Prepared by: Mr’s Raheegeh Awni

A recent joint statement by WHO, the International Confederation of Midwives and the International Federation of Gynecologists and Obstetricians focuses on the importance of a person with midwifery skills attending labour and delivery, recognizing that this is the highest priority in achieving safe motherhood and a reduction in maternal mortality ratios.

A skilled attendant is defined as "an accredited health professional--such as a midwife, doctor or nurse-who has been educated and trained to proficiency in management of normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns".

"Preventable death and disability among mothers and expectant mothers is an all-encompassing tragedy: for families, for communities, for societies, and most of all, for children."—Carol Bellamy, Executive Director, UNICEF, World Health Day, 1998

Some 1,400 women die every day from problems related to pregnancy and childbirth. Tens of thousands more experience complications during pregnancy, many of which are life-threatening for the women and their children – or leave them with severe disabilities.

The dangers of childbearing can be greatly reduced if a woman is healthy and well nourished before becoming pregnant, if she has a health check-up by a trained health worker at least four times during every pregnancy, and if the birth is assisted by a skilled birth attendant such as a doctor, nurse or midwife.

The woman should also be checked during the 12 hours after delivery and six weeks after giving birth.

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Governments have a particular responsibility to make prenatal and postnatal services available, to train health workers to assist at childbirth, and to provide special care and referral services for women who have serious problems during pregnancy and childbirth

It is important for all families to be able to recognize the warning signs of problems during pregnancy and childbirth and to have plans and resources for getting immediate skilled help if problems arise.

A skilled birth attendant, such as a doctor, nurse or trained midwife, should check the woman at least four times during every pregnancy and assist at every birth.

All pregnant women need particularly nutritious meals and more rest than usual throughout the pregnancy.

Smoking, alcohol, drugs, poisons and pollutants are especially harmful to pregnant women and young children.

Physical abuse of women and children is a serious public health problem in many communities. Abuse during pregnancy is dangerous both to the woman and the fetus.

Girls who are educated, healthy and have a good diet during their childhood and teenage years will have fewer problems in pregnancy and childbirth.

Every woman has the right to health care, especially during pregnancy and childbirth. Health care providers should be technically competent and should treat women with respect.

Health indicators

Crude birth rate is the natality or childbirths per 1,000 people per year.

Total fertility rate — average number of children born to each woman over the course of her life.

The total fertility rate (TFR, sometimes also called the fertility rate, period total fertility rate (PTFR) or total period fertility rate (TPFR)) of a population is the average number of children that would be born to a woman over her lifetime.

Fertility rate - the ratio of live births in an area to the population of that area; expressed per 1000 population per year.

Infant mortality is defined as the number of deaths of infants (one year of age or younger) per 1000 live births.

The most common cause of infant mortality worldwide has traditionally been dehydration from diarrhea.

Because of the success of spreading information about Oral Rehydration Solution (a mixture of salts, sugar, and water) to mothers around the world, the rate of children dying from dehydration has been decreasing and has become the second most common cause in the late 1990s.

Currently the most common cause is pneumonia.

Major causes of infant mortality in more developed countries include congenital malformation, infection and SIDS.

Perinatal mortality: only includes deaths between the fetal viability (22 weeks gestation) and the end of the 7th day after delivery.

Neonatal mortality: only includes deaths in the first 28 days of life.

Post-neonatal death only includes deaths after 28 days of life but before one year.

Child mortality : includes deaths within the first five years after birth.

Infant mortality rate (IMR): is the number of newborns dying under a

year of age divided by the number of live births during the year.

The infant mortality rate is also called the infant death rate.

Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy.

According to the WHO, "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of thepregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."

Generally there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or their management, and an indirect maternal death that is a pregnancy-related death in a patient with a preexisting or newly developed health problem.

Other fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths.

The major causes of maternal death are variants of gestational hypertension including pre-eclampsia and HELLP syndrome, obstetrical hemorrhage, ectopic pregnancy, puerperal sepsis, amniotic fluid embolism, and complications of abortions.

Lesser known causes of maternal death include renal failure, cardiac failure, and hyperemesis gravidarum.

As stated by the 2005 WHO report "Make Every mother and Child Count" they are: severe bleeding/hemorrhage (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labour (8%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.

Forty-five percent of postpartum deaths occur within 24 hours.

Maternal Mortality Ratio is the ratio of the number of maternal deaths per 100,000 live births.

The MMR is used as a measure of the quality of a health care system.

Sierra Leone has the highest maternal death rate at 2,000, and Afghanistan has the second highest maternal death rate at 1900 maternal deaths per 100,000 live births, reported by the UN based on 2000 figures.

According to the Central Asia Health Review, Afghanistan's maternal mortality rate was 1,600 in 2007.

Lowest rates included Iceland at 0 per 100,000 and Austria at 4 per 100,000.

In the United States, the maternal death rate was 11 maternal deaths per 100,000 live births in 2005.

Ante partum : time between conception and onset of labor.

Intrapartum: time from onset of labor until the birth of infant and placenta.

Post partum : time from birth until the woman's body return to pre pregnancy condition .

Gestation : the # of weeks since the first day of last menstrual period.

Abortion : birth that occur before 20 weeks gestation or the birth of fetus who weight <500 g.

Still birth : a fetus born dead after 20 weeks gestation.

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Gravida: a woman who is pregnant, regardless of duration.

Multi gravida: awoman who has two or more pregnancies.

Primi gravida: the woman who is pregnant for the first time.

Nulligravida: a woman who has never been pregnant with fetus who have reached the stage of fetal viability.

para: birth after 20 weeks gestation regardless of whether the infant is born alive or dead.

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Post date :pregnancy >42 weeks .

Preterm : a pregnancy that reached 20 weeks of gestation but before complete 37 weeks .

Primi para: woman who has completed one pregnancy with fetus who have reached the stage of fetal viability .

Term: a pregnancy from the beginning of 37 weeks of gestation to the end of 42 weeks of gestation .

LMP: last menstrual period .EDB/EDD/EDC: estimated date of birth (nageles

role ): 1. First day of LMP .2. Minus 3 month .3. Plus 7 days .4. Plus one year .

Viability: capacity to live out side the uterus about 22-24 weeks from last LMP or fetal wt more than 500 g.

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