The world health organization estimates that half a million women die each year due to complications arising during pregnancy or birth. In Indonesia alone the Center for Health Research at the University of Indonesia estimates that 400 maternal deaths occur in every 100,000 live births in the country (Meiwita, Hull and utomo). Maternal death is defined by the World Health Organization as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental causes”(Hunt and Mesquita).
Emergency Obstetric Care, which includes treating symptoms of “shock,” giving antibiotics and sedatives through injections, executing manual extraction of the placenta and basic curettage is vital to the reduction of maternal deaths accompanied by other lifesaving skills. There are two major causes of maternal deaths according to DFID: complications arising directly from pregnancy, delivery or postpartum duration and is also known as direct obstetric death, or due to an existing medical condition aggravated by pregnancy or delivery such as rheumatic heart disease, hepatitis, HIV-AIDS, anemia or malaria. These are known as indirect obstetric deaths. According to the above report by Center for Health Research at the University of Indonesia, direct obstetric deaths account for 75% of maternal deaths and include five major medical causes which are hemorrhage, complications of unsafe labor, eclampsia, obstructed labor and infection. All these can be treated before they become emergencies.
Even as emergencies, Emergency Obstetric Care can save all these conditions since they require no complex technology and are inexpensive. These include blood transfusions, antibiotics and other drugs, safe abortion procedures and caesarian sections. Prediction and prevention of obstetric complications is a good way of preventing maternal deaths. Pregnant women should regularly visit a doctor or a clinic throughout their pregnancy where an obstetric complication can be identified early and treated or managed before it becomes a problem. For example minor bleeding can be detected and dealt with during these visits or cases of hypertension and could also be indicators that major bleeding both during and after birth could still occur and therefore emergency obstetric care is needed such as emergency surgery.
However, some conditions appear without warning as research by center for Health Research at the University of Indonesia has indicated. Eclampsia cases can occur without prior indication of happening both during and after delivery but enough time is available to administer emergency obstetric care. The question is whether the facilities and skills to do so are available (Meiwita, Hull and utomo). In developing nations, the distribution and availability of health facilities and the necessary skills are major challenges especially in rural areas according to World Health Organization (Hunt and Mesquita). This means that pregnant women can not be able to make more frequent visits to a doctor or a clinic as they travel long distances to access them and some of the facilities required are not available. In some cases as researchers found out in Indonesia that women can not access medical professionals or adequate care during emergencies because they cannot afford the costs (Meiwita, Hull and utomo).
These women are left in the hands of community health workers, midwives and other poorly trained practitioners. Emergency obstetric care is not a complex matter, midwifes, community health workers and paramedics likely to attend in births in such areas can be trained on these skills and lives would be saved (DFID). Witnesses to birth experiences such as village officials, community health workers, traditional birth attendants, neighbors and health care personnel and women themselves have their own interpretation of emergencies according to (DFID).
They view these emergencies differently which may have a bearing on how they are handled. They may for example dismiss a case of postpartum hemorrhaging as normal which delays its management and subsequently lead to death. They can also handle a delivery unhygiencally leading to infection. Furthermore, a woman or her family or those attending her may fail to recognize the symptoms of eclampsia until it gets out of control.
This is why community based initiatives such as training make Emergency obstetric care very necessary in reducing maternal death.
DFID. Reducing Maternal Deaths: Evidence and Action: Astrategy for DFID. London: Department for International Development, 2004.
Hunt, Paul and Judith Mesquita. Reducing Maternal mortality: the contribution of the highest attainable standard of health. United Kingdom: university of essex, 2007. Meiwita, iskandar, et al. Unraveling the mysteries of maternal death in West Java : reexamining the witnesses.
Jarkata: Centre for health Research,Research Health, University of Indonesia, 1996.