Each year in Africa 30 million women become pregnant, and about 250,000 of them die from pregnancy-related causes. One-third of nearly one million stillbirths occur during labor, and approximately 280,000 babies die of birth asphyxia soon after birth. These figures are closely linked. Skilled care at birth and immediately thereafter would save the lives of many mothers and babies and prevent countless complications. Yet almost 60 percent of African women 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 skilled attendant on the continent has not increased significantly. Two in three women who need emergency obstetric care do not receive it.
The birth of a new baby is a natural process and an important and joyful social event both for the individual family and the wider community. Most women experience normal childbirth, and most babies are born healthy. Complications during childbirth, however, cannot be predicted. For this reason, all women and babies require access to childbirth care from skilled care providers.8 Timely recognition and management of complications during childbirth is important, as is avoiding unnecessary medical interventions.
The who, where, and what of skilled care during childbirth can be summarized as follows:
Who? Skilled care at birth is defined as care provided by a health worker with midwifery skills, also called a skilled attendant. Skilled attendants are accredited health professionals such as midwives, doctors, and nurses who have been educated and trained to proficiency in managing normal (uncomplicated) pregnancies, childbirth, and the immediate postnatal period and can identify, manage, and refer complications in women and newborns.9
Where? Childbirth should take place in a setting with the necessary equipment, supplies, drugs, and support of a functioning health system, including transport and referral facilities for emergencies. This is sometimes called an enabling environment. In countries with poor communication and transport networks, it is challenging for skilled attendants to provide effective childbirth care at home, and in most of Africa, skilled attendants are mainly based in health facilities.
What? Key interventions during labor and birth include
• Routine infection prevention practices
• Monitoring of labor using a partograph as an effective tool for monitoring the progress of labor.
The partograph helps identify problems such as slow progress and prolonged labor (Box III.3.3)
• Active management of the third stage of labor
• Hygienic cutting and tying of the cord
• Resuscitation if needed
• Essential newborn care (warmth, early and exclusive breastfeeding, and cleanliness)
• Prevention of mother-to-child transmission (PMTCT) of HIV
• Increasing client satisfaction and comfort, for example providing privacy, limited vaginal exams, permitting free movement, food, and drink intake, encouraging the use of a social companion at birth, and establishing a supportive relationship.
Immediate newborn care includes assessing the baby, recording the birth weight, and providing eye care to prevent gonococcal eye infections where this is local policy. Resuscitation should be started if the baby does not breathe within 30 seconds after birth. Recent reviews have concluded that adequate ventilation with a bag and mask (“ambubag”) device and room air is just as efficient as oxygen for initial resuscitation.
Source: https://www.who.int/pmnch/media/publications/aonsectionIII_3.pdf?ua=1