Essentials of Safe motherhood

How can we make motherhood safer? 

This is actually food for thought if you are determined to contribute in making motherhood safer or if you are working in such field. A mother will give birth to a healthy child without adverse events, if the mother herself is healthy. 

Pillars of safe motherhood: 

Motherhood can be made safe when some interventions are carried out. These are termed as pillars of safe motherhood. These pillars are essentials to achieve safe motherhood. Safe motherhood is founded on those elements. The pillars that supports safe motherhood are 1. family planning 2. Antenatal care 3. obstetric care 4. Post natal care 5. Abortion care 6. STD/HIV control. This can be achieved when women’s basic rights are granted and when primary health care is available for everyone. 

Figure 1: Pillars of Safe motherhood

First of all let’s glance into a story, there was a girl named Rita in a rural area of Nepal. Her parents were only literate. They didn’t have knowledge of healthy behavior, nutrition. She already had few other siblings. She was wasted. Her mother served them with staples whatever they had, mainly carbohydrates. They used to harvest black gram but they traded it for rice. They could have served that pulse but they weren’t aware of its importance. They just thought their children shouldn’t be hungry. When Rita reached the age of seventeen, they married their daughter with a young boy from neighborhood. Rita became pregnant within one year. She had short stature, She was very thin, and anemic. They had a sub-health post nearby but the in-charge was unavailable most of the time and they didn’t know they had to go to health center regularly for checkups during pregnancy. After some months she went in labor pain and she suffered prolonged labor, as they weren’t prepared to take her any health center, they just waited at home. Finally a baby boy was borne, who had low birth weight. However, she had post partum hemorrhage and she was hurried to the district hospital. It was very late. Nonetheless, the hospital had good provision of blood transfusion and the Red Cross had adequate blood of her group. At least they saved her life with proper management.

A house will be strong, if its foundation is solid, and if the bricks we add one after another are strong enough. A seed has to be planted in fertile land and when the seed sprouts, we need to water it and add the manure to make it strong and healthy and it will produce healthy seeds in the future. In the aforementioned scenario, there are many pit falls and the girl suffers a lot and she gives birth to a low birth weight child putting at more risk of infection. she got teenage marriage and subsequent pregnancy because of her family and the community, she couldn't have antenatal care because of her own ignorance, unavailability of health care providers. It was her good luck she survived the childbirth because of emergency obstetric care. Nonetheless her health and health of the baby is still at risk due to lack of continuum of care.

What is Continuum of care? 

The concept of continuum of care is an approach to integrate the care that a woman should receive to have safe motherhood or safe childbirth. The "Continuum of Care" for reproductive, maternal, newborn and child health (RMNCH) includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood. Families and communities, outpatient services, clinics and other health facilities, should provide such care. The Continuum of Care is very important for the health of the both women and the newborn child. 

There are two dimensions of continuum of care: 

1. Stages of the life cycle (Time): In simple language this is continuous care that a woman should get in her lifetime at every stage of life from her own family, community and health facilities.
 

Adolescence and Pre-pregnancy: Lets start with adolescence; adolescence is the stage at which boys and girls develop secondary sexual characteristics and is an important phase to establish healthy behavior. Adolescents should get all the information about reproductive health including contraceptives, conception, and sexual education, sexually transmitted diseases. They need to have proper nutrition for their proper development and maturity. They need to be well equipped with everything to be ready to be pregnant. They should be well informed about healthy behavior, childcare, child bearing, health care centers. They should be ready economically. They need to have good support system. 

Pregnancy: when a woman is pregnant, she needs to have support from her family, health care centers. Adequate and appropriate antenatal care from the health center and adequate nutrition supplementation, rest, birth preparedness are required during pregnancy. Birth: the current safe motherhood policy encourages institutional delivery by skilled birth attendants. Transportation facilities from home to health center, skilled health workers, blood transfusion services, facilities for complicated pregnancy, everything should be in place to ensure uneventful birth. This should be provisioned for every pregnant woman. 

Post natal period of mother: Adequate care should be provided during post natal phase of the mother so that she could take care of the baby and the family as a whole. Information and counseling about he contraceptives is equally important to women and her family.

Like wise care during neonatal period, infancy and childhood is very crucial as these are directly linked with future stages of life.

2. Places where the care is provided:

With respect to the place-of-care dimension of the continuum, MNCH interventions can be delivered:

• at a household and in a community – community level/home services;
• through outreach from first-level facilities (includes immunization, antenatal, postnatal care delivered from/at village health posts) – first level/outreach services;
• at district hospital or referral hospitals – referral level services (includes diagnostics, treatment, care, counseling and rehabilitation).

 
There should be continuity of care at different place linking the various levels of home, community, and health facilities.  Linking interventions in this way is important because it can reduce costs by allowing greater efficiency, increase uptake and provide opportunities for promoting related healthcare elements (e.g. postpartum/postnatal and newborn care).

RMNCH continuum of Care showing the stages and places to link to achieve safe motherhood.