Safe Motherhood

Some 1,400 women die every day from problems related to pregnancy and childbirth. Tens of thousands more experience complications during pregnancy, many of which are life-threatening for the women and their children - or leave them with severe disabilities.

The dangers of childbearing can be greatly reduced if a woman is healthy and well nourished before becoming pregnant, if she has a health check-up by a trained health worker at least four times during every pregnancy, and if the birth is assisted by a skilled birth attendant such as a doctor, nurse or midwife. The woman should also be checked during the 12 hours after delivery and six weeks after giving birth.

Governments have a particular responsibility to make prenatal and postnatal services available, to train health workers to assist at child-birth, and to provide special care and referral services for women who have serious problems during pregnancy and childbirth.

Most governments have ratified an international agreement, the Convention on the Elimination of All Forms of Discrimination against Women, that includes a legally binding commitment to pro-vide the services pregnant women need.

Key Messages :

What every family and community has a right to know about Safe Motherhood?

1. It is important for all families to be able to recognize the warning signs of problems during pregnancy and childbirth and to have plans and resources for getting immediate skilled help if problems arise.

2. A skilled birth attendant, such as a doctor, nurse or trained midwife, should check the woman at least four times during every pregnancy and assist at every birth.

3. All pregnant women need particularly nutritious meals and more rest than usual throughout the pregnancy.

4. Smoking, alcohol, drugs, poisons and pollutants are especially harmful to pregnant women and young children.

5. Physical abuse of women and children is a serious public health problem in many communities. Abuse during pregnancy is dangerous both to the woman and the foetus.

6. Girls who are educated, healthy and have a good diet during their childhood and teenage years will have fewer problems in pregnancy and childbirth.

7. Every woman has the right to health care, especially during pregnancy and childbirth. Health care providers should be technically competent and should treat women with respect.

Supporting Information of Safe Motherhood

1. It is important for all families to be able to recognize the warning signs of problems during pregnancy and childbirth and to have plans and resources for getting immediate skilled help if problems arise.

With any pregnancy there is a risk that something may go wrong. Most of these complications cannot be predicted. The first delivery is the most dangerous for both mother and child.

A pregnant woman needs to be checked at a clinic or health facility at least four times during every pregnancy. It is also important to seek the advice of a skilled birth attendant (such as a doctor, nurse or midwife) about where the baby should be born.

Because dangerous problems can arise without warning during pregnancy, childbirth or just after the birth, all families need to know the location of the nearest hospital or clinic and have plans and funds for quickly getting the woman there at any hour. If possible, the mother-to-be should move, temporarily, closer to a clinic or hospital so that she is within reach of medical help.

If a family knows that a birth is likely to be difficult or risky, the birth should take place in a hospital or maternity clinic. All births, especially first births, are safer in a maternity clinic or hospital.

All families need to know about special risk factors and be able to recognize the warning signs of possible problems.

Risk factors before pregnancy :

an interval of less than two years since an earlier birth

a girl is under 18 or a woman is over 35 years of age

the woman already has four or more children

the woman has had a previous premature birth or baby weighing less than 2 kilograms at birth

the woman has had a previous difficult or Caesarean birth

the woman has had a previous miscarriage or stillbirth

the woman weighs less than 38 kilograms

the woman has been through infibulation or genital cutting.

Warning signs during pregnancy:

failure to gain weight (at least 6 kilograms should be gained during pregnancy)

anaemia, paleness inside the eyelids (healthy eyelids are red or pink), very tired or easily out-of-breath

unusual swelling of legs, arms or face

the foetus moves very little or not at all.

Signs that mean get help immediately :

spotting or bleeding from the vagina during pregnancy or profuse or persistent bleeding after delivery

severe headaches or stomach-aches

severe or persistent vomiting

high fever

the water breaks before due time for delivery

convulsions

severe pain

prolonged labour.

2. A skilled birth attendant, such as a doctor, nurse or trained midwife, should check the woman at least four times during every pregnancy and assist at every birth.

Every pregnancy deserves attention, as there is always a risk of something going wrong. Many dangers can be avoided if the woman goes to a health centre or to a skilled birth attendant when she first suspects she is pregnant. She should then have at least four check-ups throughout each pregnancy and also be checked during the 12 hours following each delivery and six weeks after each birth.

If there is bleeding or abdominal pain during pregnancy or any of the warning signs listed above, a health worker or a skilled birth attendant should be consulted immediately.

Having a skilled birth attendant assist at the delivery in a health facility and check on the mother in the 12 hours after delivery reduces the likelihood of either the mother or the baby becoming ill or dying.

A skilled birth attendant (such as a doctor, nurse or trained midwife) will help ensure a safer pregnancy and healthy baby by:

checking the progress of the pregnancy so that if problems arise the woman can be moved to a hospital for the birth

checking for high blood pressure, which can be dangerous to both mother and child

checking for anaemia and providing iron/folate supplements regularly

prescribing an adequate dosage of vitamin A to protect the mother and her newborn baby against infection (in vitamin A deficient areas)

checking any infections during pregnancy, especially urinary tract infections and sexually transmitted infections, and treating them with antibiotics

giving the pregnant woman two injections to protect her and her newborn baby against tetanus

encouraging all pregnant women to use only iodized salt in food preparation, to help protect them from goitre and their children from future mental and physical disabilities

checking that the foetus is growing properly

giving antimalarial tablets, if necessary

preparing the mother for the experience of child-birth and giving advice on breastfeeding and caring for herself and her newborn

advising the pregnant woman and her family on where the birth should take place and how to get help if problems arise during childbirth or immedi-ately after delivery

advising on how to avoid sexually transmitted infections

providing voluntary and confidential HIV testing and counselling. All women have the right to voluntary and confidential HIV testing and counselling. Pregnant women or new mothers who are infected, or suspect that they may be infected, should consult a trained health worker for counselling on how to reduce the risk of infecting their infants and how to care for themselves.

During delivery, the skilled attendant knows:

when labour has gone on for too long (over 12 hours) and when a move to a hospital is necessary

when medical help is required and how to obtain it

how to reduce the risk of infection (clean hands, clean instruments and a clean delivery area)

what to do if the baby is in the wrong position

what to do if the mother is losing too much blood

when to cut the umbilical cord and how to care for it

what to do if the baby does not begin breathing right away

how to dry the baby and keep her or him warm after delivery

how to guide the baby to breastfeed immediately after delivery

how to deliver the afterbirth safely and care for the mother after the baby is born

how to put recommended drops in the baby's eyes to prevent blindness.

After delivery, the skilled attendant should:

check on the woman's health in the 12 hours after birth and six weeks after delivery

advise women on how to prevent or postpone another birth

advise women on how to avoid sexually transmitted infections such as HIV or how to reduce the risk of infecting their infants.

3. All pregnant women need particularly nutritious meals and more rest than usual throughout the pregnancy.

A pregnant woman needs the best foods available to the family: milk, fruit, vegetables, meat, fish, eggs, grains, peas and beans. All these foods are safe to eat during pregnancy.

Women will feel stronger and be healthier during pregnancy if they eat foods that are rich in iron, vitamin A and folic acid. These foods include meat, fish, eggs, green leafy vegetables, and orange or yellow fruits and vegetables. Health workers can provide pregnant women with iron tablets to prevent or treat anaemia and, in vitamin A deficient areas, an adequate dosage of vitamin A to help prevent infection. Pregnant women should not take more than 10,000 international units (IU) of vitamin A per day, or 25,000 lU per week.

Salt used should be iodized. Women who do not have enough iodine in their diet are more likely to have miscarriages and risk having an infant who is mentally or physically disabled. Goitre, a swelling at the front of the neck, is a clear sign that a woman is not getting enough iodine.

If anaemia, malaria or hookworms are suspected, the pregnant woman should consult a health worker.

4. Smoking, alcohol, drugs, poisons and pollutants are especially harmful to pregnant women and young children.

A pregnant woman can damage her own health and the health of the foetus by smoking or living in an environment where others smoke, by drinking alcohol or by using narcotic drugs. It is important not to take medicines during pregnancy unless they are absolutely necessary and prescribed by a trained health worker.

If a pregnant woman smokes, her child is likely to be born underweight and is also more likely to have coughs, colds, croup, pneumonia or other breathing problems.

To ensure the physical growth and mental development of the child, pregnant women and young children need to be protected from smoke from tobacco or cooking fires; from pesticides, herbicides and other poisons; and from pollutants such as lead, found in water transported by lead pipes, vehicle exhaust and some paints.

5. Physical abuse of women and children is a serious public health problem in many communities. Abuse during pregnancy is dangerous both to the woman and the foetus.

If a pregnant woman is abused, she and the foetus could be seriously harmed. Pregnant women who are physically abused may be unable to have any more children. Members of her family should be aware of these dangers and she should be protected from her abuser.

6. Girls who are educated, healthy and have a good diet during their childhood and teenage years will have fewer problems in pregnancy and childbirth.

Being able to read and write helps women protect their own and their family's health. Girls who have at least seven years of schooling are less likely to become pregnant during adolescence and are more likely to marry later than those with little or no education.

A nutritious diet during childhood and adolescence reduces problems in pregnancy and childbirth. A nutritious diet includes beans and other pulses, grains, green leafy vegetables, and red/yellow/orange vegetables and fruits. Whenever possible, milk or other dairy products, eggs, fish, chicken and meat should be included.

Genital cutting of girls or women can cause serious vaginal and urinary infections that can result in sterility and death. Female genital cutting can also cause dangerous complications during childbirth and mental health problems for girls and women.

7. Every woman has the right to health care, especially during pregnancy and childbirth. Health care providers should be technically competent and should treat women with respect.

If women have access to health care and professional advice during pregnancy, during delivery and after delivery, many dangers of pregnancy and childbirth can be avoided.

All women have the right to the services of a skilled birth attendant such as a doctor, nurse or midwife, and to emergency obstetric care if needed.

Quality health care enables women to make informed decisions about their health by offering information and counselling. It should be easy for women who need maternal care to reach the health facility, and cost should not prevent women from using these services. Health care providers should have the skills needed to provide quality care. They should be trained to treat all women with respect, to be sensitive to cultural norms and practices, and to respect women's right to confidentiality and privacy. n

Courtsey : "Facts for Life" Unicef, WHO, World Bank and other UN Agencies.

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