Introduction

According to the World Health Organization, an estimated 800 women die each day from preventable causes related to pregnancy, delivery and unsafe abortion, as well as 7000 newborns, the majority on the first day or during the first week of life. Almost all maternal (99%) and neonatal (98%) deaths occur in resource-limited countries. 

Essential obstetric and newborn care is designed to help reduce maternal and neonatal mortality in unfavorable contexts. 

This guide does not replace years of specialised training and experience. It is intended for midwives, doctors, and qualified health care personnel who respond to obstetric emergencies. 

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 does not perform caesarean sections – though she usually helps determine that one is indicated. On the other hand, a nurse may be permitted to perform antenatal or postnatal consultations, with appropriate training. The medical demography of resource-limited countries often requires the decentralisation of competencies. Similarly, it is important to take the paucity of obstetricians in these countries into account, and recognise that in some countries, general practitioners in remote areas are trained to perform complicated deliveries. Therefore this guide aims to serve all of these personnel with diverse qualifications, by describing basic technical procedures and general management of obstetric emergencies. It can also be used as a training tool.

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 performing a caesarean section would be dangerous or impossible.

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 should permit 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 guide. Please inform the authors of any errors detected.

To ensure that this guide continues to evolve while remaining adapted to field realities, please send any comments or suggestions

As treatment protocols are regularly revised, please check this website for updates.