SAVING WOMENS LIVES: ROLE OF THE MIDWIFE

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TITLE

• SAVING WOMENS LIVES ROLE OF THE MIDWIFE
• Angela Kamara
• Director
• RPMM Network - Africa

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Enhancing clinical skills (management of
obstructed labour, eclampsia, haemorrhage, sepsis
and abortion) - I

• Administration of intravenous infusion, including
  appropriate fluids for blood loss replacement
• Administration of intramuscular and intravenous
  antibiotics
• Emergency treatment of severe pre-eclampsia, to
  include sedation in severe cases
• Use of the partographs (partograms)
• Excerpt from Midwifery Ed Action for Safe
  Motherhood doc. Kobe90

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Enhancing clinical skills (management of
obstructed labour, eclampsia, haemorrhage, sepsis
and abortion) - II

• Vacuum extraction, low forceps delivery
• Perform and repair episotomy
• Repair of vaginal and cervical lacerations
• Manual removal of placenta
• Emergency evacuation of retained products of
  conception
• Excerpt from Midwifery Ed Action for Safe
  Motherhood doc. Kobe90

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PPH WHAT MIDWIVES SHOULD DO - I

• Estimate correctly the amount of blood lost from
  the genital tract after delivery.
• Manage correctly the third stage of labour
• Perform episiotomies at the right time
• Remove the placenta manually in patients with
  retained placenta

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PPH WHAT THE MIDWIVES SHOULD DO- II

• In case of PPH, perform bi-manual compression of
  the uterus, give an oxytocic, and start adequate
  resuscitative measures using blood or plasma
  expanders.
• Recognize and follow up pregnant women at high
  risk of PPH
• Prevent, diagnose and treat anaemia
• Set up emergency plans with village
  TBAs/auxiliaries to deal with postpartum
  haemorrhage cases.

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PPH WHAT THE MIDWIVES SHOULD DO- III

• Educate the community about the seriousness of
  PPH, the need for speed in referral, and risk
  factors that make PPH more likely.
• Provide family planning services for women at
  high risk of PPH.
• Supervise TBAs, discourage traditional practices
  that increase the risk of PPH and educate them on
  the need for speedy referral in case of PPH

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OBSTUCTED LABOUR WHAT MIDWIVES SHOULD DO - I

• Perform a pelvic assessment
• Use a partograph during labour
• Participate in emergency treatment of a patient
  in obstructed labour
• Educate communities about the dangers of
  prolonged labour and the need for speedy referral

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OBSTRUCTED LABOUR WHAT MIDWIVES SHOULD DO -II

• Educate women (and their families) who have had
  a caesarean section for obstructed labour about
  the reasons for the operation and what to do next
  time around
• Provide family planning services for women who
  have had a caesarean section for obstructed
  labour.

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SEPSIS WHAT MIDWIVES SHOULD DO -I

• Avoid unnecessary interference during labour and
  too frequent vaginal examinations.
• Keep strict asepsis during labour and postpartum
• Prevent prolonged and obstructed labour by use of
  the partograph
• Prevent, diagnose and treat anaemia

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SEPSIS WHAT MIDWIVES SHOULD DO - II

• Immunize pregnant women against tetanus.
• Detect early signs of sepsis such as temperature
  rise and severe afterpain
• Educate women at discharge about signs of
  infection and when to report back
• Treat women with appropriate antibiotics in case
  of prolonged rupture of membranes, prolonged
  labour and at first signs of infection

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SEPSIS WHAT MIDWIVES SHOULD DO - III

• Supervise traditional birth attendants and /or
  give feedback on referral by TBAs to improve
  practice
• Provide family planning services for women at
  high risk of puerperal infection

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ECLAMPSIA WHAT MIDWIVES SHOULD DO - I

• Monitor blood pressure (record as early as
  possible to obtain a basal level) and check for
  proteinuria at every prenatal visit
• Institute or participate in emergency treatment
  for women with severe pre-eclampsia or eclampsia,
  i.e. anticonvulsant and antihypertensive

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ECLAMPSIA WHAT MIDWIVES SHOULD DO II

• Educate families and communities about the signs
  and symptoms of pre-eclampsia and eclampsia, the
  seriousness of the condition and the need for
  prenatal monitoring of blood pressure and urine.
• Provide family planning services for women who
  have had pre-eclampsia or eclampsia

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ABORTION WHAT MIDWIVES SHOULD DO - I

• Educate women, families and the community about
  family planning and abortion
• Incorporate education on child spacing in
  prenatal, postnatal care and post abortion care
• Provide family planning services to women in the
  community or refer to the appropriate centre

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ABORTION WHAT MIDWIVES SHOULD DO II

• Perform or participate in life-saving functions
  in case of incomplete or septic abortion
• Engage in medical audit or confidential
  enquiries to find out circumstances in which
  deaths from abortion occur

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Emergency obstetric procedures at Juaben Teaching
Health Center, Juaben, Ghana, 1993-1995

• Procedure 1993 1994 1995
• Evacuation of uterus 13 15 21
• Salpingectomy 0 0 1
• Manual removal of placenta 2 11 9
• Vacuum extraction 0 10 31
• Ceasarean section 0 0 1
• Cervical cerclage 0 1 0
• Cervical tear repair 0 2 0
• Episiotomy repair 8 24 27
• Total obstetric surgery 23 63 90
• Blood transfusion 0 0 8
• Non-obstetric surgery 0 36 68

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JUABEN Data continued

• of Procedures by Midwives
• Manual removals (32)
• Vacuum Extractions (68)
• Episiotomies (98)

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Nsawam District Hospital

• 1997 1998 1999 2000 2001
• Obst. Complications 1112 829 1062 1464 1395
• Maternal deaths 17 17 17 16 15
• Case fatality rate () 1.53 2.05 1.60 1.09
  1.00