obstetric care

I got pregnant when I was 19, single, and in my second semester of college.  Anyone who has been there knows how terrifying that is.  I found out I was pregnant at a Planned Parenthood after going for a pap smear. 

I will forever be grateful to the nurse who sat down with me as tears streamed down my face and gave me ALL my options without judgment.  She provided me with information on local programs for obstetrics care, adoption agencies, and abortion clinics.  Ultimately, I decided to have my child – a beautiful boy who just turned 10 this weekend (who by the way watched his mom walk for her bachelors and masters degree - education is still attainable while parenting!)  

Parenting was the right choice for me – but the key word is CHOICE.  I support a woman’s right to choose.   Thankfully, we live in a country where we have safe options – making these options illegal would only increase back-alley abortions….we should cherish our woman’s health more than that.  Our bodies, our choices. 

The Peace Corps is excited to be a partner of Saving Mothers, Giving Life. We are particularly proud of the contributions Peace Corps Volunteers have made at the community level to promote the importance of essential maternal health services, and we are thrilled to continue our collaboration to aggressively reduce maternal mortality. - Acting Director Carrie Hessler-Radelet

Saving Mothers’ first Annual Report, Making Pregnancy and Childbirth Safe in Uganda and Zambia, demonstrates rapid progress towards reducing maternal mortality ratios in eight pilot districts.

In Uganda districts, the maternal mortality ratio has declined by 30%, while in facilities in Zambia, the maternal mortality ratio has decreased by 35%. The Report showcases the activities that have helped contribute to these gains, including:

  • Increasing the number of women delivering in health facilities by 62% and 35% in Uganda and Zambia, respectively
  • Enhancing women’s access to Emergency Obstetric and Newborn Care, by hiring and training skilled birth attendants;
  • Strengthening transportation and communications networks among communities and facilities, in addition to strengthening the supply chain for life-saving medicines and commodities; and
  • Expanding testing and treatment for HIV/AIDS for women and their newborns.

Download the full report

anonymous asked:

What are some aspects of family medicine you enjoy more so practising in a small rural town?

  • Not having specialists immediately available so I have to think about things myself (also sometimes a downside) and expand my comfort zone treating some things
  • knowing and treating my patients’ entire families
  • the pathology. Oh the pathology. I see way more rare and interesting stuff as a small town doc than I would in a big city. In cities, the rare and interesting stuff is taken care of by specialists.
  • it challenges my brain more - I’m not just doing diabetes, hypertension, and hyperlipidemia like I would be in a big city
  • having to rely more on my physical exam because of lesser availability of specialized testing
  • getting creative with treatments and tests because of availability of resources
  • invites from my patients to churches, parties, fish frys, community events
  • being seen as a leader in the community
  • more respect and appreciation from patients than in cities
External image
  • gifts of lemons and bacon
  • actually getting to practice the full spectrum of family medicine, from minor procedures to pediatrics to obstetrical care to geriatrics
  • lower cost of living
  • loan repayment opportunities
  • having quick access to other doctors in the area and the few specialists nearby - cell phone consults and same-day work-in appointments are pretty common

I really don’t know how to feel about the paradox of New Zealand abortion law:

1) it’s illegal and covered under criminal law, but

2) medical exemptions (which include the negative mental health impact of being refused an abortion) mean that 98% of people who ask for one get it, free of charge, in a hospital, performed by the same people who give other gyno and obstetric care

So it’s both illegal AND free and (almost) available on demand

Photo by Andrea Bruce

Most newborn & maternal deaths happen in the postnatal period.  Much of MSF’s work is devoted to preventing these types of deaths.  Read about how MSF cares for women and babies by offering pre and postnatal care in Chapter 2 of Because Tomorrow Needs Her: http://bit.ly/1CDUh78

Photo by Lynsey Addario/VII

“As I was finishing my shift at 7 a.m., the ambulance rolled in with a 17-year-old pregnant girl in a coma…” Betty Raney, an MSF OBGYN, spent 6 months working in Sierra Leone. Read the latest excerpts from her journal: http://womenshealth.msf.org/chapters/journal/#new

Photo by Andrea Bruce

Twin newborns in MSF’s hospital in Khost, Afghanistan. The postnatal period is the most dangerous time for mothers and babies: 75% of all neonatal deaths and more than 35% of maternal deaths occur during the first week after birth. Read stories from the field about the challenges to providing pre and postnatal care in Because Tomorrow Needs Her: http://bit.ly/1CDUh78

Midwives talk about the “three delays” that can kill a mother in labor or her baby.The first delay stems from an assumption or hope that they can deliver at home without skilled assistance, so they do not go to a properly resourced medical facility when complications arise. Read more in Because Tomorrow Needs Her: http://bit.ly/1CDUh78

Childbirth shouldn’t cause a lifetime of pain. To prevent fistulas, every woman needs access to emergency obstetric care. Read about the devastating impact of fistulas & how MSF works to prevent and repair them in Because Tomorrow Needs Her: http://womenshealth.msf.org/chapters/chapter-3/

Planning a Place of Birth

This is all according to one resource, the National Institute for Health and Care Excellence. If anyone (especially midwives) have any other information and good resources on home births and birthing facilities please let me know. I’ll post what the website has as well as what I’ve seen on other resources.

Everyone should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit. Everyone should be informed:

  • That giving birth is generally very safe for both the pregnant person and their baby. (650 people die from pregnancy related issues every year, about half of those giving birth each year have some sort of complication)
  • That the available information on planning place of birth is not of good quality, but suggests that among those who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a natural birth, with less intervention. We do not have enough information about the possible risks relating to planned place of birth.
  • That the obstetric unit provides direct access to obstetricians, anaesthetists, neonatologists and other specialist care including epidural analgesia.
  • Depending on locally available services, the likelihood of being transferred into the obstetric unit and the time this may take. Take this into consideration.
  • That if something does go unexpectedly seriously wrong during labour at home or in a midwife-led unit, the outcome for could be worse than if they were in the obstetric unit with access to specialised care.
  • That if they have a pre-existing medical condition or has had a previous complicated birth that makes them at higher risk of developing complications during their next birth, they should be advised to give birth in an obstetric unit.

I know that a lot of birthing centers do make sure that you are as safe as possible and that if things do go wrong you are transferred to emergency care quickly.

Factors to consider when planning the place of birth

1. Medical conditions that may indicate a need for obstetric care.

These conditions include:

  • Confirmed cardiac disease
  • Hypertensive disorders 
  • Asthma requiring an increase in treatment or hospital treatment
  • Cystic fibrosis
  • Haemoglobinopathies – sickle-cell disease, beta-thalassaemia major
  • History of thromboembolic disorders
  • Immune thrombocytopenia purpura or other platelet disorder or platelet count below 100,000
  • Von Willebrand’s disease
  • Bleeding disorder in the adult or unborn baby
  • Atypical antibodies which carry a risk of haemolytic disease of the newborn
  • Risk factors associated with group B streptococcus whereby antibiotics in labour would be recommended
  • Hepatitis B/C with abnormal liver function tests
  • Carrier of/infected with HIV
  • Toxoplasmosis – receiving treatment
  • Current active infection of chicken pox/rubella/genital herpes in the adult or baby
  • Tuberculosis under treatment
  • Systemic lupus erythematosus
  • Scleroderma
  • Hyperthyroidism
  • Diabetes
  • Abnormal renal function
  • Renal disease requiring supervision by a renal specialist
  • Epilepsy
  • Myasthenia gravis
  • Previous cerebrovascular accident
  • Liver disease associated with current abnormal liver function tests
  • Psychiatric disorder requiring current inpatient care

2. Other factors that may suggest needing obstetric care

Situations where there is an increased risk for parent or child:

  • Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty
  • Previous baby with neonatal encephalopathy
  • Pre-eclampsia requiring preterm birth
  • Placental abruption with adverse outcome
  • Eclampsia
  • Uterine rupture
  • Primary postpartum haemorrhage requiring additional treatment or blood transfusion
  • Retained placenta requiring manual removal in theatre
  • Caesarean section 
  • Shoulder dystocia
  • Multiple birth 
  • Placenta praevia
  • Pre-eclampsia or pregnancy-induced hypertension
  • Preterm labour or preterm prelabour rupture of membranes 
  • Placental abruption
  • Anaemia –- haemoglobin less than 8.5 g/dl at onset of labour
  • Confirmed intrauterine death
  • Induction of labour 
  • Substance misuse
  • Alcohol dependency requiring assessment or treatment
  • Onset of gestational diabetes 
  • Malpresentation – breech or transverse lie
  • Body mass index at booking of greater than 35 kg/m2
  • Recurrent antepartum haemorrhage
  • Small for gestational age in this pregnancy (less than fifth centile or reduced growth velocity on ultrasound)
  • Abnormal fetal heart rate (FHR)/Doppler studies
  • Ultrasound diagnosis of oligo-/polyhydramnios
  • Myomectomy
  • Hysterotomy

Now many health organizations, like the World Health Organization, say not to focus too much on high risk pregnancies as this causes many supposed “low risk” pregnancies to not get the level of care they need and also limits choices for “high risk” pregnancies that may be totally fine and not need obstetric care.

3. Medical Conditions that aren’t necessarily reasons to have obstetric care but may indicate further consideration

  • Cardiac disease without intrapartum implications
  • Atypical antibodies not putting the baby at risk of haemolytic disease
  • Sickle-cell trait
  • Thalassaemia trait
  • Anaemia – haemoglobin 8.5–10.5 g/dl at onset of labour
  • Hepatitis B/C with normal liver function tests
  • Non-specific connective tissue disorders
  • Unstable hypothyroidism such that a change in treatment is required
  • Spinal abnormalities
  • Previous fractured pelvis
  • Neurological deficits
  • Liver disease without current abnormal liver function
  • Crohn’s disease
  • Ulcerative colitis

4. Other factors that aren’t necessarily reasons to have obstetric care but may indicate further consideration

  • Stillbirth/neonatal death with a known non-recurrent cause
  • Pre-eclampsia developing at term
  • Placental abruption with good outcome
  • History of previous baby more than 4.5 kg
  • Extensive vaginal, cervical, or third- or fourth-degree perineal trauma
  • Previous term baby with jaundice requiring exchange transfusion
  • Antepartum bleeding of unknown origin (single episode after 24 weeks of gestation)
  • Body mass index at booking of 30–34 kg/m2
  • Blood pressure of 140 mmHg systolic or 90 mmHg diastolic on two occasions
  • Clinical or ultrasound suspicion of macrosomia
  • Para 6 or more
  • Recreational drug use
  • Under current outpatient psychiatric care
  • Age over 40 at booking
  • Fetal abnormality
  • Major gynaecological surgery
  • Cone biopsy or large loop excision of the transformation zone (LLETZ)
  • Fibroids

For more information on planning your place of birth, visit this post!

Photo by Sa'adia Khan

One woman dies nearly every hour in Pakistan from complications of giving birth. The maternal mortality rate is even higher in Balochistan than the rest of the country. The largest but least populated province has some of the lowest national developmental indicators. A third of the women marry before reaching 15 and two thirds of them are illiterate. Only three out of ten pregnant women deliver their babies with skilled attendants present at the scene. And this can be fatal. MSF tries to mitigate this reality running maternal healthcare programmes in four projects in Baluchistan (Chaman, Quetta, Kuchlak and Dera Murad Jamali).

In Dera Murad Jamali, MSF provides comprehensive emergency obstetric care, neonatal and pediatric inpatient care, basic health care, and nutrition services at the District Headquarter Hospital. Here, women walk to the Ambulatory Therapeutic Feeding Center with their children.

In more than 20 countries,  Doctors Without Borders/Médecins Sans Frontières (MSF) focuses on reducing maternal and infant mortality through care during pregnancy, birth, and after delivery. Teams provide prenatal consultations, emergency obstetric care, postnatal care, and access to contraception and family planning services. Go to doctorswithoutborders.org to learn more.

New mother Mashal Hosine and proud grandmother Karima Thariy gaze at Zohal and Ojate in Dasht-e-Barchi’s Kangaroo Mother Care Unit. Low birthweight babies like this set of twins need to stay in the newborn unit until they gain weight. They must be fed and monitored regularly, and kept warm, to help them grow.

A few weeks later, having shown good progress, the twins have been discharged from hospital and are now home in Kabul. We made a home visit to check in on them.

Since November 2014 we’ve been running a specialized maternity department dedicated to emergency obstetric, neonatal care services and complicated deliveries in the Dasht-e-Barchi public district hospital. The hospital serves a population of more than 1.3 million in western Kabul.

Doctors Without Borders/Médecins Sans Frontières (MSF) has surgery teams to address medical issues ranging from fistula and other issues of obstetric care to tuberculosis patients and trauma surgery for those injured during wartime, as well as reconstructive surgery, as in our project in Amman, Jordan. “I am a surgeon but I am also a human being, and [I am] affected by what I see in my work,” said MSF surgeon Ali Al-Ani of his experience providing care in Amman. "I feel pain when I am face-to-face with innocent children and older men and women whose lives have been forever changed by man-made conflict. But as a surgeon, I am in a position to treat these vulnerable people, to make them smile and enjoy a sense of independence again. I feel proud that this project has relieved the suffering of so many patients—by reconstructing their injured bodies and helping them to regain functionality—especially as those who are referred here may not be able to afford such care otherwise.“ Go to doctorswithoutborders.org to learn more.