Labour and Delivery Care Module: Introduction

Introduction to the Labour and Delivery Care Module

The World Health Organization (WHO) states that every year more than 133 million babies are born globally, of which 90% are in low- and middle-income countries. Every year, almost 8 million children die before their fifth birthday, but the great majority of these deaths occur in the perinatal period (i.e. around the time of birth). Global perinatal mortality is estimated to be about 7 million deaths every year (3.5 million stillbirths and 3.5 million deaths in the first7 days). This death toll is more than the combined annual deaths globally due to HIV/AIDS(2.1 million), tuberculosis (1.6 million) and malaria (1.3 million), which together add up to 5 million lives lost. Almost one quarter of the 7 million perinatal deaths occur during labour and delivery. The causes of perinatal and maternal deaths in developing countries are almost similar (haemorrhage, hypertensive disorders of pregnancy, eclampsia, infection and obstructed labour).

The lives of many women in labour and delivery and their babies could be saved in less developed countries if births were attended by well-trained health professionals. Globally, the proportion of births attended by a skilled birth attendant in less developed countries increased from about 50% in 1990 to 60% in 2006. The global targets set at a special session of the United Nations General Assembly in 1999 were 80% by 2005, 85% by 2010 and 90% by 2015. This shows that the achievement was far below the target and there is a great need for further endeavour. To be specific, regions with the lowest proportions of skilled-birth-attended deliveries were eastern Africa (34%), western Africa (41%) and south-central Asia (47%). It is also in these regions where the highest numbers of maternal and perinatal deaths occur.

In Ethiopia there is some progress in antenatal care coverage, but the labour and delivery service may be the lowest in the world: more than 94% of pregnant women labour and deliver at home, unattended by skilled healthcare personnel. Probably that is why more than 10,000 Ethiopian women are suffering at home from one of the morbid complications of obstructed labour (fistula, an opening between the birth canal and other internal organs), and the maternity wing of almost all public hospitals outside Addis Ababa are filled by women with complications due to obstructed labour. An estimated 22,000 women die in Ethiopia every year from a cause associated with their pregnancy or childbirth.

Many of the common causes of maternal and perinatal mortality, including obstructed labour, eclampsia and postpartum haemorrhage, are of an unpredictable nature. Therefore it is the presence of skilled personnel intervening during an emergency in labour and delivery that brings significant change in maternal and child health outcomes. Taking this into account, the current recommendation is that every labouring mother should be attended by a skilled person either at a health facility or at home. The aim is to conduct a normal delivery for the majority, and early detection and referral for those women and babies who develop complications.

This Labour and Delivery Care Module is formulated to equip you with the basic principles and practice of skilled birth attendance at Health Post and home level. It has 11 study sessions. You will first learn in detail how to identify true labour, the different stages of labour, the preparations and skills for conducting a normal delivery and supporting the mother through the four stages, and techniques for monitoring the progress of labour using a chart called the partograph. The second half of the Module introduces you to the basic techniques of newborn resuscitation, identifying and managing malpresentations and twin births during labour, and the diagnosis and emergency interventions in obstructed labour, uterine rupture and postpartum haemorrhage. All of the principles and techniques taught in this Module will be reinforced and expanded in your practical skills training. Blending the theory and practice of labour and delivery care will enable you to support the health and the survival of labouring women and newborns in your community.

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