06 Obstetric Care
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The document discusses reducing maternal deaths by addressing the three delays that prevent women from receiving timely emergency obstetric care: delay in deciding to seek care, reaching care, and receiving care. Interventions like skilled birth attendance, emergency obstetric care in well-equipped facilities, and improving access through community education and mobilization have been shown to significantly reduce maternal and newborn mortality when comprehensively implemented. A multi-pronged approach is needed that addresses both supply of and demand for quality maternal healthcare services.
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06 Obstetric Care
- 2. What Is Maternal Death? The death of a woman while she is pregnant … From any cause related to or aggravated by the pregnancy World Health Organization (WHO) within 42 days of the termination of the pregnancy… … or…
- 6. India & WB- Neonatal Mortality Source-SRS Annual Report 2009 INDICATOR INDIA WEST BENGAL Infant Mortality Rate 50 33 Neonatal Mortality Rate 34 25 Early Neonatal Mortality Rate 27 19 Perinatal Mortality Rate 35 30 Under-5 Mortality Rate 64 40
- 7. What Do Women Die Of? They Die of Obstetric Complications that Need Not Be Fatal
- 8. Causes of Maternal Death Infection 14.9% Hemorrhage 24.8% Indirect causes 19.8% Other direct causes 7.9% Unsafe abortion 12.9% Obstructed labor 6.9% Eclampsia 12.9%
- 9. WHERE DO WOMEN DIE TODAY? 99% of Maternal Deaths Today Occur in Africa, Asia and Latin America
- 10. Most Obstetric Complications Occur Suddenly If women do not receive medical treatment on time, they will probably suffer disability… Or Die Without Warning
- 22. Maternal Mortality Reduction Sri Lanka, 1940 – 1985 85% births attended by trained personnel
- 23. Maternal Mortality: UK 1840 – 1960 Improvements in nutrition, sanitation Antibiotics, banked blood, surgical improvements Antenatal care
- 24. Maternal Mortality Ratio per 100,000 live births % Skilled Attendant at Delivery Source : Safe Motherhood Initiative website and Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA 2001. Relationship between Skilled Attendant at Delivery and MMR for countries with MMR<500
- 25. Source : Safe Motherhood Initiative website and Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA 2001. Maternal Mortality Ratio per 100,000 live births % Skilled Attendant at Delivery Relationship between Skilled Attendant at Delivery and MMR for countries with MMR>500
- 26. Good Quality Maternity Services Will Save the Lives of Newborns AbouZahr and Wardlaw 2001.
- 29. How Can We Improve Access to EmOC? By making sure health facilities provide the services needed to save women’s lives. Eight key functions “signal” a facility’s ability to provide EmOC
- 39. Thank You
Editor's Notes
- EmOC Learning Resource Package For each woman who dies during pregnancy, 30 women suffer complications. Initiatives should include: Family planning Management of complications of abortion Management of complications of pregnancy and childbirth
- EmOC Learning Resource Package
- EmOC Learning Resource Package Review of the past interventions: Traditional birth attendants and antenatal care still play a role, but the role needs clarification.
- EmOC Learning Resource Package Wide use of antenatal care in UK, US and Australia. Still, maternal mortality in US was 700/100.000 in 1940s.
- EmOC Learning Resource Package Risk screening is another intervention that has been used. It is problematic because only about 10 – 15% of women who are thought to be “at risk” for a complication actually go on to have a problem. And most women who do develop complications have no risk factors. If “risk factors” are ruled out, the patient and provider develop a false sense of security, and are then not prepared when complications arise. All women, therefore, should be considered at risk.
- EmOC Learning Resource Package
- EmOC Learning Resource Package Midwifery skills: Provision of emergency obstetric care. Untrained birth attendants are unable to provide emergency obstetric care.
- EmOC Learning Resource Package
- EmOC Learning Resource Package Other interventions can make a difference, but not as substantial as skilled providers. For example, in this graph, the implementation of antenatal care did not reduce maternal mortality in the UK. Improvements came only with skilled providers who could provide surgical intervention if needed, and who had access to and could use appropriate antibiotics and blood products. Nevertheless, antenatal care remains an important intervention in maternal care because it provides an opportunity to detect problems and to be prepared to handle them.
- EmOC Learning Resource Package A skilled provider should have a good range of skills, be able to identify problems, recognize complications early, be able to perform essential basic interventions and make referrals to appropriate levels of care when necessary.