The Washington PostDemocracy Dies in Darkness

My son was born in our car. He was still safer than if he’d been born in 21 other countries.

When an ER nurse delivered our baby in the hospital parking lot, it reminded me how fortunate we were—where skilled birth attendants are absent, maternal mortality rates soar.

Newborns in a nursery. (

I’d heard my wife scream like this once before: two and a half years ago, about 10 minutes before she gave birth —unmedicated — to our daughter. This time around, 40 weeks into her pregnancy, we were at least 11 minutes away from the hospital. For us, the only question was whether or not we’d get there in time.

And while I wasn’t thinking about it at the time — the adrenaline-filled drive to the hospital and the imminent arrival of our son were about all I could handle at the moment— our heart-pounding adventure put in perspective my years of reporting on global health. Safety for my wife and baby was a short drive away. This was rarely the case in many of the countries from which I’ve reported, where complications from childbirth kill and maim mothers and newborns each day.

Driving to the hospital, every red light that stopped us cost precious seconds in which we could be advancing closer to our destination. On the way I ran one red light, but thought better of running a second one. With the hospital just 10 blocks away, my wife’s water broke and I had to keep telling myself that “Babies don’t just come flying out.”

At yet another red light my wife screamed “Oh my God!” louder than I’ve heard any human ever yell. And when I finally pulled our car to a screeching halt in front of the emergency room and a parking valet heard my wife’s screams and ran inside to alert the security guard, I ran around to the passenger side and looked down to see the top of my crowning baby’s head and hoped what I saw wasn’t what I thought it was. I was calm until that point, singularly focused on getting to the hospital. And as I felt the panic start to set in, shouting, “We need help!” I looked up and saw relief.

A pair of hands in sterile blue medical gloves.

They belonged to the ER nurse who was on her way to lunch when she heard the commotion and instinctively jumped into action. Her poise was a counterpoint to my panic. With efficiency, and in deliberate sequence, she issued instructions, to someone, into a radio mic on her lapel, moved toward the car as I stepped aside and, as I watched through the windshield, she delivered my son, healthy and safe, right there in our 2003 Highlander.

For us, the story ended happily. And though this was her first delivery, our nurse was a highly trained medical professional who took command of the situation and delivered our baby.

Not everyone, however, has our good fortune.

In my career as a global affairs journalist covering international development, I’ve reported on the health systems of countries where maternal and neonatal mortality is exceptionally high — in many instances because births were not attended by anyone with medical training. In the United States, 99 percent of all births happen in some form of controlled medical setting, often with a midwife or obstetrician present. But in many developing countries, less than half of all births occur under the supervision of what the World Health Organization calls a “skilled birth attendant.”

A 2010 National Institutes of Health study found that 28 countries in Sub-Saharan Africa, the Middle East, Asia and Latin America in which fewer than 50 percent of all births are attended by skilled birth attendants. According to the report, 69 percent of all maternal deaths in these regions occur in those 28 countries, “despite the fact that these countries only constitute 34% of the total population in these regions.” In short, where there are few skilled birth attendants, maternal mortality rates soar.

I’ve seen the effects of this deficit first hand, and also what many of these countries are trying to do to improve these numbers. In Ethiopia, I met high-school-aged girls who serve as “health extension workers,” bringing basic health care to rural communities. In Bangladesh, I interviewed a “shasto shabika” — essentially a community health worker from a rural village who’s given medical training as part of a national health-care system. In Liberia, I visited a rural hospital staffed by one doctor on call for obstetric emergencies.

Partly because of these kinds of interventions, the number of births attended by someone with medical training is increasing and maternal and newborn deaths are on the decline. According to the Kaiser Family Foundation, there are now 21 countries in which fewer than 50 percent of all births are attended by someone with medical training — down from 28 countries five years prior.

Globally, maternal mortality has decreased 45 percent from an estimated 523,000 deaths in 1990. Newborn deaths are down, also, from 24.9 deaths per 1,000 live births in 2006, to 19.2 deaths per 1,000 live births this year.

These improvements are profound. But the number of mothers who die as a result of pregnancy and newborns who do not live past one month are still shockingly high. In all, about 289,000 women died in 2013 from complications related to pregnancy, approximately 210 women dying for each 100,000 live births. The situation for newborns is much graver: nearly 3 million infants die in their first month of life.

If not for the impending birth of my child, I would’ve been at the United Nations reporting on a global gathering addressing ways to reduce these numbers even further. Just four days before my baby boy came to life in the passenger seat of our old Toyota, world leaders gathered in New York to approve an initiative called the Sustainable Development Goals, which will guide the U.N.’s international development agenda for the next 15 years. These are ambitious goals to wipe out extreme poverty and improve health and living conditions across the globe, including goals to reduce the global maternal mortality ratio to less than 70 deaths per 100,000 live births and reduce neonatal mortality to at least as low as 12 per 1,000 live births.

To get there, the United Nations also launched something called the “Global Strategy for Women’s Children’s and Adolescents’ Health,” a blueprint for ending preventable maternal and child deaths. This includes substantially increasing the number of well-trained medical professionals present at births.

Every baby may not be able to be born in a state-of-the-art hospital like St. Joseph’s in Denver, where my son was born, or even rustic Phebe Hospital in Liberia. But every baby deserves the care of someone like our heroic ER nurse, to increase the chances of a safe and healthy delivery for mother and baby — at home, in a medical facility or, in some cases, in an old car.

Correction: This article has been updated to reflect that according to the United Nations Population Fund, there were an estimated 289,000 maternal deaths in 2013, not 2014.