Interventions For Postpartum On Developing Countries

Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).

Infant deaths in the neonatal period are caused by complications arising from preterm births, birth defects, maternal health conditions, complications of labor and delivery, and lack of access to appropriate care at the time of delivery. Infant deaths in the post-neonatal period are driven by sudden unexpected infant death (SUID) (including sudden infant death syndrome [SIDS]), injury, and infection (MMRW, 2013). An increasing proportion of post-neonatal infant deaths occur among infants who were born preterm but survived the neonatal period (Callaghan, 2006). On the other hand there is lesser knowledge of the incidence and etilogy of fetal mortality which according to MacDorman et al, makes fetal mortality an overlooked public health issue. Lee et al, echoed the same idea when they said infant mortality has been the main focus of public health programming while fetal deaths have gone untargeted. However, with the decrease in infant mortality rates there have been recent approaches such as perinatal period of risk analysis framework (PPOR) that highlight the need to include fetal

Maternal mortality represents more than the loss of lives for individual women, as it also reflects the larger value and prioritization of women 's health and threatens the health and survival of families, young children, and even the communities in which they live (Royston and Armstrong, 1989). Maternal mortality is unacceptably high (WHO, 2015b). Globally, approximately 830 women die every day from pregnancy- or childbirth-related complications (ibid.). The causes of maternal mortality are predominately preventable and can be classified into three fundamental causes: (1) medical - consisting of direct medical problems and pre-existent/coexistent medical problems that are aggravated by pregnancy, (2) underlying - social and legal conditions, and (3) health systems laws and policies that address availability, accessibility, and quality of reproductive health services (PHP et al, 2011).

Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12

In 2006, data was collected on 303 babies who were diagnosed with anencephaly and were not terminated. Of those 303 babies, about 40% were born prematurely (before 37 weeks) and 4% beyond 42 weeks. Two-thirds of the mothers were either induced or had a planned cesarean section for those born at term. Polyhydramnios was present in 30% of the cases which accounted for 60% of those born prematurely. When delivered by cesarean section, 4% died during birth, 53% died within twenty-four hours, 30% lived up to five days, and 13% lived longer than six days. For vaginal births, 37% of babies died during birth when a doctor or midwife ruptured the amniotic bag, opposed to 18% if the amniotic bag ruptured naturally.

Healthy childbirth is defined as a safe, natural process that rarely requires medical intervention (Goer & Romano, 2012). The medical model of care, however, often includes interventions that are not supported by the evidence and can increase a woman’s risk of having a cesarean section. These intrusions into labor and birth often lead to what has been called the “cascade of interventions” (DeClercq, Sakala, Corry,

The fifth goal is to increase maternal health in countries with a focus on reducing the maternal mortality rate by three-fourths and universal access to reproductive health both by 2015. Despite a 43% reduction in maternal deaths since 1990, there are still a large number of women who die during childbirth from preventable causes such as hemorrhaging (United Nations, 2015, p. 38).

The stern figures of the global burden of pregnancy-related deaths are now so well known. Every year, approximately eight million women suffer pregnancy-related complications 289 000 women die due to complications in pregnancy and childbirth, and 6.6 mil¬lion children below 5 years of age die of complications in the newborn period and of common childhood diseases. Worldwide, the majority of maternal and newborns deaths occur around the time of birth, typically within the first 24 hours after childbirth. In developing countries, one woman in 16 may die due to pregnancy-related complications compared to one in 2800 in developed countries. Many of these maternal and neonatal deaths more than 80% of could be prevented or avoided through actions

According to the MDGs progress report; maternal mortality ratio stands at 16 in the developed countries, 220 in South Asia and 500 in Sub-Saharan Africa (UNDP, 2012). Lack of access to and utilization of health care services for delivery are among the main reasons for the high maternal and neonatal mortality rates in these regions (WHO, 2012). Maternal death can occur anytime in pregnancy, but delivery is by far the most dangerous time for both mother and baby (UNICEF, 2012).

You may continue to bleed for 4 to 6 weeks after delivery. The amount of blood usually decreases over time and the color of the blood usually gets lighter, although increased flow of bright red blood may reoccur if you have been too active. If you need to use more than one pad in an hour because your pad gets soaked, or if you pass a large clot:

In 2013, 289 000 women died during pregnancy and childbirth and it was estimated that everyday 800 women all over the world died from childbirth or childbirth-related problems (World Health Organization, 2014). Often, maternal mortality is found to occur more often in developing countries than developed countries. Maternal mortality refers women who died from the situation like during pregnancy, termination of pregnancy within 42 days, regardless of duration and place of pregnancy, from aggravation caused by the pregnancy or pregnancy management (Nwagha et al, 2010). Maternal mortality may be resulted from direct or indirect cause. Direct causes are from obstetric complications of pregnancy, labour, and puerperium, and interventions whereas indirect causes are from the worsening of current conditions by pregnancy or delivery (Givewell, 2009). This paper aims to examine the causes for maternal mortality in both developed and developing countries and will end with a proposal for government to ensure women are given reproductive health rights.

Of particular concern is women and maternal health in Ethiopia. According to the millennium goal developments, the fifth goal is to reduce maternal mortality rate by 75% by 2015. One reason that maternal health needs to be increased in Ethiopia is because of the large amount of women who die each year. According to Skolnik (2012), the highest maternal mortality ratios are in sub-Saharan Africa, where there are 940 maternal deaths per 100,000 live births. This means that a woman in some countries of sub-Saharan countries of Africa such as Ethiopia face 250 times the risk of dying a maternal death as does a woman in the high-income countries. (Skolnik, 2012) There are many factors that come into play when looking at maternal health. Among the first are the nutritional status and general health status of the mothers, in addition there is a link between maternal death and the level of education and income of the mother (Skolnik, 2012, p. 191). In order to help reduce the high incidence of maternal mortality rate focus should be turned to wards identifying ways to improve the access to care for women who are pregnant. I believe this issue is the important to tackle because it can improve the prenatal care that women in Ethiopia receive resulting

Pregnancy is normally the best and the happiest stage of any woman, but it can also be uncertain because anything can go wrong if you do not know exactly what to do. In order to understand the reasons of why Preterm Birth occurs, it is important to know what it is and how risky it can be. Preterm Birth is also known as Premature labor which mainly begins after “20 weeks but before 37 completed week’s gestations. Approximately 12.9 million babies worldwide are born too early every year representing an incidence of PTB of 9.6%” (Berghella, pp. 2, 8). Baby Center Medical Advisory Board says that about 12 percent of babies

The sign and symptoms of PPH include; the apparent excessive bleeding, hematocrit-reduction of the number of red blood cells, reduced blood pressure, development of symptoms of shock and anaemia, and severe pain and swelling of tissues and muscles of the vagina, vulva, pelvic and perineum (Simpson & Creehan, 2008). Besides, Ricci & Kyle (2009) avow that there are different factors that place a mother at risk for PPH, and they comprise; prolonged first, second or third stage of labour, previous history of PPH, foetal macrosomia, uterine infection, arrest of descent and multiple gestation. Other risk factors may include; mediolateral episiotomy, coagulation abnormalities, maternal hypertension, maternal exhaustion, malnutrition or anaemia, preeclampsia, precipitous birth, polyhydramnios and previous placenta previa (Ricci & Kyle, 2009).

This woman was invited to the maternity assessment unit due to spontaneous rupture of membranes. This is her first birth in this country as her other 3 children were born in India- All normal vaginal deliveries. Although, her antenatal period had been low risk, she had not had a recent enough full blood count (FBC) taken, which would put her at risk of having a low Hb level and due to her parity – she could also be at risk of a postpartum hemorrhage (Royal college of obstetricians & gynaecologists, 2009). Therefore, the decision was made to put her on delivery suite rather than in the low risk birth centre.