Standards for Maternal and Neonatal Care


Resource: Dr. Karim Abawi karim.abawi@gfmer.org.From Research to Practice:Training in Sexual and Reproductive Health Research 2015.
 What is the purpose of the Standards for Maternal and Neonatal Care?
The purpose of the Standards for Maternal and Neonatal Care is to assist programme managers and health care providers to:
• Develop evidence-based national and sub-national standards for maternal and neonatal health care.
• Introduce standards setting and a quality improvement process at facility level.
• Provide quality and effective maternal and neonatal health services.
• Use existing resources to achieve the optimal health care outcomes; and improve individuals’, families’ and community’s satisfaction and utilization of maternal and neonatal health services.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research. Standards for maternal and neonatal care. World Health Organization; 2007.
7. Provision of effective antenatal care
Many maternal and perinatal deaths occur in women who have received
no ANC.
• Globally true progress has been made in terms of increasing access and
use of ANC. A recent study on antenatal care estimated that worldwide
only 70% of women ever receive any ANC, whereas in industrialized
countries more than 95% of pregnant women receive ANC.
• There are still disparities in the proportion of antenatal coverage between
developing and developed countries.
• Epidemiological studies have demonstrated the benefits of ANC in
reducing maternal and perinatal complications, although the exact
components and timing of such ANC has been difficult to demonstrate.
. Abou – Zahr CL, Wardlaw, TM. Antenatal Care in Developing Countries: Promises, Achievements and Missed Opportunities; an Analysis of Trends, Levels and Differentials, 1990 – 2001. Geneva: World Health Organization; 2003.
7. Provision of effective antenatal care
Standard
• All pregnant women should have at least four antenatal care (ANC) assessments
by or under the supervision of a skilled attendant.
• These should, as a minimum, include all the interventions outlined in the new WHO
antenatal care model and be spaced at regular intervals throughout pregnancy,
commencing as early as possible in the first trimester.
Aim
• To prevent, alleviate or treat/manage health problems/diseases (including those
directly related to pregnancy) that are known to have an unfavourable outcome on
pregnancy.
• To provide women and their families/partners with appropriate information and
advice for a healthy pregnancy, childbirth and postnatal recovery, including care of
the newborn, promotion of early exclusive breastfeeding and assistance with
deciding on future pregnancies in order to improve pregnancy outcomes.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research.
Standards for maternal and neonatal care. World Health Organization; 2007.
7. Provision of effective antenatal care
Requirements
• A national policy and locally adapted guidelines that protect the rights of all women,
regardless of their socioeconomic status or place of residence, to access good
quality ANC services.
• National evidence – based guidelines detailing the essential minimum components of
ANC, in line with the country epidemiological profile and country priorities and
based on WHO guidelines and recommendations.
• Availability of sufficient number of skilled attendants to provide all women with good
quality ANC.
• The necessary equipment and drugs to provide essential ANC.
• The system for referral of any pregnant woman to a facility capable of managing
obstetrical and neonatal complications.
• National or locally-adapted evidence-based protocols and/or guidelines for the
management of pregnancy-related complications.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research.
Standards for maternal and neonatal care. World Health Organization; 2007.
8. Birth and emergency preparedness in antenatal care
Key elements to reduce maternal morbidity and mortality during labour, birth
and the period immediately afterwards:
• Delivery by skilled health professionals.
• Timely management of complications that may arose during labour.
• Provision of appropriate information on how to ensure a safe birth and to
seek timely skilled care in emergencies to woman and her family.
• Interventions to reduce the other barriers to seeking care, such as
transport costs, perceptions of poor quality of care and cultural differences.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research.
Standards for maternal and neonatal care. World Health Organization; 2007.
8. Birth and emergency preparedness in antenatal care
A birth plan/emergency preparedness plan includes identification of the
following elements:
• The desired place of birth.
• The preferred birth attendant.
• The location of the closest appropriate care facility.
• Funds for birth-related and emergency expenses.
• A birth companion.
• Support in looking after the home and children while the woman is
away.
• Transport to a health facility for the birth.
• Transport in the case of an obstetric emergency.
• Identification of compatible blood donors in case of emergency.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research.
Standards for maternal and neonatal care. World Health Organization; 2007.
8. Birth and emergency preparedness in antenatal care
The standard
• All pregnant women should have a written plan for birth and for dealing
with unexpected adverse events, such as complications or emergencies,
that may occur during pregnancy, childbirth or the immediate postnatal
period, and should discuss and review this plan with a skilled attendant at
each antenatal assessment and at least one month prior to the expected
date of birth.
Aim
• To assist women and their partners and families to be adequately
prepared for childbirth by making plans on how to respond if complications
or unexpected adverse events occur to the woman and/or the baby at any
time during pregnancy, childbirth or the early postnatal period.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research. Standards for maternal and neonatal care. World Health Organization; 2007.
8. Birth and emergency preparedness in antenatal care
Requirements
• National and local policies to support access of all pregnant women to
maternal and neonatal health care, including referral care.
• Skilled health care providers to support the woman in preparing the birth
and emergency plan, to discuss it with pregnant women.
• National and local health education activities to promote the need for all
women to access maternal and neonatal health care, and for all pregnant
women to make a birth and emergency plan during pregnancy.
• National and local activities to facilitate community action to participate in,
or where necessary mobilize, local efforts to ensure the timely transfer of
women and babies with pregnancy – and birth – related complications,
especially emergencies, to a facility that has the capacity to manage such complications or emergencies. World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research. Standards for maternal and neonatal care. World Health Organization; 2007.
Reference Documents
1.Abou-Zahr CL, Wardlaw, TM. Antenatal Care in Developing Countries: Promises,
Achievements and Missed Opportunities; an Analysis of Trends, Levels and Differentials,
1990-2001. Geneva: World Health Organization; 2003. Available from:
2.World Health Organization. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. Geneva: World Health Organization; 2003. Available from:
3.World Health Organization, Reproductive Health and Research. Sexually Transmitted and
Other Reproductive Tract Infections: A Guide to Essential Practice. Geneva: Dept. of
Reproductive Health and Research, World Health Organization; 2005. Available from:
4. World Health Organization, Department of Making Pregnancy Safer and Department of
Reproductive Health and Research. Standards for maternal and neonatal care. World Health Organization; 2007. Available from: http://whqlibdoc.who.int/hq/2007/a91272.pdf
5. World Health Organization. Investment case for eliminating mother-to-child transmission of syphilis. World Health Organization; 2012. Available from: http://apps.who.int/iris/bitstream/10665/75480/1/9789241504348_eng.pdf
6. World Health Organization. World Malaria Report 2014. World Health Organization; 2014. Available from: http://www.who.int/malaria/publications/world_malaria_report_2014/en/
 Reference Document
7. World Health Organization. World Malaria Report 2014. World Health Organization; 2014.
8. World Health Organization. Rubella: Fact sheet N° 367. World Health Organization; 2014.
9. World Health Organization. Immunization coverage: Fact sheet N ° 378. World Health

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