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Edit Comment Close Premium member Presentation Transcript “Every Pregnancy Is at Risk:”Current Approach to Reduction of Maternal Mortality: “Every Pregnancy Is at Risk:” Current Approach to Reduction of Maternal Mortality Advances in Maternal and Neonatal HealthSession Objectives: Session Objectives To review: Magnitude of maternal and neonatal mortality Causes of maternal mortality Interventions to reduce maternal mortality Traditional birth attendant Antenatal care Risk screening Skilled attendant at childbirthWhat Is Safe Motherhood?: “ A woman’s ability to have a SAFE and healthy pregnancy and childbirth. ” What Is Safe Motherhood?Maternal Health: Scope of Problem: Maternal Health: Scope of Problem 180–200 million pregnancies per year 75 million unwanted pregnancies 50 million induced abortions 20 million unsafe abortions (same as above) 600,000 maternal deaths (1 per minute) 1 maternal death = 30 maternal morbiditiesNeonatal Health: Scope of Problem: Neonatal Health: Scope of Problem 3 million neonatal deaths (first week of life) 3 million stillbirths Maternal Mortality: A Global Tragedy: Maternal Mortality: A Global Tragedy Annually, 585,000 women die of pregnancy related complications 99% in developing world ~ 1% in developed countries Maternal Death Watch: Every Minute... Maternal Death Watch 380 women become pregnant 190 women face unplanned or unwanted pregnancy 110 women experience a pregnancy related complication 40 women have an unsafe abortion 1 woman dies from a pregnancy-related complicationGlobal Causes of Maternal Mortality: Global Causes of Maternal MortalityBut WHY Do These Women Die?: But WHY Do These Women Die? Delay in decision to seek care Lack of understanding of complications Acceptance of maternal death Low status of women Socio-cultural barriers to seeking care Delay in reaching care Mountains, islands, rivers — poor organization Delay in receiving care Supplies, personnel Poorly trained personnel with punitive attitude Finances Three Delays ModelMaternal Health Services: Maternal Health Services Good quality maternal health services are not universally available and accessible > 35% receive no antenatal care ~ 50% of deliveries unattended by skilled provider ~ 70% receive no postpartum care during 1st 6 weeks following deliveryInterventions to Reduce Maternal Mortality: Interventions to Reduce Maternal Mortality Historical Review Traditional birth attendants Antenatal care Risk screening Current Approach Skilled attendant at deliveryHistorical Review of Interventions: Historical Review of Interventions The flawed assumption: Most life-threatening obstetric complications can be predicted or preventedInterventions: Traditional Birth Attendants: Interventions: Traditional Birth Attendants Advantages Community-based Sought out by women Low tech Teaches clean delivery Disadvantages Technical skills limited May keep women away from life-saving interventions due to false reassuranceMaternal Mortality ReductionSri Lanka 1940–1985: Maternal Mortality Reduction Sri Lanka 1940–1985 Health system improvements: Introduction of system of health facilities Expansion of midwifery skills Decreased use of home delivery and delivery by untrained birth attendants Spread of family planningMaternal Mortality ReductionSri Lanka 1940–1985: Maternal Mortality Reduction Sri Lanka 1940–1985 85% births attended by trained personnelInterventions: Traditional Birth Attendants: Interventions: Traditional Birth Attendants Conclusion: TBAs are useful in the maternal health network, but there will not be a substantial reduction in maternal mortality by TBAs delivering clinical services aloneInterventions: Antenatal Care: Interventions: Antenatal Care Antenatal care clinics started in US, Australia, Scotland between 1910–1915 New concept - screening healthy women for signs of disease By 1930’s large number (1200) ANC clinics opened in UK No reduction in maternal mortality However, widely used as a maternal mortality reduction strategy in 1980’s and early 1990’s Is ANC important? YES!! Early detection of problems and birth preparationMaternal Mortality: UK 1840–1960: Maternal Mortality: UK 1840–1960 Improvements in nutrition, sanitation Antibiotics, banked blood, surgical improvements Antenatal care Maine 1999.Interventions: Risk Screening : Interventions: Risk Screening Disadvantages Very-poorly predictive Costly: Removes woman to maternity waiting homes If risk-negative, gives false security Conclusion: Cannot identify those at risk of maternal mortality — every pregnancy is at risk Interventions: Skilled Attendant at Childbirth: Interventions: Skilled Attendant at Childbirth Proper training, range of skills Assess risk factors Recognize onset of complications Observe woman, monitor fetus/infant Perform essential basic interventions Refer mother/baby to higher level of care if complications arise requiring interventions outside realm of competence Have patience and empathy WHO 1999.Interventions: Skilled Attendant at Childbirth: Interventions: Skilled Attendant at Childbirth Proven effective Malaysia: basic maternity services 320 157 Cuba: national priority 118 31 China: facility based childbirth 1500 50 Malaysia vs. Indonesia: Trained community midwives (2 years) vs. untrained midwives (4 years)Slide22: The higher the proportion of deliveries attended by skilled attendant in a country, the lower the country’s maternal mortality ratio % skilled attendant at delivery Maternal deaths per 1000000 live birthsSummary: Summary Skilled attendant at childbirth is the most effective intervention WHO 1999.References: References Maine D. 1999. What's So Special about Maternal Mortality?, in Safe Motherhood Initiatives: Critical Issues. Berer M et al (eds). Blackwell Science Limited: London. World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a Technical Working Group. WHO: Geneva. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.