Better postpartum care saves lives

Abstract

This article discusses the role of postpartum care as well as other options for reducing health risks from pregnancy. Process indicators are identified for determining successful interventions. One-fourth of the estimated 585,000 maternal deaths result from hemorrhage; one-sixth result from infection. Other major causes are eclampsia, other hypertensive disorders, and obstructed labor. One study found that pregnancy-related morbidity ranged from 153 women per maternal death in Bangladesh to 908 per maternal death in Indonesia. In developing countries and the US, over 60% of maternal deaths occur in the postpartum period. Nearly 50% occur in the first week, and 80% occur within 2 weeks. A World Health Organization (WHO) panel of experts recommends that mothers have a postpartum check-up 3 days after delivery. Maternal mortality and morbidity decline with fewer pregnancies, increased use of contraceptives, and improved medical care during pregnancy. Health risks are greater for first pregnancies, adolescents, older women, and sometimes low-risk women in their 20s. Obstetric complications are dealt with in developed countries with improved surgical procedures, better aseptic techniques, the drug oxytocin, antibiotics, blood transfusions, and management of eclampsia. Improvements in care are not always expensive. Maternal midwives posted at the village level can improve maternal survival. Surviving complications may depend upon the time it takes to receive care. WHO identifies six process measures for determining successful interventions: availability of emergency obstetric care; geographic distribution of facilities; proportion of births in medical facilities; proportion of women with complications who are treated at medical facilities; percentage of all births by cesarean section; and case fatality rate. These indicators are essential for program management.