Majority new-borns deaths occurs within first 24 hours

Worldwide, the majority of maternal and newborn deaths occur around the time of birth, typically within the first 24 hours after childbirth; of which most are preventable.

The World Health Organisation’s (WHO) new “Safe Childbirth Checklist and Implementation Guide”, which was made available to the Ghana News Agency on Friday, by Tarik Jasarevic, WHO Communications Officer, targets the major causes of maternal and newborn complications and deaths, including post-partum haemorrhage, infection, obstructed labour, preeclampsia and birth asphyxia.

According to the Guide, of the more than 130 million births occurring each year, an estimated 303 000 result in the mother’s death, 2.6 million in stillbirth, and another 2.7 million in a newborn death, within the first 28 days of birth.

It said the majority of these deaths occur in low-resource settings, often lacking skilled birth attendants.

“Far too many women and children are still dying in childbirth from preventable causes often linked to poor quality of care,” said Dr Marie-Paule Kieny, WHO Assistant Director-General, Health Systems and Innovation.

“The WHO Safe Childbirth Checklist will help health care workers follow the essential care standards for every birth,” she stated.

The checklist was developed and tested in partnership with Ariadne Labs, a joint centre of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health and supported by the Bill & Melinda Gates Foundation.

It synthesises existing evidence-based WHO guidelines and recommendations into a single and practical bedside tool, targeted at improving adherence to best practices, including adequate communication around the time of delivery.

“We know from other health disciplines such as surgery that a properly implemented checklist of best practices encourages a culture of teamwork, problem solving and discipline that leads to better care,” said Ariadne Labs Executive Director Dr Atul Gawande, a surgeon and Harvard School of Public Health professor.

The checklist identifies four pause points each corresponding to a specific period in a health worker’s normal flow of work: when the mother is admitted, just before pushing (or before Caesarean section), within one hour after birth and before the mother and newborn are discharged.

These pause points allow birth attendants to make their “checks” at times when they can not only protect the mother and newborn against dangerous complications, but also at the most convenient times in their work flow.

For example, during the “soon after birth” phase, the birth attendant should check to make sure the mother is not bleeding abnormally or does not have an infection and that she has started breastfeeding and skin-to-skin contact.

It said during the “before discharge” phase, the birth attendant should confirm that the mother and newborn have stayed at the facility at least 24 hours after delivery, the mother’s blood pressure is normal and the baby is feeding well.

Like the WHO Safe Surgery Checklist, the WHO Safe Childbirth Checklist initiative has been established in consultation with health practitioners, patient safety experts, maternal and newborn health experts and patients around the world.

The checklist was first piloted for usability in nine countries in Africa and Asia.

Subsequently it was field-tested in Karnataka State, India, where adherence to recommended practices at each birth increased from an average of 10 out of 29 practices prior to introduction of the checklist to an average of 25 out of 29 practices after the checklist had been introduced.

Achieving skilled attendance at every birth has emerged as a global priority and women in high-risk regions are increasingly being encouraged and incentivised to deliver in health facilities.

In practice, however, poor quality care at health facilities is frequently observed.

All countries agreed to a new set of Sustainable Development Goals from 2016-2030, which include a goal to substantially reduce global maternal and newborn deaths.

To advance this agenda, WHO and partners also launched a new Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030, a roadmap for countries on what evidence-based investments and actions are required to end the preventable deaths of women, children and adolescents’ and to improve their overall health and well-being.

“In agreeing to the Sustainable Development Goals and the new Global Strategy, world leaders have shown that the health of women, children and adolescents’ are top priorities,” said Dr Flavia Bustreo, WHO Assistant Director-General for Family, Women’s and Children’s Health.

“Now it is time to translate this strategy into action. The Safe Childbirth Checklist is a practical tool that could contribute to improving the quality of care of mothers and newborns,” she said.

The WHO, in collaboration with global partners, would now focus on scaling up the implementation of the checklist by providing support to countries and health facilities.