Introduction


According to the World Health Organization, an estimated 800 women die each day from preventable pregnancy- and delivery-related causes. Ninety-nine percent of maternal deaths occur in developing countries. There are a number of factors limiting access to the high quality care that would reduce this mortality to a more acceptable level; these include limited family resources, living far from a health care facility, and the lack of a reliable system of transportation.

Essential obstetric and newborn care is designed as a tool to help protect mothers and their children in adverse environments. It is intended for midwives, doctors with obstetrics training, and health care personnel who deal with obstetric emergencies.

This guide is not intended as a treatise on obstetrics, or as a replacement for years of specialised training and experience. The goal here is to describe the essentials needed to manage the most common illnesses and problems encountered during pregnancy, in order to save the life of the mother, protect her from the sequelae of a difficult pregnancy or delivery, and deliver the infant in the best possible conditions.

Not all the procedures described in this guide are within reach of all medical staff. For example, while many obstetrical procedures fall within a midwife’s scope of practice, she is not qualified to perform a caesarean – though she usually helps determine that one is indicated. On the other hand, a nurse may be permitted to perform antenatal consultations, with appropriate training. The medical demography of low-income countries often requires the decentralisation of competencies. Similarly, it is important to take the paucity of obstetricians in developing countries into account, and recognise that in some countries, general practitioners in remote areas are trained to do difficult and caesarean deliveries. Hence this guide aims to serve all of these variously-qualified personnel, by describing basic technical procedures and general management of obstetric emergencies. It can also be used as a reference tool for training.

While some of the methods in this guide, such as symphysiotomy and embryotomy, may appear obsolete, they have purposely been included for situations in which there is limited or no access to caesarean sections.

Broadly speaking, there are two types of medical facilities that provide care for mothers and newborns: BEmONCs, which dispense Basic Emergency Obstetric and Newborn Care, and CEmONCs, which offer Comprehensive Emergency Obstetric and Newborn Care. The geographic distribution of these facilities permits proximity to care, in the case of the BEmONCs, with the CEmONCs serving as reference facilities for more complicated deliveries. The different procedures and techniques described in this guide are to be performed in the relevant medical facility.

Despite all efforts, it is possible that certain errors may have been overlooked in this manual. Please inform the authors of any errors detected. It is important to remember, that if in doubt, it is the responsibility of the prescribing medical professional to ensure that the doses indicated in this manual conform to the manufacturer’s specifications.

The authors would be grateful for any comments or criticisms to ensure that this manual continues to evolve and remains adapted to the reality of the field.

As treatment protocols are constantly changing, medical staff are encouraged to check this website for updates.