Emergency Obstetric Care

Midwife listening to baby's heartbeat through a fetoscope, Cambodia

A care package required to treat complications that arise from pregnancy and childbirth is collectively known as Emergency Obstetric Care (EmOC). Basic EmOC includes parenteral administration of parenteral antibiotics, uterotonic drugs and parenteral anticonvulsants, manual removal of placenta, removal of retained products, performance of assisted vaginal delivery and neonatal resuscitation. At a higher level of care, Comprehensive EmOC includes all Basic EmOC interventions, blood transfusion and caesarean section services (World Health Organization 2009).

Emergency Obstetric Care is an evidence-based care package designed to save lives and reduce preventable maternal and neonatal mortality and morbidity and stillbirths. However, studies show that in many low- and middle-income settings Emergency Obstetric Care is not available or only in part, distribution of health facilities able to provide Emergency Obsteric Care is geographically inequitable and the quality of Emergency Obstetric Care is often sub-standard.     

CMNH carried out multi-country assessments to map out which cadres of healthcare providers are expected to provide Skilled Birth Attendance and/or Emergency Obsetric and Early Newborn Care.

In the last strategic period (2012-2017), CMNH developed and evaluated the effectiveness of a short ‘skills and drills’ training package in Emergency Obstetric Care and Early Newborn Care (EmOC&NC) aimed at building the capacity of these healthcare providers. EmOC&NC ‘skills and drills’ training results in significant improvements in knowledge and skills of healthacre providers, improved team work and organisation of care. Before and after comparison demonstrates that at healthcare facility level there is an increase in availability of Emergency Obsteric Care signal functions with reduced maternal case fatality rates and stillbirths.

Between 2012 and 2017, EmOC&NC training was introduced, adopted and scaled up across 17 countries in Sub-Saharan Africa and Asia. The EmOC&NC training package includes participant and facilitator manuals, equipment and mannequins and instruction for these, quality asurance tools and a franchising model. Skills laboratories and guidelines for these have also been developed and are supported by CMNH.

 

Skilled Birth Attendance
“A skilled birth attendant is 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.” (WHO, ICM and FIGO, 2004)

Skilled attendance at birth is the first of three coverage indicators used to assess progress against the SDG targets for maternal and newborn health. Skilled birth attendance has two key components - a skilled attendant and an enabling environment. The term skilled attendant refers to 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) pregnancy, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns. The enabling environment is less clearly defined, but equipment, supplies, drugs, transport, referral, regulatory frameworks and policies are cited as components.

Latest estimates show that globally 73% of births are attended by skilled health personnel; this ranges from 54% in the African Region to 99% in the European region. Despite the heavy reliance on the proportion of births attended by a skilled attendant as the key indicator for measuring progress towards the achievement of MDG 5, there is little consistency in how this is monitored and evaluated in the various country settings.  

The State of the World’s Midwifery 2014 defines midwifery asthe health services and health workforce needed to support and care for women and babies, including sexual and reproductive health and especially pregnancy, labour and postnatal care. This includes a full package of sexual and reproductive health services, including preventing mother-to child transmission of HIV, preventing and treating sexually transmitted infections and HIV, preventing unwanted pregnancy, dealing with the consequences of unsafe abortion and providing safe abortion in circumstances where it is not against the law”. This definition is wider than, for example, the Medical Subject Headings definition, introduced in 1966, which simplifies midwifery to “the practice of assisting women in childbirth”.

The majority of low- and middle-income countries are endeavouring to expand and deliver equitable midwifery services, but  comprehensive, disaggregated data for determining the availability, accessibility, acceptability and quality of skilled birth attendance and/or midwifery are generally not available.