhage. It is less effective than oxytocin but very inexpensive so use in developing countries is more cost-effective.  However in randomized trials there have been more deaths with misoprostol than with control groups. 

My cuticles were being snipped in the nail salon when I noticed the mother of one of my daughter’s school friends. I couldn’t remember the girl’s name, although I could envision her on the soccer field as a 10-year-old.  I was informed by the mother, who was having her nails painted a lovely shade of pink, that Meredith (yes, now I remember) was in her last year of pharmacy school in Boston. We chatted and thankfully, there was no mention of my divorce.

We both migrated to the drying machines where our fingers were warmed and dried under the blowing air and the manicurists gave us mini-neck massages. I was happy that I had decided to get my nails done after all. It was cozy, it was female bonding, it was a little indulgent.

She asked me if I still worked at the hospital in the Bronx and I said yes. She had taken a teaching job for the family benefits, and I wondered if she had gotten divorced or if her husband had lost his job, but I didn’t ask.  Briefly her son and his girlfriend stopped by and said “hello” to her and left. I noticed the girlfriend’s boots, which I liked a lot.

She asked me again about my job and I told her I was finishing a thesis on maternal mortality. And then she told me that the mother of her son’s girlfriend, the girl with the boots I liked, had died last year in childbirth at the age of 43, not in Afghanistan, or Sierra Leone, or Rwanda, but in Maryland, in a hospital, surrounded by well-trained professionals. Her labor had been assessed as taking too long, but before they did a C-section they decided to try a drug that could induce labor. She convulsed and went into a coma and died; her heart was kept pumping for five days until the family requested that the machines be turned off. She had given birth before her death to a healthy baby boy who would never know his mother because she died from hyperpyrexia -- death by misoprostol. And a young girl would never again shop for boots or a prom dress or go to a nail salon with her mother or have her as a role model for her own motherhood. Maternal mortality any place in the world is a tragic loss to children, families, communities and to all of us. We lose more than 500,000 mothers a year. We need to assure that there are clean supplies, trained health workers, and appropriate labor management so that every delivery is a safe delivery, every child has a mother, and every mother has her life.