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Making Childbirth Safer Around the World

November 2010Andrew Schwartz

In 1969, Suellen Miller was working at a halfway house for teenage girls in Washington, DC. When one of the girls there wound up with pelvic inflammatory disease from an undiagnosed STD, the resulting surgery almost robbed her of her fertility. Miller, a recent college graduate, was appalled.

“The next day, I took all of the girls out to get condoms and contraceptive sponges,” she says, her eyes flashing at the memory. “I had always been fascinated by how women’s bodies worked, and I thought it was unfair for us not to teach these women how to protect themselves.”

Miller’s boss disagreed and gave Miller – who today directs the Safe Motherhood Programs at UCSF’s Bixby Center for Global Reproductive Health – a stern lecture about being an enabler. It was a lecture that unwittingly launched a career in nursing, midwifery, public health and research that has “enabled” thousands of women to deliver their children more safely and humanely.

In the Vanguard of Home Birth

Suellen Miller Over the next seven years, Miller got her RN license, worked as a labor and delivery nurse, moved to California, returned to school to become a certified nurse midwife, gave birth to a daughter and, in 1976, decided to open a home birth midwife practice in Marin County with two current UCSF faculty members, Judith Bishop and Marcia Hansen. There was only one problem with the home birth idea.

“It didn’t exist here,” says Miller. “There was a midwifery practice at San Francisco General [Hospital], but for an independent group, outside of a hospital there was no means of reimbursement, no hospital privileges. People at the hospitals would say, ‘You can’t apply here; we don’t even have the forms.’ But as children of the ’60s, we wouldn’t take no for an answer. We had a march and a meeting of 150 mothers and babies, and it worked.”

The successful practice helped spawn a burgeoning home birth movement in the area, which thrived for a few short years. But in the early 1980s, says Miller, the consolidation of physician practices essentially forced independent midwives to work under the auspices of a physician group. She joined an obstetrics and gynecology practice in Greenbrae with a physician who valued her skills and experience.

A Fateful Overseas Trip

Miller spent the next few years working tirelessly, on call all the time, until she became concerned that she was not spending enough time with her own 10-year-old daughter. In 1986, Miller arranged a monthlong, mother-daughter adventure to Thailand and Nepal. The trip not only deepened a central relationship in Miller’s life, but also opened another doorway in her career.

“I discovered how women in the rest of the world were having babies, and decided to devote the rest of my life’s work to working with women internationally,” she says.

When she returned home and began researching her new passion, she quickly learned that, to be effective, she would need public health training and a PhD degree.

“So I went to the UCSF School of Nursing; that’s where I fell in love with research,” she says. “I had mentors who treated me like a colleague. Some were nurses [including Interim Dean Sally Rankin] and midwives; others were sociologists, anthropologists, epidemiologists. But without people like [sociologist] Adele Clarke, I wouldn’t be sitting here. Higher-level nurse training has enabled me to do so many things.”

After attaining her PhD in 1994 – and spending a few years doing post-doctoral work, international consulting and a stint with the Population Council in New York – Miller returned to UC to join her colleague Nancy Padian’s new venture: the Women’s Global Health Imperative.

LifeWrap

Suellen Miller training Zambian health care workers how to use the LifeWrap It was shortly after her return that a colleague pointed her to an article in BJOG: An International Journal of Obstetrics and Gynaecology. Written by Stanford physician Paul Hensleigh, the piece examined the cases of six hospitalized women in Pakistan who, after hemorrhaging during childbirth (the leading cause of maternal mortality), had been treated using a non-pneumatic antishock garment. The device was an attempt to improve upon inflatable antishock garments, which NASA had developed to combat anti-gravity effects and emergency workers used to stabilize patients with lower body injuries.

Skeptical at first, Miller eventually read the piece and began to wonder whether health care workers in remote areas might be able to use the garment to stabilize and safely transport women with obstetric hemorrhage to hospitals where they could receive proper treatment. She contacted Hensleigh, and the two teamed up to validate the efficacy of what came to be known as the LifeWrap and to train health workers in developing countries how to use the device.

The work has generated international interest. Miller has been publishing a series of papers, and is finishing a randomized cluster trial in Zambia and Zimbabwe that the World Health Organization is waiting to see before it makes its recommendations on the LifeWrap’s use. In the meantime, Miller says, “We have had some remarkable results – enough so that colleagues in Egypt and Nigeria are moving ahead with purchasing LifeWrap.”

Onward

While the LifeWrap is a major focus of Miller’s career, she also is investigator or adviser for numerous other studies on maternal health in developing countries. Her next study, to be funded by the Bill & Melinda Gates Foundation, will examine the value of universally and prophylactically administering the drug misoprostol to prevent postpartum hemorrhage.

All of this seems to follow naturally from the time, 40 years earlier, when an outraged college graduate refused to let ignorance deprive young women of the miracle of childbirth. Miller has used that moment – and a diverse education – to transform her own life as well as the lives of women and families around the world.

 

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