From YouTube: "Original PBS airdate: Tuesday, July 15, 2008. Sub-Saharan Africa is the world's deadliest place to give birth. Each year over a quarter of a million women die in childbirth in the region. But Mozambique is combating high maternal death rates by implementing unconventional programs. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. 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. 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."
My thoughts: I would really like to see the whole film, but the PBS site doesn't load very well. A good point is brought up about midwifery: in the United States it would be unthinkable to have anyone but a doctor perform a surgery of any kind. But in Africa, the ratio of doctors to people doesn't allow for such strict ideas about medical care. I'm not sure what the number is now, but at one point while I was in Mozambique, there were around 500 doctors in the entire country, to serve a population of 10 million people. And of course most of the doctors were centered in Maputo or Beira. So to say that only doctors should be able to perform cesarean sections doesn't seem as reasonable.
It would seem part of the solution would be to train more doctors- however, a medical degree is expensive and prestigious and how likely would it be that once a Mozambican became a doctor they would choose to live and serve in a rural area? They would almost have to work in Maputo just to pay for their education. It actually makes a lot of sense to train midwives to perform cesarean sections. There are more midwives in the country, they already know a lot about childbirth and they are likely to stay in their communities once they are trained.