BIRTH RIGHT

CEmONC SERVICES
 Comprehensive Emergency Obstetric and New born
Care services (CEmONC)

Analysis of the maternal and infant mortality data revealed that 75% of

maternal deaths occured during intra partum and post partum and 25% occured in

antepartum.

One common issue was that of referral. When the hospital where the pregnant

woman accessed for care did not have adequate facilities, she had to be referred to

another hospital elsewhere. Covering the distance between two hospitals at such a

critical stage could prove fatal, as it was usually the complicated cases that were

referred to other hospitals especially in the rural areas.

Hence, it was decided to strengthen the obstetric and new born services in the

hospitals which led to the creation of the ‘Comprehensive Emergency Obstetric and

Neonatal Care’ Centres.

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Establishment of CEmONC Centres

In September 2004, a Government Order was passed to establish

CEmONC Centres in the State.

During Phase 1, 66 Centres were established (52 project hospitals

and 14 tertiary care centres) such that the travel time was reduced to

approximately an hour.

In Phase 2, 32 Centres were established and in Phase 3, 27 centres

were established.

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 Salient features of CEmONC Centre

The CEmONC Centre is equipped with both the manpower and the

­infrastructure required to care for the mother and the new born.

Round the clock, the centre has Obstetricians, Paediatricians, Doctors,

Staff Nurses, lab technicians, and support staff on duty and Anesthetists on

call.

Intensive inputs were provided, in terms of training and physical

­infrastructure to ensure quality care

Around 508 doctors and 562 nurses positions have been sanctioned

and posted exclusively for CEmONC services in addition to the existing doctors

and nurses.

The centre is equipped with a fully functional maternity block, including

a labour ward, operation theatre, blood bank/storage unit, new born ward, new

born intensive care unit (NICU) and isolation ward. Buildings worth Rs. 150

crores and equipment worth Rs. 40 crores have been provided to the CEmONC

Centres.

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Services available in a CEmONC Centre
* Resuscitation of all obstetric emergencies
* Resuscitation of all newborn emergencies * Free 108 emergency ambulance system maintained
* Blood transfusion facilities with all groups of blood
* Supportive lab and imaging services
* PPTCT Services
Labour Room
* Emergencies met by trained obstetrician and staff
nurse round the clock
* Emergency treatment protocols, equipment and
drugs are available in the casualty, labour room and
new born care services
* Emergency USG are taken for maternal emergencies
* Partographs are used
* Bio medical waste management procedures
followed
* Free antenatal and postnatal counseling services
* Uninterrupted power supply
* Healthcare waste management facility
New born care services
* Resuscitation of new born by trained paediatrician
* Emergency treatment protocols, equipment and
drugs are available in the casualty, labour room and
new
born care services
*
Initiation of breast feeding immediately after birth
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 Training

Doctors, including obstetricians and paediatricians, staff nurses, and maternity

assistants were provided the following trainings to improve the technical skills in delivery

and new born care.

* CEmONC doctors were given ultrasound training by obstetricians and radiologists /

sonologists from medical colleges.

* Paediatricians were given four-days training on using new-born ventilators.

* All Staff nurses in CEmONC Centres were trained to use Partograph by OG specialists.

* All staff nurses were given 15-day hands-on training on emergency and labor ward
skills.

* Paediatricians were trained on setting up and maintaining the Neonatal Intensive Care
Unit (NICU).

* Obstetricians were given 15 days skills training in Medical Colleges on the management
of emergency obstetric care.

* Blood bank training through Tamil Nadu State AIDS Control Society (TANSACS) to the
technicians concerned.

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Counselling services

To provide assistance and health education to the antenatal and postnatal

mothers who attend the CEmONC Centres, three counselors have been appointed in

each of these centres.

The counselors have been provided with booklets and counseling materials to

aid them in advising the mothers on a variety of subjects, including appropriate diet,

antenatal, and postnatal care, family planning services, and immunization of babies.

Monitoring and Evaluation

Monthly performance is monitored by Joint Directors along with District Project

Management unit medical officer. Quarterly review is done by the Director of Medical

and Rural Health Services. State-level review is done by the Special Secretary, Health

and Family Welfare and other senior officers.

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 Certifying CEmONC Centres

CEmONC Centres are certified once in every 2 years to ensure that the services

provided adhere to the standards prescribed quality standards.

An expert team visits the centre with a 36 page format prescribing norms for

labour ward, neonatal unit, operation theatre and blood bank. Deficiencies pointed out

have to be rectified within the prescribed time limit.

The certifying team comprises of the following members

* Professor of Obstetrics, professor of Neonatology of a nearby Medical College

* Expert Advisor from project management unit

* Additional Director of Medical and Rural Health Services

* Joint Director of the District

* Chief Medical Officer/ Hospital Superintendent

* Nursing Superintendent/ Head Nurse

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Quality of Care

In order to ensure quality of care provided in the CEmONC Centres,

infection control and waste management is also one of the priorities. Some of

the steps include:

* Bio waste segregated and disposed through appointed agencies.

* Operation theatre swabs taken to ensure proper sterlisation.

* Equipments sterilized regularly.

* Needles and sharps disposed properly through needle destroyers.

* Soiled sheets soaked in sodium hypochlorite solution for 30 minutes to

destroy HIV virus.

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 Reducing the travel time

The CEmONC’s have been placed in locations where people can access them, approximately in

30 minutes. This time has been further reduced by the 108 emergency ambulance services which ensure

that adequate tranport is available during critical times. So far, the 108 emergency ambulances have

transported around 1,10,200 pregnant mothers.

Phase Phase 1 Phase 2 Phase 3

No. of centres 66 32 27

Time of travel One hour Half-an hour

Reduction in infant and maternal mortality rate

During the period 2006 -2009, a total of 2,62,255 complicated maternal cases and 63,580

neonatal cases were treated through CEMONC Centres. This resulted in reduction of maternal

mortality rate from 19.5 to 13.7, and neonatal mortality rate from 5.24 to 3.73.

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Analysis of data
Studies on data from CEmONC Centres

There is ample data available at the CEmONC Centres to facilitate studies on maternal and child health.

* A study to analyze the indications for LSCS, maternal complications, and the outcome of
referral in and referral out of antenatal mothers in Tamil Nadu: Study completed. Data is being
consolidated and analysis to commence.

* Study on congenital anomalies: An on going study is being conducted to arrive at the reasons for
high congenital anomalies in five hospitals.

Performance of Phase 1 CEmONC Centres:

Highlights (comparing data between 2008-09 and 2009-10):

* Total maternity admissions increased by 3.1 per cent

* Complicated maternity admissions increased by 3.7 per cent
* A corresponding increase in LSCS rate by 14 per cent
* Referral-in of complicated maternity admissions increased by 3.4 per cent
* Neonatal admissions decreased by 1 per cent
* Complicated neonatal admissions increased by 10.9 per cent

Performance of Phase 2 CEmONC Centres:

Highlights (comparing data between 2008-09 and 2009-10):

* Total maternity admissions increased by 9.9 per cent

* Complicated maternity admissions increased by 28.4 per cent
* A corresponding increase in LSCS rate by 33.9 per cent
* Referral-in of complicated maternity admissions increased by 21.5 per cent
* Neonatal admissions increased by 10.9 per cent
* Complicated neonatal admissions increased by 23.1 per cent

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