Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
CHAPTER 3: Maternal Care to Improve
Maternal and Newborn Survival
The fetus’ growth and development depend on the health of the mother. The mother’s body
provides nutrition, rest, oxygen, and protection to the fetus. A healthy woman, who receives
good antenatal care, has a much greater chance of giving birth to a healthy, term baby and of
surviving pregnancy and childbirth.
The goals of antenatal care are as follows:
• To promote and maintain the physical, mental, and social health of the mother and baby
by providing education on nutrition, personal hygiene, and the birthing process.
• To detect and manage complications during pregnancy, whether medical, surgical, or
obstetrical.
• To develop a birth-preparedness and complication-readiness plan.
• To help prepare the mother to breastfeed successfully, experience normal puerperium
(the period from 4-6 weeks after delivery), and take good care of the child physically,
psychologically, and socially.
EVERY PREGNANCY IS “AT RISK”
In the past, health services used a risk system to identify “high risk” pregnancies so that these
women could be referred to specialized care centers. A “risk factor” is anything that increases a
person's chances of developing a disease or a complication. Risk factors may be associated
with but do not necessarily cause a particular disease or complication. In addition, persons
without the risk factor can also develop the disease or complication.
More than 10 years of experience with the risk factor approach have shown us that it has many
limitations, including:
• So-called “risk factors” cannot predict complications because they are usually not the
direct cause of the complication; for example, although young age can be associated
with eclampsia, it does not always cause eclampsia. Women in older age groups can
also develop eclampsia.
• Because maternal mortality is a relatively rare event in the population at risk, i.e., all
women of reproductive age, and because the so-called “risk factors” are relatively
common in the same population, these “risk factors” are not good indicators to identify
women who actually do experience complications.
• The majority of women who actually did experience a complication were considered “low
risk,” while the majority of the women (90 percent) considered to be “high risk” gave birth
without experiencing a complication.
What can be done, then? The literature strongly suggests that:
• All health care providers and families understand that “normal pregnancy” and “normal
birth” are retrospective diagnoses and can only be made at the end of pregnancy and
childbirth.
• All pregnancies be regarded as potentially at risk and managed with the utmost care.
Integrated maternal and newborn care
Basic skills course
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