Care during childbirth

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  • Care for pregnant women differs fundamentally from most other medical endeavours. ‘Routine’ care during pregnancy and birth interferes in the lives of healthy people, and in a process which has the potential to be an important life experience. It is diffi cult to measure the extent to which our efforts may, for example, disturb the development of a confi dent, nurturing relationship between mother and baby. The harmful effects we measure in randomised trials are limited to those we have predicted may occur.

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  • A study in Herat province concludes that the extraordinarily high number of deaths of women during pregnancy and childbirth are largely preventable. They are a direct consequence of the very young marriage age for women and girls (according to UNIFEM, 54% of girls under the age of 18 are married),12 poor health and nutrition, too-frequent childbearing, and virtually no access to gynecological and obstetrical services.

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  • Imagine the plight of a young woman, some time during the thousands of years before the mid-18th century, who, soon after a diffi cult childbirth, fi nds she can no longer keep from leaking urine. She is standing in the chill winter wind, her urine-soaked clothes clinging wet against her thighs as she comforts her crying baby knowing that she faces a life of misery, shame and social ostracism. Or imagine the middle-aged wife of a tenant farmer on the remote central Illinois plain, straining with her husband to lift a heavy log that has fallen on their only milk cow only to feel a deep...

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  • The poor nutritional status of women in developing countries has been associated with maternal mortality. Maternal deaths do not result from malnutrition alone, however, but mainly from a lack of access to obstetric care and from previous conditions that may be aggravated by poor nutrition.

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  • It has been documented, for example, that high maternal pre-pregnancy weight and excessive weight gain during pregnancy are often associated with adverse pregnancy outcomes, including greater risks of gestational diabetes, childbirth complications, caesarean sections, hypertension and pre-eclampsia, and post-partum obesity. Women with severe (morbid) obesity are more likely to experience even poorer outcomes such as stillbirths or neonatal deaths.

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  • In some countries, adolescents are less likely than adults to obtain skilled care before, during and after childbirth. 8,9 WHO’s recommendations for increasing the use of skilled antenatal, childbirth and postpartum care are informed by one graded study, one ungraded study, existing WHO guidelines and the collective experience and judgment of a panel of experts. The studies were conducted in Chile and India. One intervention was a home visit programme for adolescent mothers. Another was a cash transfer scheme contingent upon health facility births.

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  • This  interagency  list  is  a  tool  to  support planning  for  the  selection,  quality  assurance  and  procurement  of medical  devices  to  implement  the Maternal  and Newborn Health  (MNH)  interventions, which are defined as the “Essential care to women and their newborn during  pregnancy, childbirth and postnatal period: up to six weeks after delivery.

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  • Midwives and the care they provide to women, babies and families are of the utmost importance to society. Across the United Kingdom midwives are key professionals in ensuring that women have a safe and emotionally satisfying experience during their pregnancy, childbirth and postnatal period. The coming decade will present new challenges and opportunities for midwives to develop further their role as practitioners, partners and leaders in delivering and shaping maternity services.

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  • Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries, killing over half a million women in 2000 and causing disability and suffering among many millions more. In 2000, half of these deaths (251 000) occurred in Africa, about 48% (253 000) occurred in Asia, about 4% (22 000) in Latin America and the Caribbean, and less than 1% (2 500) in the more developed regions of the world. Universal access to reproductive health care, including family planning, is the starting point for maternal health.

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  • In developing countries, a mother’s death in childbirth means that her newborn will almost certainly die and that her older children are more likely to suffer from disease.Moreover, when mothers are malnourished, ill, or receive inade- quate care, their newborns face a higher risk of disease and premature death. 9 Almost one-quar- ter of newborns in developing countries are born low birth weight, largely due to their mothers’ poor health and nutritional status, which results in increased vulnerability to infection and a high- er risk of developmental problems.

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