Lawson, JB, Harrison, KA, Bergström, S Maternity Care in Developing Countries . 422 pages. London : Royal College of Obstetricians and Gynaecologists, RCOG Press , 2001 . Price GBP 26.00, or 19.50 to Fellows, Members and Registered Trainees of the RCOG. In the introductory overview on poverty, deprivation and unsafe motherhood, editors Kelsey A. Harrison and Staffan Bergström reflect on the present decline in income per capita in sub-Saharan Africa and conclude that a groundbreaking shift in policy with debt cancellation and currency stabilization is paramount. ‘It cannot be otherwise where, for example, … debt servicing exceeds all funds available for health and education combined, having reached US$ 300 billion per year or 110% of GDP’. This sorry state of affairs serves asa background to the contents of the present textbook on maternity care in poor countries, explaining, for example, why high technology tools like ultrasound apparatuses and electrocardiographs are hardly mentioned. Indeed, if you serve in areas where electric power cuts, poor roads which become impassable after heavy rains, and lack of proper ambulances are the order of the day, your worries are elsewhere. Without proper storage facilities, medicines decay rapidly and replenishment may be days or weeks away. While essential drugs are relatively cheap, anti-retroviral drugs, which are not labeled essential but nevertheless can prevent fetuses from becoming infected with HIV and therefore save lives, are still too expensive to be in general use. In the chapter on anesthesia for obstetrics in developing countries, D. Bruce Scott explains that complex anesthetic machines are usually not available and spare parts may be hard to obtain, and enumerates a number of other obstacles which dictate alternative solutions to many every-day problems in obstetrical analgesia and anesthesia. In the preface to Maternity Care in Developing Countries readers are reminded of the 1967 textbook Obstetrics and Gynecology in the Tropics and Developing Countries, edited by J. B. Lawson and D. B Stewart, which over the years became partly outdated. With the advent of the Safe Motherhood Initiative, interest reawakened, and the present book is a radical revision of the former. Co-editor John Bateman Lawson died before it appeared in print and is remembered in the Dedication. The book is comprehensive, covering every aspect from organization, quality, audit and training of professionals for safer motherhood, through the various problems of pregnancy, birth and diseases of the newborn, to sexually transmitted diseases including HIV and AIDS in pregnancy, to childlessness and family planning. The latter chapter is written by Mahmoud Fathalla, professor at Assiut University Hospital in Egypt, previously Director of the Human Reproduction Programme of the World Health Organization and President of FIGO, who better than most knows and explains the special considerations that should be heeded by gynecologists giving contraceptive advice in developing countries. All the chapters are well-written and worthy of study. I was particularly impressed with those on malaria, anemia and the hemoglobinopathies in pregnancy, by Kelsey A. Harrison, emeritus professor of the University of Port Harcourt, Nigeria, presently living in Finland. Discussing obstructed labor and its sequelae, Chris N. Hudson states that there is still a place for destructive operations of the head of the dead fetus to permit vaginal delivery and explains and illustrates the technique, while symphysiotomy is described by Chris Lennox in the chapter on difficult labor. For monitoring labor, he describes and illustrates the use of the partograph as the invaluable tool it is, whether in developing or developed settings, as I see it. It is no secret that doctors tend to settle in the big cities, where hospital resources and opportunities for private practice are reasonably good, while district hospitals are poorly staffed. The immediate solution is to leave most of the daily chores to assistant medical officers, without whose diligent work health services would totally break down in many developing countries. Similarly, in remote areas, home deliveries are still attended by traditional birth attendants with little or no education. Everybody agrees that educating more skilled personnel has high priority, and that midwives and auxiliary midwives should replace the traditional birth attendants, which indeed happens when girls are allowed to go to school and illiteracy wanes. When it comes to the question of training assistant medical officers to perform cesarean sections, however, opinions differ among the book's authors. Staffan Bergström argues that evidence from Tanzania, Mozambique and other countries clearly indicates that assistant medical officers, well trained and periodically supported, are an extremely important asset to achieve safe motherhood in remote areas, while Kelsey A. Harrison and K. Bhasker Rao (Professor in Chennay, India) argue that while this practice may have short-term beneficial effects, it will lead to long-term damage to health, administrative and educational development. I have only mentioned a few of the expert contributors. Space precludes the mention of every name; no offence meant. They have all made fine contributions to this excellent book, which deserves a wide readership among those who wish to practice better obstetrics and to care for mothers and newborns in developing countries, and a host of others, who will gain a better understanding of the problems to be tackled if we really want a world where equity prevails. In 1994, Staffan Bergström, who is now professor of International Health at Karolinska Institutet in Stockholm, edited Health and Disease in Developing Countries (London and Basingstoke: Macmillan) together with three Finnish colleagues. That book clearly met a need and was widely distributed in developing countries, in large measure free of charge because of generous donations. I do hope that Maternity Care in Developing Countries will also be studied by many, even if libraries and individuals will have to pay for it. Considering its wealth of information, the price is modest.
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Per Bergsjø (2002) studied this question.