The Role of Midwives in MCH

17th of February, 2009

Alison Lindner BSN, CNM, MPH

What Do We Know?What Do We Know?

Skilled attendants for pregnancy care Skilled attendants for pregnancy care and birth are lackingand birth are lacking

This lack of skilled attendants is This lack of skilled attendants is disturbing since many maternal and disturbing since many maternal and infant deaths and morbidities are infant deaths and morbidities are preventable during the prenatal period, preventable during the prenatal period, as well as during labor and birth.as well as during labor and birth.

OutcomeOutcome

In much of the developing world In much of the developing world home birth with unskilled attendants home birth with unskilled attendants or no attendant is the norm.or no attendant is the norm.

Maternal and neonatal mortality is Maternal and neonatal mortality is high in the developing worldhigh in the developing world

WHO DefinitionWHO Definition A midwife is a person, who, having been A midwife is a person, who, having been

regularly admitted to a midwifery education regularly admitted to a midwifery education program, duly recognized in the country in program, duly recognized in the country in which she is located, has successfully which she is located, has successfully completed the prescribed course of studies in completed the prescribed course of studies in midwifery and has acquired the requisite midwifery and has acquired the requisite qualifications to be registered and/or legally qualifications to be registered and/or legally licensed to practice midwifery. She must be licensed to practice midwifery. She must be able to give the necessary supervision, care able to give the necessary supervision, care and advice to women during pregnancy, labor and advice to women during pregnancy, labor and the postpartum period, to conduct and the postpartum period, to conduct deliveries on her own responsibility and to deliveries on her own responsibility and to care for the newborn and the infant.care for the newborn and the infant.

Midwifery and Maternal Midwifery and Maternal MortalityMortality

The midwife can assist in the The midwife can assist in the prevention of maternal and child prevention of maternal and child mortality and morbidity by mortality and morbidity by providing:providing: Nutritional education Nutritional education Family planning services (birth spacing, Family planning services (birth spacing,

safe abortion and post abortion care) safe abortion and post abortion care) Safe sex information to prevent STDs, Safe sex information to prevent STDs,

HIV/AIDs and cervical cancerHIV/AIDs and cervical cancer

Midwifery and Maternal Midwifery and Maternal MortalityMortality

Antepartum CareAntepartum Care Maternal nutrition - Maternal nutrition -

Vitamin A, Folic Acid, Vitamin A, Folic Acid, Protein, Iron – Protein, Iron – prevention of anemia, prevention of anemia, congenital anomaliescongenital anomalies

HIV HIV screening/prevention of screening/prevention of MTCTMTCT

Malaria Malaria prophylaxis/bed netsprophylaxis/bed nets

Recognition of PIH, Recognition of PIH, other maternal other maternal conditionsconditions

Midwifery and Maternal Midwifery and Maternal MortalityMortality

Intrapartum CareIntrapartum Care - -Identify problems Identify problems early and transfer to early and transfer to the next level of carethe next level of care

Prolonged or Prolonged or obstructed labor – use obstructed labor – use of partogramof partogram

Life Saving Skills for Life Saving Skills for mother – delivery of mother – delivery of placenta, management placenta, management of maternal of maternal hemorrhage, oral hemorrhage, oral rehydration, transfer of rehydration, transfer of carecare

Midwifery and Maternal Midwifery and Maternal MortalityMortality

Postpartum CarePostpartum Care Early identification of problems with Early identification of problems with

mother mother HemorrhageHemorrhage Infection Infection EclampsiaEclampsia

Early identification of problems with infantEarly identification of problems with infant PrematurityPrematurity Trouble breathing – needs resuscitationTrouble breathing – needs resuscitation InfectionInfection

Kangaroo Care for preterm infants

Midwifery and Maternal Mortality

Post abortion care Many legal and other barriers Training needs are great in this area Need to provide preventive services, as

well as safe abortion integrated into reproductive health services, making midwives and other skilled health workers the ideal providers.

Midwifery and Maternal Midwifery and Maternal MortalityMortality

Postpartum CarePostpartum Care Family Family

planning/child planning/child spacingspacing

Promotion of Promotion of breastfeedingbreastfeeding

So what is this telling So what is this telling us?us?

Postpartum care has been a relatively Postpartum care has been a relatively neglected aspect of maternity care. neglected aspect of maternity care.

This low level of care is disturbing, This low level of care is disturbing, since timely interventions during the since timely interventions during the postpartum period can prevent deaths postpartum period can prevent deaths of both mothers and newborn infants, of both mothers and newborn infants, and can reduce the incidence of long-and can reduce the incidence of long-term pregnancy-related morbidities term pregnancy-related morbidities

Safe MotherhoodSafe Motherhood

Safe Motherhood Initiative Safe Motherhood Initiative Launched in 1987 in Nairobi, KenyaLaunched in 1987 in Nairobi, Kenya Placed maternal health at the forefront Placed maternal health at the forefront

of the international public health of the international public health agendaagenda

Addressed the high rates of maternal Addressed the high rates of maternal mortality and morbidity related to the mortality and morbidity related to the complications of pregnancy and complications of pregnancy and childbirthchildbirth

MidwiferyMidwifery

Midwifery care is key – skilled birth Midwifery care is key – skilled birth attendants who can conduct safe, attendants who can conduct safe, clean deliveries, recognize clean deliveries, recognize complications and manage obstetric complications and manage obstetric complications (either themselves or complications (either themselves or through referral)through referral)

Trained TBAs from the communityTrained TBAs from the community Partnerships with women and Partnerships with women and

communitiescommunities

Community Mobilization• Health promotion• Referral linkages

• Support to Guides

A A communitcommunit

y y partnershipartnershi

p modelp model

LSS(Basic)

• Trainers• Referral facility staff

HBLSS• Guides

• Women, families• Home birth attendants

LSS(Advanced)• Trainers

• Referral facility staff

for saving lives

Home-Based Life Home-Based Life Saving Skills - Saving Skills -

ObjectivesObjectives Increase access to life-Increase access to life-

saving measures within saving measures within home & communityhome & community

Decrease delays in referralDecrease delays in referral

Increase use of Increase use of postpartum postpartum

& post abortion family & post abortion family planningplanning

HBLSS – Intended HBLSS – Intended AudienceAudience

Pregnant women Pregnant women & family & family caregiverscaregivers

Home birth Home birth attendants, TBAsattendants, TBAs

HBLSS - FocusHBLSS - Focus

Core Topics Introduction * Woman & baby

problems * Preventing problems Referral *

Mother Topics Too much bleeding * Sickness with pain & fever * Birth delay Pregnancy swelling & fits Too many children…………………………………

Baby Topics Trouble breathing at birth Born too small Baby falls sick *

* Topic covered

Example-- Example-- Take Action Take Action CardCard

‘Too Much Bleeding After ‘Too Much Bleeding After Birth’Birth’Problem side Action Side

HBLSS - Community HBLSS - Community MobilizationMobilization

Meetings with community leaders to discuss ways to improve the situation including transportation and support for HBLSS guides

HBLSSHBLSS

Field trials completed in Ethiopia, India Field trials completed in Ethiopia, India and Vietnam suggest that it increases and Vietnam suggest that it increases access to basic life saving care in the access to basic life saving care in the home and community, decreases delays home and community, decreases delays in women reaching referral facilities in women reaching referral facilities and supports the communities efforts and supports the communities efforts to decrease maternal and infant death.to decrease maternal and infant death.

Further evaluations are planned.Further evaluations are planned. A manual will be available soon.A manual will be available soon.

LSS - ObjectivesLSS - Objectives

Increase trained health workers Increase trained health workers skills in managing complications skills in managing complications

Increase referral facilities ability to Increase referral facilities ability to provide emergency obstetrical care.provide emergency obstetrical care.

LSS - AudienceLSS - Audience

Trained health workers in referral Trained health workers in referral facilitiesfacilities HospitalsHospitals Health centersHealth centers

LSSLSS

Competency based training program Competency based training program that equips midwives with the skills that equips midwives with the skills to intervene in the top five life to intervene in the top five life threatening maternal conditions threatening maternal conditions including obstetrical hemorrhage, including obstetrical hemorrhage, obstructed labor, obstetric sepsis, obstructed labor, obstetric sepsis, hypertensive disorders and hypertensive disorders and complications of unsafe abortion.complications of unsafe abortion.

Classroom and clinical training.Classroom and clinical training.

SummarySummary This is just a brief This is just a brief

example of some of the example of some of the efforts to improve MCH efforts to improve MCH care through midwifery – care through midwifery – there are many others there are many others working.working.

If we are to prevent If we are to prevent unnecessary maternal and unnecessary maternal and infant death anywhere in infant death anywhere in the world we must be the world we must be committed to social justice committed to social justice and the rights of women and the rights of women to safe and effective to safe and effective reproductive care. reproductive care.

Thank You

to Katherine Carr