Direct maternal deaths

This chapter discusses direct causes of maternal death, which account for nearly three quarters of maternal deaths worldwide. These deaths occur disproportionately in low-resource settings and are largely due to obstetric complications. It is therefore possible to significantly reduce these deaths. We discuss the five most important causes: postpartum haemorrhage, abortion-related deaths, hypertensive disorders, sepsis, and obstructed labour. The three delays in deciding, reaching, and receiving adequate care are then used to consider the broad areas to address to reduce direct maternal deaths. Possible strategies which could be implemented to reduce preventable direct maternal deaths such as implementing women’s groups and skills training are discussed. Finally, we highlight some of the challenges surrounding reducing direct deaths, including difficulties in measurement and increasing skilled attendance at birth. To overcome these challenges and prevent direct maternal deaths, comprehensive strategies addressing both community and health systems issues need to be employed.

Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study

Background. In Ethiopia, majority (62%) of pregnant women receive at least one antenatal follow-up, yet only 26% give birth in health facility. Understanding factors underlying this high uptake of antenatal care and low institutional delivery service is critical. Women had antenatal care follow-up means; by default they have access to health facilities. Thus, why do some give birth at home even after receiving antenatal care? Methods. Fourteen key informant interviews and six focused group discussions were held among purposively selected women who gave birth in the last 12 months without skilled attendance after receiving antenatal care. The study explored women’s perspectives on maternity care, care providers, and factors that influence place of delivery. Interpretative phenomenological analysis was used to examine various behaviors and beliefs of respondents. Results. Study participants described range of experiences and beliefs that made them give birth at home after receiving antenatal care at health facilities. Four themes emerged from women’s description: poor counseling during antenatal care service, traditions, early pregnancy symptoms, and lack of planning in advance for childbirth. Conclusion. Poor counseling during antenatal care is deterring women from seeking skilled attendance at birth. Thus, healthcare providers need to stress necessity of facility based delivery care during antenatal follow-up counseling.

Experience of Facility Based Childbirth in Rural Ethiopia: An Exploratory Study of Women’s Perspective

Background. In Ethiopia, majority (62%) of pregnant women attend antenatal care at least once, yet only 26% deliver with skilled birth attendants in the available health units. Thus, this study explored beliefs and behaviors related to labour and skilled attendance among the women, their perspectives on health care providers, and traditional birth attendants. Methods. Sixteen key informant interviews and eight focus group discussions were conducted among purposively selected women who had previous experience of facility based childbirth but gave birth to their most recent child without skilled attendance in the last 12 months. Thematic content analysis was used to elicit and assess the various perspectives of each group of participants interviewed. Findings. The study participants described a range of experiences they had during childbirth at health facilities that forced them to choose home delivery in their most recent delivery. Three themes and six subthemes emerging from women’s description were abusive and disrespectful treatment, unskilled care, poor client provider interaction, noncontinuous care, lack of privacy, and traditional practices. Conclusion. The abuse and disrespect from providers are deterring women from seeking skilled attendance at birth. Thus the health care providers need to improve client provider relationships.

Early Pregnancy Termination with Oral Mifepristone and Vaginal Misoprostol

Objective: To determine the efficacy, side effect and acceptability of medical abortion using mifepristone 200mg orally and misoprostol 800?g vaginally in patients less than 49 days of gestation.Materials and methods: Seventy six women who requested termination of pregnancy up to 49 days of gestation were administered 200mg mifepristone orally followed 48 hours later by 800?g of misoprostol per vaginally.Results: Ninty six percent (96%) women had complete abortion with this regimen. There was no ongoing pregnancy. The average duration of per vaginal bleeding was 12-13 days. There were some side effects, which include abdominal pain, vomiting, fever etc.Conclusion: This mifepristone-misoprostol regimen is highly effective in terminating pregnancy in women up to 49 days duration with minimum side effects and this medical method may be advisable to practice as an alternative to surgical procedure where adequate skilled attendance is lacking.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 44-49