Slide 2
We will review the magnitude of maternal mortality and its causes. Then, we will review past interventions aimed at reducing maternal mortality, and focus on the most recent development, having a skilled attendant at childbirth
Slide 3
High maternal mortality has gone on too long. It’s time for initiatives that are proven effective.
Slide 4
For each woman who dies during pregnancy, 30 women suffer complications.
Initiatives should include:
Slide 6
Maternal mortality is a global tragedy, but if affects the developing world. Almost all of the deaths from pregnancy-related complications occur in the developing world.
Slide 8
The most common cause of maternal mortality is hemorrhage (24.8%), followed by infection (14.9%), obstructed labor (6.9%) and unsafe abortion (12.9%). Indirect causes account for 19.8%.
Slide 9
Multiple factors affect WHY a woman dies during pregnancy.
The “three delays” model”:
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Delay in decision to see care: lack of information about problems/warning signs, social factors
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Delay in reaching care: having transportation, road conditions
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Delay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnel
Slide
11
There have been many interventions implemented to try to improve maternal mortality. We will review the ones used to date.
TBAs and antenatal care still play a role, but the role needs clarification.
Slide 12
Certain interventions can help prevent problems: active management of third stage of labor and clean delivery. Should be routine, however, pre-eclampsia and uterine atony cannot be prevented.
Slide 13
Traditional birth attendants: use has many advantages and disadvantages. The biggest disadvantage is that their skills are limited and may delay a woman getting to an appropriate level of care.
Slide 14
Midwifery skills: provision of emergency obstetric care. Untrained birth attendants are unable to provide emergency obstetric care.
Slide 15
Even with TBA’s and other interventions, maternal mortality decreased in Sri Lanka. The reduction, however, was the greatest (maternal mortality was the lowest) after having births attended by skilled providers The government’s commitment to this intervention was crucial.
Slide 16
TBAs are useful, but more skilled attendants are needed to substantially reduce maternal mortality.
Slide 17
Wide use of antenatal care in UK, US and Australia. Still maternal mortality in US 700/100.000 in 1940s.
Slide 18
Other interventions can make a difference, but not as substantial as skilled attendants. For example, in this graph, the implementation of antenatal care did not reduce maternal mortality in the UK. Improvements came only with skilled attendants 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 be prepared to handle them.
Slide 19
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.
Slide 20
A skilled attendant 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.
Slide 22
As shown in this graph, there appears to be a relationship between having skilled attendants at childbirth and a reduction in maternal mortality. We believe the association is real. So far, it appears to be the most effective intervention.
