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Birth Preparedness and Complication Readiness - A Matrix of Shared Responsibilities

Birth Preparedness and Complication Readiness - A Matrix of Shared Responsibilities

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Published by Anil Mishra

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Published by: Anil Mishra on Sep 27, 2010
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MNH Program Birth Preparedness Matrix (English, pub. 2001)1
Birth Preparedness and Complication Readiness:A Matrix of Shared Responsibilities
Maternal and Neonatal Health Program1615 Thames Street, Suite 100Baltimore, MD 21231-3492Telephone: (410) 537-1900Fax: (410) 537-1479E-mail: mnh@jhpiego.netThis publication was made possible through support provided by the Office of Health and Nutrition, Center for Population, Health and Nutrition, Bureau for Global Programs, Field Support and Research, U.S. Agency for InternationalDevelopment, under the terms of Award No. HRN-A-00-98-00043-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.Photograph by Rick Maiman, courtesy of The David and Lucile Packard Foundation.
MNH Program Birth Preparedness Matrix (English, pub. 2001)2
Delays can kill mothers and newborns
 Many more women and newborns would survive childbirth if they received the care they need when they needit. The Three Delays, an explanatory model, identifies three phases during which delays can contribute to thedeath of pregnant or postpartum women and their newborns. These phases are:deciding to seek carereaching carereceiving careThere are several reasons for these delays. The model groups the reasons into factors that underlie each delay
.For example, failure to recognize signs of complications, failure to perceive severity of illness, costconsiderations, previous negative experiences with the healthcare system, and transportation difficulties arefactors that result in delayed decisions to seek care. The lengthy distance to a facility or provider, the conditionof roads, and the lack of available transportation are factors that commonly create a delay in reaching care. Theuncaring attitudes of providers, the shortages of supplies and basic equipment, the non-availability of healthcarepersonnel and the poor skills of healthcare providers are factors contributing to a delay in receiving care.Many of the reasons contributing to these delays are neither unpredictable nor unique. This means that it ispossible to anticipate and plan for them in many settings.
Preparing for birth and complications reduces delays
The Maternal and Neonatal Health Program believes that these commonly cited factors can be averted withadvance preparation and rapid action, thus reducing the delays in seeking, reaching or receiving care. This is theessence of Birth Preparedness and Complication Readiness (BP/CR).Life-threatening delays can happen at home, on the way to care, or at the place of care. BP/CR must, therefore,include plans and actions that can be implemented at each of these points. BP/CR is a comprehensive matrixthat includes the woman and her family, as well as the community, healthcare providers, facilities that servethem, and the policies that affect care for the woman and the newborn.The BP/CR matrix encompasses the responsibilities, actions, practices and skills needed to help ensure thesafety and well-being of the woman and her newborn throughout pregnancy, labor, childbirth, and thepostpartum period. It outlines plans and actions that can be implemented wherever life-threatening delays mayoccur—at home, on the way to care or at the place of care.A key element of birth preparedness is identifying a skilled provider, who can support a woman during laborand childbirth and manage complications that may arise or refer for higher level care.
Birth preparedness and complication readiness is a shared
The BP/CR matrix is a programming tool. It is a list of behaviors and skills that address delay-causing factors at various levels.Program planners can use the matrix to select desirable and feasible activities and adapt them to local realities.The BP/CR matrix is also an advocacy tool. It enumerates the roles of facilities and communities and the responsibilities of policymakers, healthcare providers, families, and women. In this role, it helps support provider and community demands forimprovements.Identifying and knowing how to reach a skilled provider, as well as having adequate personal funds to pay for expensesincurred, are examples of how individuals and families can be prepared for childbirth. Establishing communal transportationschemes and accessible emergency funds are examples of how communities can be ready, should life-threatening complicationsoccur. Advocating for skilled providers, 24-hour services, improved roads and communication systems are examples of whatcommunities and families can do together for readiness. Collaboration among the community, the health center, and the districthospital for efficient referral is an example of a joint partnership that helps ensure that women will have skilled care when theyneed it. Finally, policies that allow performance of life-saving procedures by a range of providers build an enabling environmentfocused on maternal and newborn survival.The BP/CR matrix promotes a comprehensive, empowering approach to maternal and newborn well-being. The hallmark of theBP/CR matrix is that all of its parts are complementary. It shows that individually as well as together, policymakers, facilitymanagers, providers, communities, families and women affect birth preparedness and influence complication readiness. Itdemonstrates that all of these stakeholders share responsibility for saving the lives of women and newborns.
1Thaddeus S and D Maine. Too far to walk: maternal mortality in context. Soc Sci Med 38, 1091, 1994.
MNH Program Birth Preparedness Matrix (English, pub. 2001)3
Creates an environment that supports the survival of pregnant women and newborns. Is equipped, staffed and managed to provide skilled care for the pregnant woman and newborn.Provides skilled care for normaland complicated pregnancies,births and the postpartum period. Advocates and facilitates preparedness and readinessactions.Supports pregnant woman's plansduring pregnancy, childbirth and the postpartum period.Prepares for birth, values and seeks skilled care during pregnancy, childbirth and the postpartum period.
Promotes health and survival forpregnant women and newborns.Ensures that skilled antenatal carepolicies are evidence-based, in place andpolitically endorsedUses evidence-based information tosupport systems that routinely updateservice delivery and cadre-specificguidelinesPromotes and facilitates the adoption of evidence-based antenatal careEnsures that adequate levels of resources(financial, material, human) arededicated to supporting antenatal careand an emergency referral systemEncourages and facilitates participationin policy-making and resource allocationfor safe childbirth and emergencyreferral services by communities,families, individuals and advocacygroupsCoordinates donor support to integratebirth preparedness and complicationreadiness into antenatal servicesHas a national policy document thatincludes specific objectives for reducingmaternal and newborn deathsEnsures that protocols are in place forclinical management, blood donation,anesthesia, surgical interventions,infection prevention and physicalinfrastructureAdvocates birth preparedness andcomplication readiness through allpossible venues (e.g., nationalcampaigns, press conferences,Has essential drugs and equipmentFollows infection prevention principlesand practicesHas a functional emergency system,including:
safe blood supply
emergency fundsHas service delivery guidelines onappropriate management during theantenatal periodHas job aids to assist providers inperforming appropriate antenatal careEnsures availability of a skilled provider24 hours a day, 7 days a week Is gender and culturally sensitive, client-centered and friendlyInvolves community in quality of careReviews case management of maternaland neonatal morbidity and mortalityProvides skilled antenatal care,including:
detecting and managingcomplications
promoting health and preventingdisease, including:
provision of iron/folate and tetanustoxoid
vitamin A and iodine in areas withdeficiencies
presumptive treatment of malaria andworms in areas of prevalence
encourages use of bed nets
screening for and managingHIV/AIDS, tuberculosis, STDs
assisting the woman to prepare forbirth including:
items needed for clean birth
identification of skilled provider for thebirth
plan for reaching provider at time of delivery
identification of support people to helpwith transportation, care of children/household, and accompanimentto health facility
Complication Readiness Plan - in caseof emergency: emergency funds,transportation, blood donors, anddecision-making
counseling/educating the womanand family on danger signs,nutrition, family planning,breastfeeding, HIV/AIDS
informing woman and family of existence of emergency funds
referring to higher levels of carewhen appropriate
honoring the pregnant woman’schoicesSupports the community s/he servesRespects community's expectations andworks within that settingEducates community members aboutbirth preparedness and complicationreadinessSupports and values the use of antenatalcareSupports special treatment for womenduring pregnancyRecognizes danger signs and supportsimplementing the ComplicationReadiness Plan.Supports mother- and baby-friendlydecision-making for normal births andobstetric emergenciesHas a functional transportationinfrastructure for woman to reach carewhen neededHas a functional blood donor systemHas community financing plan forobstetric emergenciesCan access facility and communityemergency fundsConducts dialogue with providers toensure quality of careDialogues and works together withprovider on expectationsSupports the facility that serves thecommunityEducates members of the communityabout birth preparedness andcomplication readinessAdvocates for policies that supportskilled healthcarePromotes concept of birth preparednessand dispels misconceptions and harmfulpractices that could prevent birthAdvocates for skilled healthcare forwomanSupports and values the woman’s use of antenatal care, adjusts responsibilities toallow attendanceMakes plan with woman for normal birthand complicationsIdentifies a skilled provider forchildbirth and the means to contact orreach the providerRecognizes danger signs and facilitatesimplementing the ComplicationReadiness PlanIdentifies decision-making process incase of obstetric emergencyKnows transportation systems, where togo in case of emergency, and supportpersons to accompany and stay withfamilySupports provider and woman inreaching referral site, if neededKnows supplies to bring to facility orhave in the homeKnows how to access community andfacility emergency fundsHas personal savings for costs associatedwith emergency care or normal birthKnows how and when to accesscommunity blood donor systemIdentifies blood donorAttends at least four antenatal visits(obtains money, transport)
Makes a birth plan with provider,husband, familyDecides and acts on where she wants togive birth with a skilled provider
Identifies a skilled provider for birth andknows how to contact or reach theproviderRecognizes danger signs and implementsthe Complication Readiness PlanKnows transportation systems, where togo in case of emergency, and supportpersons to accompany and stay withfamilySpeaks out and acts on behalf of her andher child’s health, safety and survivalKnows that community and facilityemergency funds are availableHas personal savings and can access incase of needKnows who the blood donor is

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