Preparing to give birth - A choice for women

HealthcareMaternal Healthcare

A community health volunteer (pictured left) in Mugu, the poorest and most remote district in Nepal. Photo: Kaj Jensen/UMN
A community health volunteer (pictured left) in Mugu, the poorest and most remote district in Nepal. Photo: Kaj Jensen/UMN

Goal 5 Improve maternal health

by Dr Maureen Dar Iang.

In some countries in the world, women can choose how and where they would like to give birth. Different kinds of care are available. Often women can choose whether to give birth in a hospital or at home.

However, the situation is very different in other countries where women are more likely to die in childbirth and choices are limited. The most effective strategy to save mothers' and babies' lives is for each woman to have:

  • a well-prepared birth plan
  • access to emergency obstetric care services for complications.

The main factors responsible for maternal deaths are the three 'delays':

  • delay in deciding to seek care
  • delay in reaching care
  • delay in receiving care at the health facility.

These delays are caused by many factors including:

  • a lack of money
  • inaccessible and poor-quality health care services
  • inadequate community and family awareness about maternal and newborn issues
  • the low status of women.

Many women give birth at home assisted by family members or traditional birth attendants (TBAs). TBAs lack formal training and in the past many programmes have focused on improving their skills. Such programmes can be very effective.

However, experts around the world now think that skilled birth attendants are better at preventing maternal deaths than TBAs. A skilled birth attendant is an accredited health professional - such as a midwife, doctor or nurse - who has been educated and trained to proficiency in the skills needed to manage:

  • normal, uncomplicated pregnancies
  • childbirth
  • the immediate postnatal period.

Skilled birth attendants also know how to identify complications in women and newborns. They are then able to work out whether they can look after the woman themselves or if they need to find help from someone else. This means that the proportion of births overseen by skilled attendants has become one of the indicators for achieving the Millennium Development Goal. However, skilled attendants are still far from the reach of many women.

A well-prepared birth plan includes purposeful advance preparation and decision-making by pregnant women and their families. The plan should help them to prepare for a normal birth and be ready to deal effectively with potential complications. Ideally it should include:

  • routine care during pregnancy
  • attending antenatal care at least four times during pregnancy
  • identifying a skilled attendant and making a plan to reach her (or him) during labour
  • saving funds to cover the cost of travelling and giving birth with a skilled attendant
  • recognising signs of complications
  • being aware of community resources
  • a plan for emergencies including emergency transport, communication and identifying blood donors.

In Nepal, the national safe motherhood plan promotes birth preparedness. Female community health volunteers - village women who are willing to give time to help improve the health of their community - are very important for the success of the plan. They visit pregnant women and women who have recently delivered and provide one-to-one health education, counselling and advice needed for care during pregnancy, childbirth and following delivery. They also encourage and support women and their families in preparing for the birth. This allows women to choose where to give birth. It also creates an opportunity to integrate a number of life-saving community-based health care interventions for mothers and newborn children. These include prevention of bleeding following a delivery and prevention of umbilical cord infection. This approach has been tested in different areas and has been successful. It is now being used nationwide.

A pregnant woman and her family's preparation for birth would not be successful without support from various groups of people with an interest in safe motherhood, including policy makers, service providers and communities. We need to coordinate our efforts to improve the following factors to reduce the three delays and save the lives of pregnant women and their babies.

Factors affecting maternal mortality

  • the empowerment of women and gender equality, as the status of a woman in a family and society is strongly related to her ability to make decisions about her own health care (see Goal 3)
  • availability and accessibility of good quality obstetric care where service providers are competent and sympathetic to a woman's and her family's needs
  • availability of means of communication
  • local transport options including road networks and bridges, ambulances and bicycle / tricycle ambulances
  • women and their families' awareness of maternal and newborn health issues and ability to recognise the signs of complications
  • community support to women and their families in times of emergency.

Saving women’s lives from pregnancy related complications needs commitments at all levels of society, from policy makers to the community. Encouraging each pregnant woman and her family to have a well-prepared plan that will assist her to have a successful birth and a healthy baby should be a commitment for all of us who are working with and for the community.

Dr Maureen Dar Iang is the Health Team Leader for United Mission to Nepal.

United Mission to Nepal
PO Box 126

Deliveries attended by skilled birth attendants

5.8% in Ethiopia (2005)
22.8% in Nepal (2006)
46.6% in India (2005–06)
99% in Jordan (2007)

Discussion questions

  • How do women prepare for birth in our community?
  • Where are the nearest skilled attendants?
  • How can we lower the risks for women and newborns in our community?