Maternal Health: How We Respond

Emergency obstetrics are a key component of this strategy. Emergency care administered promptly by qualified staff can save the lives of women experiencing complications during or just after delivery, which is when half of all maternal deaths occur. To help reduce barriers to use of our emergency obstetric services, we adapt services to local cultures and, as with all Doctors Without Borders programs, make them free of charge, as our beneficiaries are often among the poorest in the population.

During conflicts or natural disasters, when health services often collapse or are inadequate, emergency obstetrical needs are among the major needs we see. Over the period of 2008 to 2015, 56 percent of all Caesarean sections we performed were in active conflict settings. For this reason, rapid implementation of emergency maternal care is now incorporated into our response to these crises.

We also aim to locate services close to the people who need them. In some settings where this is not possible or we serve a large region, we have introduced mobile clinics that travel to areas where people often have no access to health care, combined with referral systems to identify women with pregnancy complications and transfer them when necessary to a health post or hospital that can provide appropriate care.

In remote locations such as Kabezi, a rural district in Burundi, we have also implemented ambulance services, which have been linked to significant reductions in maternal mortality.

Antenatal care improves the mother’s health during her pregnancy and helps reduce or manage complications for both mother and newborn. In addition, these consultations provide opportunities to inform women and their families about how to recognize complications and to prepare for emergencies, and about health structures where women can go for emergency care if needed, and for delivery.

Post-natal care is another critical area for reducing maternal and infant death and improving the physical and mental wellbeing of mother and child. Most maternal illnesses and deaths occur at or soon after delivery, while the majority of infant deaths occur in the first few days post-delivery—and 30 percent of all child deaths below the age of five occur in the first four weeks of life.

Without treatment, 25 to 40 percent of all children born to HIV-positive mothers will also be infected. This rate can be reduced to below five percent with antiretroviral treatments for the mother and a short course of antiretroviral drugs for the baby, together with appropriate breastfeeding practices.

We have opened programs on prevention of mother-to-child transmission in many of the world’s most affected regions. In Swaziland, for example, we provided HIV treatment to thousands of HIV-positive pregnant women as soon as possible after their diagnosis to prevent their babies from becoming infected.

Pregnant women are more susceptible to infectious diseases, and when infected they are more likely to experience pregnancy complications, facing an increased risk of miscarriage or stillbirth.

For this reason, we offer preventive treatment to pregnant women exposed to diseases such as malaria and tuberculosis, and provide extra care where appropriate to pregnant women with these diseases, or others such as cholera and hepatitis E.

Hemorrhage, or excessive bleeding, can happen after a complicated birth. Often it results from failure of the uterus to contract after delivery. Normally, these contractions stop the bleeding that occurs once the placenta separates from the uterine wall. But complications or incomplete placental separation can lead to continued bleeding, and without rapid medical intervention, a woman can quickly bleed to death.

A woman can lose half a litre of blood in one minute and bleed to death rapidly unless action is taken quickly to stop the bleeding.

When skilled birth attendants are present, oxytocin can be given to prevent bleeding. If severe bleeding does occur, the mother is resuscitated and attendants apply methods ranging from further medication and manual pressure to stop the bleeding through to emergency surgery.

Severe infection can develop during pregnancy or from unhygienic conditions during delivery. One common type is reproductive tract infections (RTI), which cause intrauterine infections that can eventually be fatal to the woman. They can also cause life-threatening infection in the infant.

Access to clean water and hygienic conditions during delivery, such as clean hands and a clean delivery surface like a plastic cover, are vital to preventing infections. If an infection occurs, early detection and treatment with the appropriate antibiotic can prevent serious illness or death.

Eclampsia and other hypertensive disorders of pregnancy are linked to high blood pressure and are characterized by seizures that can lead to coma and death. Eclampsia begins during pregnancy as pre-eclampsia, which leads to high blood pressure. Without prenatal care, pre-eclampsia can develop into severe pre-eclampsia or full eclampsia, causing symptoms such as swelling, sudden weight gain, headaches, changes in vision, and potentially fatal convulsions.

Unsafe abortion is a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards, or both, as defined by the World Health Organization. Globally, at least 22,000 women die every year from unsafe abortion—the only major cause of maternal death that has not declined in recent decades, despite it being almost complete preventable. Of those women who survive, 7 million suffer serious consequences such as infertility, injury, or complications with future pregnancies.

Comprehensive sexual and reproductive health services can greatly reduce the number of unsafe abortions, by offering safer alternatives through family planning and access to safe abortion care.

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Obstructed labor can occur if the baby’s head is too large or its position is abnormal, blocking passage through the birth canal. When a mother is malnourished or is very young and therefore has an underdeveloped pelvis, the birth canal itself is often not wide enough to accommodate the head of the baby. If an obstructed labor becomes prolonged, lasting more than 24 hours, the baby may die and the woman is at risk of postpartum hemorrhage, uterine rupture or fistula, and severe infection—all potentially fatal.

Skilled staff are essential in managing complicated deliveries and identifying signs that interventions are needed. These can range from IV fluids and/or medications to support labor, to an instrument-assisted delivery (vacuum cup or forceps) or caesarean section.

Indirect causes, in particular complications from infectious disease, account for about 20 percent of maternal deaths.

During pregnancy, already dangerous diseases can pose even greater threats to both mother and fetus. For example, malaria in pregnant women increases their risk of miscarriage and causes over 10,000 maternal deaths globally, while tuberculosis also increases rates of miscarriage and maternal death. Malaria, tuberculosis, and cholera all raise the risk of stillbirths, death of newborns, or low birth weight infants.

For pregnant women at risk for any of these diseases, protecting their health starts with preventive measures. These can include reducing exposure (such as by sleeping under mosquito nets in malaria regions, and ensuring access to clean water and supplies for good hygiene) and short-term use of anti-malarial or anti-tuberculosis drugs during pregnancy. For those who become ill, early diagnosis and treatment are essential. Whether treating malaria, HIV, tuberculosis, or another disease, effective treatment reduces the risk of developing severe complications that threaten the lives of both mother and baby.