Lessons from the confidential enquiry into maternal deaths, Malaysia

Ravichandran, Janani; Ravindran, J

doi:10.1111/1471-0528.12944

Cited by 28 publications

(53 citation statements)

References 3 publications

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“…Review of maternal deaths in a fully functional MDSR system typically has a proper structure to coordinate MDR. For example, in Malaysia MDR committees sit at state level and are overseen by a national secretariat [18]; in RSA, provincial level coordinators receive data from facilities, coordinate assessment of deaths by provincial assessors, and liaise with the national MDR committee for quality assurance and reporting [17]; and in the UK, a collaboration of academic institutions coordinate the confidential enquiry process supported by consultant assessors appointed by the Royal Colleges [19]. …”

Section: Resultsmentioning

confidence: 99%

“…In the UK, CEMD reports provide recommendations for action at national, district and facility level, and include vignettes of stories generated through confidential enquiry which can act as powerful arguments for changing practice [19]. In Malaysia CEMD reports provide information directly to government to support budget requests to target services that needs strengthening, and service level key performance indicators integrate factors from the CEMD to ensure improvements are sustained [18]. However, CEMD reports are usually published triennially, and in high burden countries, it may not be feasible to wait this long to make changes.…”

Section: Resultsmentioning

confidence: 99%

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Implementing maternal death surveillance and response: a review of lessons from country case studies

Smith

Ameh

Roos

et al. 2017

BMC Pregnancy Childbirth

139

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BackgroundMaternal Death Surveillance and Response (MDSR) implementation is monitored globally, but not much is known about what works well, where and why in scaling up. We reviewed a series of country case studies in order to determine whether and to what extent these countries have implemented the four essential components of MDSR and identify lessons for improving implementation.MethodsA secondary analysis of ten case studies from countries at different stages of MDSR implementation, using a policy analysis framework to draw out lessons learnt and opportunities for improvement. We identify the consistent drivers of success in countries with well-established systems for MDSR, and common barriers in countries were Maternal Death Review (MDR) systems have been less successful.ResultsMDR is accepted and ongoing at subnational level in many countries, but it is not adequately institutionalised and the shift from facility based MDR to continuous MDSR that informs the wider health system still needs to be made. Our secondary analysis of country experiences highlights the need for a) social and team processes at facility level, for example the existence of a ‘no shame, no blame’ culture, and the ability to reflect on practice and manage change as a team for recommendations to be acted upon, b) health system inputs including adequate funding and reliable health information systems to enable identification and analysis of cases c) national level coordination of dissemination, and monitoring implementation of recommendations at all levels and d) mandatory notification of maternal deaths (and enforcement of this) and a professional requirement to participate in MDRs.ConclusionsCase studies from countries with established MDSR systems can provide valuable guidance on ways to set up the processes and overcome some of the barriers; but the challenge, as with many health system interventions, is to find a way to provide catalytic assistance and strengthen capacity for MDSR such that this becomes embedded in the health system.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Implementing maternal death surveillance and response: a review of lessons from country case studies

Smith

Ameh

Roos

et al. 2017

BMC Pregnancy Childbirth

139

View full text Add to dashboard Cite

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“…(13) Historically, home birthing in Malaysia was conducted by traditional birth attendants (TBAs) who learned from experience and knowledge passed down from one generation to the other. (14) These traditional birth attendants are not healthcare personnel. The government later introduced formal training to these traditional birth attendants that resulted in a dramatic reduction in maternal and infant mortality rate of the country.…”

Section: Introductionmentioning

confidence: 99%

Why women chose unassisted home birth in Malaysia: A qualitative study

Tajuddin

Suhaimi

Ramdzan

et al. 2020

Preprint

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Background: Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. Methods: Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.Results: Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and steadfast despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs.Conclusions: Women may choose unassisted home birth to express their personal views and values, at the expense of the health risks. Apart from increasing mothers' awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values.

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“…18 Historically, home birthing in Malaysia was conducted by traditional midwives who learned from experience and knowledge passed down from one generation to the other. 19 The government later introduced formal training to these traditional midwives that resulted in a dramatic reduction in maternal and infant mortality rate of the country. 19 Subsequently, all nurses in the community health clinics were trained to conduct births with a proportion of them receiving further post-basic training in midwifery.…”

Section: Introductionmentioning

confidence: 99%

“…19 The government later introduced formal training to these traditional midwives that resulted in a dramatic reduction in maternal and infant mortality rate of the country. 19 Subsequently, all nurses in the community health clinics were trained to conduct births with a proportion of them receiving further post-basic training in midwifery. A pathway for assisted home births have existed for low-risk mothers for many years.…”

Section: Introductionmentioning

confidence: 99%

Why women chose unassisted home birth in Malaysia: A qualitative study

Suhaimi¹,

Ramdzan²,

Bakar³

et al. 2019

Preprint

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Background: Reports of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child delivery facilities. We aimed to explore the reasons for women to make such decision. Methods: Twelve mothers participated in-depth interviews. They were identified using snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Results: Women in this study described a range of birthing experiences and personal beliefs to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) a natural process, iii) expressing autonomy and iv) faith, as reasons for choosing unassisted homebirth. Such decision was firm and strong despite the possible risks and complications that can occur during home birthing. Giving birth is perceived to occur naturally regardless of assistance and home birthing provide the preferred environment which health facilities may lack. Women believed that they were much in control of the birth processes apart from fulfilling the spiritual beliefs. Conclusions: Women may choose unassisted home birth to express their personal beliefs and values, at the expense of the health risks. Apart from increasing mothers’ awareness of the possible complications arising from unassisted home births, urgent efforts is needed to providing a better birth experiences in healthcare facilities that resonate with the mothers’ beliefs and values. Keywords: Home birth; free birth; unassisted home birth; Malaysia; healthcare delivery system; qualitative.

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Lessons from the confidential enquiry into maternal deaths, Malaysia

Cited by 28 publications

References 3 publications

Implementing maternal death surveillance and response: a review of lessons from country case studies

Implementing maternal death surveillance and response: a review of lessons from country case studies

Why women chose unassisted home birth in Malaysia: A qualitative study

Why women chose unassisted home birth in Malaysia: A qualitative study

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