Birth Preparedness and Complication readiness

Case Scenario

“In a rural area of Nepal, a woman is due to childbirth and she lives almost 5-6 hours far from the health care center. She belongs to low middle income socio-economic class. she is not aware of danger signs of pregnancy. Her family members think that childbirth is simply a natural process of giving birth and there is no necessity of special precaution because they gave birth to their children at home without anyone’s attendance from generation to generation. They know there is ambulance service but they don’t know the contact details of the ambulance service. The woman, her husband and other family members are not aware of any danger signs of childbirth. She starts getting contraction and pain but her mother in law is very sure that she delivers baby without any events. Her labor progresses, but instead of head, the cord prolapses. The outcome is yet unknown”

In above scenario, what are the conditions that can lead to adverse events of maternal and child morbidities, deaths?

1.  She is not institutionalized for the childbirth.
2.  They don’t have enough money saved for childbirth
3. They don’t have vehicle even if they want to take her to health care center in case of   emergency. She might reach the health center after golden hours.
4. They even don’t know when should they be contacting health care workers
5. They haven’t identified the people, who can donate blood if needed
6. They will take very long time to identify the complications, arrange money, vehicles and to decide which health center, they will be going.

What could have done to make sure healthy childbirth?

1. Birth Preparedness and complication readiness!!: definitely an answer among many others.

What is Birth Preparedness and complication readiness?

Whenever we study measures that effectively helped to reduce maternal mortalities and neonatal mortalities, we encounter the phrase ‘birth preparedness and complication readiness’. Birth preparedness package is simply a set of planning strategies that better assist the process of giving birth to a child to make child bearing process safe, appropriate, affordable, and accessible. Though birth preparedness is equally important to everyone, this concept is much more relevant and emergent for the developing world, where the childbirth is taken for granted and maternal death and newborn death during the child bearing process are high. It is proactive step to preclude maternal and newborn complications and mortalities. This strategy includes preparation of family, who are expecting child with counseling for preparing anticipated funds for delivery of baby, vehicles for transportation, probable hospital and health care providers, warm clothes for both baby and mother, blood donors in case of need, educational materials regarding danger signs of pregnancy, childbirth and postpartum period. In a birth preparedness package, counselling and educational materials are provided to the couple and family informing all the preparation.

How it impacts?

It helps in tackling three delays, identified to be main causes of maternal and newborn deaths. Birth preparedness obviates delay in seeking, delay in reaching and delay in receiving the care at the time of birth. For example, in the aforementioned case scenario, there is a high possibility that the family members would take a longer time to identify that the prolapse of cord is a danger sign of the childbirth that may cost child’s life and even if they identify the danger signs, they will take longer time to arrange money, vehicle or if they don’t have any transportation facilities, it will take even days to reach health care facility and health care providers. These delays may cause mother’s morbid conditions, death, and fetal death.

A woman or a family is considered to be prepared for birth and tackling tentative complications if they arrange estimated money, identify blood donors, transportation mechanism, know danger signs of pregnancy, childbirth and postpartum, identify health care providers and health care center.

Promoting Birth Preparedness and complication readiness is one of the three major strategies of safe motherhood and newborn health program of Nepal, others being Aama Surakshya Program and expansion of 24-hour emergency obstetric care services at public health facilities. These strategies have been successful in decreasing the maternal mortality rate of Nepal.