The postpartum period: the key to maternal mortality

“…In high-income countries, intrapartum stillbirth rates are typically less than 0·5 per 1000 total births, or about 14% of thirdtrimester stillbirths, compared with rates of 12 per 1000 total births or higher (>50% of still births) in many countries in south Asia and sub-Saharan Africa ( Birth, and the fi rst few hours and days after birth, are also times of high risk of death for women and newborn babies. This period is the key time for programmatic action to reduce third-trimester stillbirths, maternal 52 and neonatal deaths, 7 and maternal morbidity (such as obstetric fi stula), neonatal morbidity, and lifelong disability subsequent to neonatal complications.…”

Section: When Do Stillbirths Occur?mentioning

confidence: 99%

Stillbirths: Where? When? Why? How to make the data count?

et al. 2011

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for The Lancet's Stillbirths Series steering committee* Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classifi cation systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specifi c perinatal certifi cates and revised International Classifi cation of Disease codes, are needed. A simple, programme-relevant stillbirth classifi cation that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment. Why don't stillbirths count?Stillbirths are invisible in many societies and on the worldwide policy agenda, but are very real to families who experience a death. Despite 30 years of attention to child survival interventions, 1,2 more than 20 years of attention to safe motherhood, 3,4 and increasing recent attention to survival of newborn babies, 5-7 the focus worldwide has remained on survival after livebirth. Stillbirths remain mostly ignored, not counting on policy, programme, and investment agendas, both internationally and often also at the national level. 8 The importance of neonatal deaths has risen on the worldwide policy agenda, mainly because of the Millennium Development Goals (MDGs) and recognition of the increasing proportion of child deaths that happen in the fi rst month of life-from 37% in 2000 7 to 41% in 2008. 9 A baby who dies just after birth counts in the MDG tracking, but a baby who dies in the third trimester or even during labour does not. Neither the MDGs nor the Global Burden of Disease metrics mention stillbirths, and stillbirth data are not routinely compiled by the UN. Even when stillbirths are recorded in surveys, the data are frequently combined with early neonatal deaths and reported as perinatal mortality, a combination that reduces visibility and might mask reporti...

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“…Consequently, serious complications which account for two thirds of all maternal and neonatal deaths occur during the postnatal period [6]. In Malawi, 60% of the maternal deaths occur during the postpartum period, of which 70% occur during the first week and 30% within 2 weeks afer delivery [7]. To reduce these deaths, the Government of Malawi formulated a Roadmap for the Reduction of Maternal and Neonatal mortality.…”

Section: Introductionmentioning

confidence: 99%

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

Chimtembo¹,

Maluwa²,

Chimwaza³

et al. 2013

OJN

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This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region of Malawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become standalone priority sites to improve the quality of the postnatal care services rendered.

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The postpartum period: the key to maternal mortality

Cited by 253 publications

References 11 publications

Maternal mortality: a tertiary care hospital experience in Upper Egypt

Maternal mortality: a tertiary care hospital experience in Upper Egypt

Stillbirths: Where? When? Why? How to make the data count?

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

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