Skilled Health Workers: Critical Asset to Maternal Health Efforts
An expectant mother in an industrialized nation may choose to forgo delivering her child in the hospital, instead opting to deliver in the comfort of her own home. A skilled birth attendant, such as a midwife, nurse, or doctor, will attend labor and delivery. If complications arise, she can be quickly transferred to the closest hospital. If all goes according to plan, she will be resting with a healthy baby by the end of this joyous occasion. This idealized picture of “natural home birth” contrasts the harsh reality that women in low-income countries face.
Many mothers in the developing world do not have these luxuries. Because access to health care facilities is often limited, most women give birth at home out of necessity. In Sub-Saharan Africa, more than half of all births occur without a skilled birth attendant. (1) Without skilled care, pregnancy complications are often left untreated and may cause death. For example, postpartum hemorrhage (PPH), uncontrolled bleeding after birth, continues to be the leading cause of maternal death. PPH can kill a healthy woman within hours. However, death from PPH is both preventable and treatable with access to skilled care. This lack of skilled birth attendants is more problematic in rural areas and remote villages, where the nearest hospital is not nearly close enough and health care is costly. In contrast, urban areas have higher rates of hospital births, births that are attended by midwives or those with comparable skills and have increased access to emergency care. Because of the disparity between urban and rural areas, trained health workers can make a tremendous difference in treating pregnancy related complications such as PPH.
The World Health Organization (WHO) defines a skilled birth attendant as “an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.”(2) Skilled care at birth not only ensures the timely referral and delivery of emergency care services, but also allows midwives to begin treatment at the earliest signs of complications.
The current recommendations for treating PPH, the loss of more than 500 mL of blood, hinge on trained birth attendants. Active management of the third stage of labor (AMTSL), with the use of uterotonics immediately following childbirth, remains critical in the prevention of severe blood loss and death.(3) Uterotonics, such as oxytocin and misoprostol, cause uterine contractions that promote blood clotting and decrease the risk of PPH. However, oxytocin, the drug of choice, requires refrigeration, sterile equipment and a skilled provider to administer the drug. Hence, skilled birth attendants are necessary to provide mothers with this particular treatment. In cases without skilled care at birth, community workers may deliver misoprostol. AMTSL also includes delayed cord clamping, regular assessment of uterine tone after delivery of the placenta and uterine massage for postpartum hemorrhage treatment. Utilization of AMTSL depends upon the skills of birth attendants, the frontline health workers that truly do save women’s lives every day.
AusAID. 2006. Maternal and child health training. [Photograph]. Retrieved from https://flic.kr/p/hiPH81*
1. United Nations Population Fund. “Skilled Attendance at Birth.” UNFPA. <http://www.unfpa.org/public/mothers/pid/4383>
2. Making pregnancy safer – The critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO. Geneva, World Health Organization, 2004. <http://www.who.int/entity/maternal_child_adolescent/documents/9241591692/en/index.html>
3. MCHIP and WHO. WHO Recommendations on Prevention and Treatment of Postpartum Haemorrhage: Highlights and Key Messages from New 2012 Global Recommendations.
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