Labour, birth and the immediate postnatal period is the most dangerous time for mothers and their newborn babies, and there is more that medical professionals need to do to help reduce mortality rates around the world, says FIGO President Professor Sir Sabaratnam Arulkumaran in his plenary lecture today at the 2014 RCOG World Congress in Hyderabad, India.
Professor Sir Arul’s presentation, ‘Making labour safe: the achievable dream’, focuses on maternal and neonatal mortality during childbirth. The deaths of mothers and babies during labour and childbirth are an unnecessary and often avoidable tragedy, and with the 2015 deadline for the UN’s millennium development goals fast-approaching, Professor Sir Arul says that while significant progress has been made we are still falling short of the mark.
According to UN statistics there has been a decline in maternal mortality rates of 47 per cent since 1990 with eastern and southern Asia recording a decline of almost two-thirds. Professor Sir Arul says that while maternal mortality ratios vary greatly between the developed and developing world, the main causes of maternal mortality remain the same, just on different scales.
While cardiac complications and sepsis are the biggest causes for maternal mortality in the UK, in India haemorrhage and hypertensive diseases are the biggest contributors. Prof Sir Arul acknowledges that there are major problems that require urgent redress for safer maternity services globally, particularly in under-resourced settings where the lack of skilled birth attendants during labour and standardised care throughout pregnancy and birth cause major health disparity among women.
However, in addition to this Professor Sir Arul stresses the importance of data recording. The accurate recording of data, particularly serious incidents and adverse health outcomes, is a simple task that can be overlooked in busy birth settings but is hugely important to prevent maternal mortality in all countries. For example, the establishment of confidential enquiries into maternal death in the UK have been very successful in improving outcomes and reducing deaths by highlighting deficiencies in care.
The same applies to neonatal mortality, which has also decreased over the past two decades and which Professor Sir Arul defines as not only the survival rate of newborns during labour but the longevity of their health as children.
Professor Sir Arul says that in countries like India, there is an increased need for better monitoring and management of labour to prevent birth problems such as shoulder dystocia among newborns. Whereas in regions like the UK, which is generally a safe place to give birth, he says that stillbirth is still a big problem.
These problems arise due to the growing birth rate along with the high number of complex pregnancies, making labour more hazardous in developed countries, says Professor Sir Arul. He emphasizes that this only puts further importance on the fact that these health problems need to be addressed not only from a clinical but an organisational standpoint.
Professor Sir Arul said:
“For better health outcomes for mothers and their babies, there needs to be a two-pronged approach to making labour safer. As medical professionals we need to address the deficiencies within our organisational structures as well as improving our clinical standards through research and training. One will not work without the other.
“The availability of statistics and maternity dashboards, particularly in regard to serious incident reporting, is vital in all birth settings. This provides us with valuable information on where we need to improve as units and where our time and money can be spent more effectively.
“There are many promising trials for new devices and techniques that show great promise for the future of safer childbirth, but research outcomes can only be assessed properly if we have fundamental baseline data to compare it with.
“Everyone who is attending this Congress is doing so because they are devoted to improving women’s health worldwide. And while we may not be able to do much in terms of providing the hundreds of skilled health professionals that are needed in maternity services across the world, we can play a part in ensuring the best standards and clinical practice are kept up-to-date. Through training and auditing our work as medical professionals, we will ensure that our profession keeps progressing to reduce mortality among women and provide newborns with the best possible start to life.”
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Professor Sir Sabaratnam Arulkumaran is a Professor Emeritus of Obstetrics and Gynaecology at St George's University, London. He is the current President of the International Federation of Obstetrics and Gynaecology (FIGO) and the President of the British Medical Association. He also served as President of the Royal College of Obstetricians and Gynaecologists (RCOG) from 2007–2010.
Read the RCOG report Safer Childbirth: Minimum standards for the organisation and delivery of care in labour.