Safe maternal and newborn care

Dr L Dipenty *

Every pregnant woman hopes for a healthy baby and an uncomplicated pregnancy. However 800 women and 7700 newborns still die each day from preventable complications related to pregnancy and childbirth and in the postnatal period with an additional 7300 women experiencing a stillbirth. If the current trend continues, 48 million children under the age of 5 are projected to die between 2020 and 2030, half of them newborns.

Recognizing the significant harm and burden women and newborns are predisposed to due to the unsafe care, added by the current disruption in health services by the COVID-19 pandemic, WHO introduced the theme “Safe maternal and newborn care” for this year’s World Patient Safety Day.

Objectives of World Patient Safety Day

Raise awareness on the issues of maternal and newborn safety globally, particularly during childbirth. Engage multiple stakeholders and adopt effective and innovative strategies to improve maternal and newborn safety.

Call for urgent and sustainable actions by all stakeholders to scale up efforts, reach the unreached and ensure safe maternal and newborn care, particularly during childbirth. Encourage development of systems and procedures for the elimination of all avoidable health care related harm to patients and management of risks in health care.

The well-being of women and newborns determine the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. The outcome of the care for women and newborns around the time of birth in health facilities reflects the evidence-based practices used and the overall quality of services provided.

The quality of care depends on the physical infrastructure, human resources, knowledge, skills and capacity to deal with both normal pregnancies and complications that require prompt, life-saving interventions. Improving the quality of care in health facilities is thus increasingly recognized as an important focus in the quest to end preventable mortality and morbidity among mothers and newborns.

What every family and community should know !

Education and nutritious diet provided to girls throughout their childhood and teenage year increases the likelihood of having healthy babies and also go through pregnancy and childbirth safely if childbearing begins after they are 18 years old.

The risks associated with childbearing for the mother and her baby can be greatly reduced if a woman is healthy and well-nourished before becoming pregnant. During pregnancy and while breastfeeding, all women need more nutritious meals, increased quantities of food, more rest than usual, iron-folic acid or multiple micronutrient supplements, even if they are consuming fortified foods, and iodized salt to ensure the proper mental development of their babies.

Every pregnancy is special. All pregnant women need at least four prenatal care visits to help ensure a safe and healthy pregnancy. Pregnant women and their families need to be able to recognize the signs of labour and the warning signs of pregnancy complications. They need to have plans and resources for obtaining skilled care for the birth and immediate help if problems arise.

Childbirth is the most critical period for the mother and her baby. Every pregnant woman must have a skilled birth attendant, such as a midwife, doctor or nurse, assisting her during childbirth, and she must also have timely access to specialized care if complications should occur.

Post-natal care for the mother and child reduces the risk of complications and supports mothers and fathers or other caregivers to help their new baby get a healthy start in life. The mother and child should be checked regularly during the first 24 hours after childbirth, in the first week, and again six weeks after birth. If there are complications, more frequent checkups are necessary.

A healthy mother, a safe birth, essential newborn care and attention, a loving family and a clean home environment contribute greatly to newborn health and survival. Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to pregnant women, the developing fetus, babies and young children.

Violence against women is a serious public health problem in most communities. When a woman is pregnant, violence is very dangerous to both the woman and her pregnancy. It increases the risk of miscarriage, premature labour and having a low-birth weight baby.

In the workplace, pregnant women and mothers should be protected from discrimination and exposure to health risks and granted time to breastfeed or express breast milk. They should be entitled to maternity leave, employment protection, and medical benefits and, where applicable, cash support.

Every woman has the right to quality health care, especially a pregnant woman or a new mother. Health workers should be technically competent and sensitive to cultural practices and should treat all women, including adolescent girls, with respect.

The Government of India, the WHO and other organizations have launched several health programs to reduce maternal and perinatal deaths. The programs include
1) Safe Motherhood Initiatives
2) Maternal and Child Health (MCH) services including Child Survival and Safe Motherhood (CSSM) program, Reproductive and Child Health (RCH) program and National Rural Health Mission ( NRHM).
3) New initiatives including Janani Suraksha Yojana, Vande Mataram Scheme and training of doctors in emergency obstetric care.

The most common direct causes of maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe abortion, and obstructed labour, as well as indirect causes such as anemia, malaria, and heart disease. A total of 80% of maternal deaths are preventable.

Maternal deaths have declined slowly and steadily in the past few years. The reasons include:
1) Increase in skilled attendants and hospital deliveries,
2) Country led health plans,
3) Better antenatal and intrapartum care,
4) Safe abortion,
5) Use of antibiotics and
6) Training in emergency obstetric care

Similarly various strategies to reduce perinatal deaths consist of:
1) Prenatal nutrition,
2) Improving antenatal care,
3) Delivery by skilled birth attendants,
4) Training of traditional birth attendants (TBAs) in newborn care and
5) Socioeconomic development and education.

Simply surviving pregnancy and childbirth can never be the marker of successful maternal health care. Ending the preventable maternal deaths must remain at the top of the global agenda. It is therefore, critical to expand efforts reducing maternal injury and disability to promote health and well-being.

Every pregnancy and birth is unique. Addressing inequalities that affect health outcomes, especially sexual and reproductive health and rights and gender, is fundamental to ensuring all women have access to respectful and high-quality maternity care.

OPD Timing:

8 am to 11 am (Shija Hospitals) & 11:30 am to 1:30 pm (Tues, Thurs & Fri – Shija Urban OPD, Keishampat)