The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirths

Abstract

BackgroundOf the global burden of 2.6 million stillbirths, around 1.2 million occur during labour i.e. are intrapartum deaths. In low-/middle-income countries, a significant proportion of women give birth at home, usually in the absence of a skilled birth attendant. This review discusses the impact of skilled birth attendance (SBA) and the provision of Emergency Obstetric Care (EOC) on stillbirths and perinatal mortality.MethodsA systematic literature search was performed on PubMed/MEDLINE, Cochrane Database and the WHO regional libraries. Data of all eligible studies were extracted into a standardized Excel sheet containing variables such as participants’ characteristics, sample size, location, setting, blinding, allocation concealment, intervention and control details and limitations. We undertook a meta-analysis of the impact of SBA on stillbirths. Given the paucity of data from randomized trials or robust quasi-experimental designs, we undertook an expert Delphi consultation to determine impact estimates of provision of Basic and Comprehensive EOC on reducing stillbirths if there would be universal coverage (99%).ResultsThe literature search yielded 871 hits. A total of 21 studies were selected for data abstraction. Our meta-analysis on community-based skilled birth attendance based on two before-after studies showed a 23% significant reduction in stillbirths (RR = 0.77; 95% CI: 0.69 – 0.85). The overall quality grade of available evidence for this intervention on stillbirths was ‘moderate’. The Delphi process supported the estimated reduction in stillbirths by skilled attendance and experts further suggested that the provision of Basic EOC had the potential to avert intrapartum stillbirths by 45% and with provision of Comprehensive EOC this could be reduced by 75%. These estimates are conservative, consistent with historical trends in maternal and perinatal mortality from both developed and developing countries, and are recommended for inclusion in the Lives Saved Tool (LiST) model.ConclusionsBoth Skilled Birth Attendance and Emergency/or Essential Obstetric Care have the potential to reduce the number of stillbirths seen globally. Further evidence is needed to be able to calculate an effect size.

Stillbirths

“…22 Screening for delivery of fetuses with fetal growth restriction, postdate status, placenta previa, and many other maternal and fetal conditions has also led to a reduction in stillbirths. 26 Better maternal nutrition, education, and overall improved health have likely had a smaller but still important role in stillbirth reduction. Because of the many interventions introduced over the years, and the many conditions they affect, the specific reductions in stillbirth associated with any specific intervention can at best be estimated.…”

“…These pregnancies are often monitored with various tests, such as contraction stress or nonstress tests, biophysical profiles, amniotic fluid volume, Doppler flow assessments, and fetal movement counting. [24][25][26] A decision to deliver is generally based on the perceived severity of the distress and the gestational age of the fetus.…”

The interconnections between maternal and newborn health – evidence and implications for policy

“…Provision of SBA also showed a significant impact on the incidence of stillbirths (OR 0.77; 95% CI: 0.69 to 0.85) [210] and perinatal deaths (OR 0.88; 95% CI: 0.82 to 0.95) [210]. A review by Darmstadt et al [211] indicates a significant impact in providing community-based skilled care attendance on perinatal (RR 0.88; 95% CI: 0.83 to 0.95) and neonatal mortality (RR 0.87; 95% CI: 0.7 to 0.97).…”

Status of Maternal Mortality in Zambia: Use of Routine Data

“…Therefore, delivery at a health facility becomes crucial for effective intervention to women during childbirth. To ensure optimal pregnancy outcomes, all women need access to skilled birth attendance, and provision of basic and emergency obstetric care (Yakoob et al 2011), this could prevent up to 33% of maternal deaths due to presence of skilled attendance at birth (Graham et al, 2001). Delivery at health facility could provide skilled personnel at delivery with an enabling environment, adequate supplies and equipment and an adequate referral system (Phiri et al, 2014;Adegoke & Broek, 2009).…”