Childbirth care - WHO

1 CHAPTER 3 IIIEach year in Africa 30 million women become pregnant, and about 250,000 ofthem die from pregnancy-related causes. One third of nearly one millionstillbirths occur during labour, and approximately 280,000 babies die of birthasphyxia soon after birth. These figures are closely linked. Skilled care atbirth and immediately thereafter would save the lives of many mothers andbabies and prevent countless complications. Yet almost 60 percent of Africanwomen give birth without a skilled attendant 18 million a year at home and during the last 10 years, the average coverage of births with a skilledattendant on the continent has not increased significantly.

2 Two in threewomen who need emergency obstetric care do not receive up skilled attendance and emergency obstetric care is fundamentalto reaching Millennium Development Goal (MDG) 5 for maternal health, andscaling up care during Childbirth will also contribute to MDG 4 for childsurvival. How can progress be accelerated? How can newborn care bestrengthened while skilled care is scaled up? What canbe done in the short term, medium term, and longterm, bearing in mind that the poorest, most isolatedwomen, who often experience birth complications, arelast to receive skilled care during Childbirth ?

3 Childbirth careLuwei Pearson, Margareta Larsson,Vincent Fauveau, Judith Standley64 Opportunities for Africa s NewbornsProblemNewborn health and survival are closely linked to care the mother receives before and during pregnancy, Childbirth , and the postnatal period. Throughout the continuum of care , the period with the highest risk of death and disability for both mothers and newborns is labour, birth, and the first few hours after and lack of care at this crucial time has consequences for mothers and women Each year in Africa, an estimated quarter of a million women die of problems relatedto pregnancy, while nearly half die around the time of Childbirth and during the first week after birth, mainlyof causes directly related to , obstructed labour, eclampsia.

4 And infections make up thelargest causes of mothers deaths, accounting for two thirds of maternal deaths in sub-Saharan alone accounts for one third of all maternal deaths in Africa, yet many of these deaths arepreventable. Obstetric fistula resulting from obstructed labour is a long term complication suffered by asmany as two million women. About 15 percent of all pregnant women have Childbirth complications thatrequire emergency obstetric care (EmOC), yet few are able to access such services. The costs of acaesarean section in some African countries can bankrupt the and newborns Babies are vulnerable during Childbirth , and intrapartum complications result ina much higher risk of death than pre-pregnancy or antenatal complications.

5 At least 300,000 babies in Africadie as intrapartum stillbirths dying during Childbirth from Childbirth complications such as obstructedlabour. Among babies born alive, another 290,000 die from birth asphyxia, also primarily related tochildbirth complications. Some of these deaths could be prevented by skilled care during pregnancy, Childbirth , and the immediate postnatal period. For every baby who dies, an unknown number develop longterm disabilities. Although most babies breathe spontaneously at birth, up to 10 percent of newbornsrequire some assistance to initiate breathing, with less than one percent needing extensive to breathe at birth may be due to preterm birth or to birth asphyxia.

6 An estimated four million lowbirthweight (LBW) babies are born in Africa each year. These babies are particularly vulnerable and withoutextra care are more likely to die from avoidable causes, such as hypothermia (cold), hypoglycaemia (lowblood sugar), or ability of families and communities to recognise and access care quickly in case of an emergencydetermines the survival and health of both mother and baby. For some obstetric complications, particularlyhaemorrhage, the window of opportunity to respond and save the life of the mother may be measured inhours.

7 For the baby, either in utero or just born, death can come even more quickly. Any delay may havefatal consequences (Box ).BOX delaysThree delays in care seeking affect the survival of both mothers Delays in recognising problems and deciding to seek care Complications not recognised as serious Family members delay care seeking Spiritual or cultural beliefs may reinforce delays or result in othertreatments2. Delays in transportation to reach appropriate care Lack of transport and/or funds Distance and travel time to reach health facilities 3. Delays in receiving appropriate care at the health facility Lack of appropriately trained staff and negative attitudes of health workers Lack of essential equipment, drugs and suppliesSource: Adapted from reference5 Opportunities for Africa s Newborns 65 IIIThe first two delays reveal questions about seeking care atthe family and community level.

8 Are families equipped tomake healthy choices? Can the family and communitysupport women when transportation and emergency costsare necessary? In many cultures, a woman must receivepermission and money from her husband or other familymembers to seek care when complications take distance, high cost, and poor quality of care alsocontribute to the first and second third delay is related to health care providers, thefacility, and the health South Africa, datacollected for the national perinatal problem identificationprogramme, which now covers over one third of SouthAfrica s births.

9 Show that while the majority of avoidablefactors for stillbirths and neonatal deaths are related topoor maternal care during labour and the immediatepostnatal period, about one third are due to delays athome and in transportation6(Box ).BOX 10 preventable delays associated with perinatal deaths in ruralareas of South Africa, according to confidential enquiry of maternal death 1. Inadequate facilities and equipment in neonatal units and nurseries of deaths2. Non-existent or poor antenatal care Poor intrapartum fetal monitoring Patient delay in seeking medical attention during labour Prolonged second stage of labour with no intervention Inappropriate response to rupture of membranes Lack of transport from home to the health facility Poor progress in labour and incorrect use of partograph Delay in medical personnel calling for expert assistance Inadequate neonatal management plan.

10 Adapted from reference7 This chapter will outline the package for care inchildbirth, including skilled attendance at birth andemergency obstetric and newborn care . We then describethe current situation for Childbirth care in Africa andexplore opportunities to integrate and strengthennewborn interventions, suggesting practical steps to scaleup skilled care and address key challenges, particularly the18 million women who currently give birth withoutskilled care . Package New analysis presented throughout this publicationsuggests that high coverage of care during Childbirth ,including skilled maternal and immediate newborn care ,EmOC, and additional interventions, such as antenatalsteroids for preterm labour, could avert up to 34 percentof neonatal deaths.