WHO

The World Health Organization (WHO) is in the process of revising and updating its guidance on postpartum and postnatal care delivered by skilled providers. The purposes of revision are to encourage and support broader provision of care and to foster a new, woman-centered concept of care that promotes health as well as maintains vigilance against dangerous complications. In October 2008 an expert consultation took place in Geneva to advise WHO on the coverage, form and content for revised and updated guidance. This meeting, which is documented here, prepared for an upcoming technical consultation to develop the guidance itself.

This document is not intended to be a comprehensive guide on management of PPH and retained placenta. Rather, it reflects the questions that were regarded as high priority by a multidisciplinary panel of international health workers and consumers.

This document is one of two evidence-based cornerstones of the World Health Organization’s (WHO) new initiative to develop and implement evidence-based guidelines for family planning. The first cornerstone, the Medical eligibility criteria for contraceptive use (third edition) published in 2004, provides guidance for who can use contraceptive methods safely. This document, the Selected practice recommendations for contraceptive use (second edition), provides guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate.

The best way to guarantee that reproductive health services meet the needs of the refugee community is to involve the community in every phase of the development of those services: from designing programmes to launching and maintaining them to evaluating their impact. Only then will refugees benefit from services specifically tailored to their needs and demands; and only then will they have a stake in the future of those services. This Inter-agency Field Manual on Reproductive Health in Refugee Situations is the result of a collaborative effort of many UN agencies, governmental and non-governmental organisations and refugees themselves. Information in this Manual is based on the normative, technical guidance of the World Health Organization. A draft of the Field Manual was first issued in 1996 and tested extensively in the field. This new version can, and should, be shaped and adapted to suit the particular circumstances and requirements of each refugee situation as it arises and evolves.

Recommendations for birth spacing made by international organizations are based on information that was available several years ago. While publications by the World Health Organization (WHO) and other international organizations recommend waiting at least 2-3 years between pregnancies to reduce infant and child mortality, and also to benefit maternal health, revent studies supported by the United States Agency for International Development (USAID), have suggested that londer birth spacing, 3-5 years, might be more advantageous. Country and regional programmes have requested that WHO clarify the significance of the USAID-supported studies.

To support the upgrading of midwifery skills so that countries can respond to this situation by strengthening maternal and newborn health services, a set of midwifery training modules was developed by the World Health Organization (WHO). The modules, while primarily intended for in-service training programmes for midwives and nurse-midwives, can also be used in basic and post-basic midwifery programmes. In addition, the modules can be used to update the midwifery skills of other health care professionals. This module begins with an explanation of the problem of puerperal sepsis. The content then covers the factors which contribute to the infection, how it can be identified and differentiated from other conditions, how it can be prevented and, if it does occur, how it can be managed. A session on HIV and AIDS, related to childbearing women, is also included.The skills specific to preventing and managing puerperal sepsis include: identification of risk factors; identification of symptoms and signs; taking a midstream specimen of urine; taking a high vaginal swab; and maintaining vulval hygiene. The general skills in this module include: taking and recording observations; taking blood samples for analysis; setting up and monitoring an intravenous infusion; maintaining fluid balance; universal precautions for prevention of infection; administering necessary drugs; preventing thromboembolic disorder; and maintaining records.

This manual, and a similar one on the management of preterm and sick newborns, is written for midwives and doctors working in district hospitals. This manual complements and is consistent with the Essential Care Practice Guide for Pregnancy and Childbirth which is prepared mainly for the primary health care level. Together these manuals will provide guidance for health workers who are responsible for the care of pregnant women and newborns at all levels of care.

This document describes the key effective interventions organized in packages across the continuum of care through pre-pregnancy, pregnancy, childbirth, postpartum, newborn care and care of the child. The packages are defined for community and/or facility levels in developing countries and provide guidance on the essential components needed to assure adequacy and quality of care.

On a global scale, the continued incidence of obstetric fistula in low-resource settings is one of the most visible indicators of the enormous gaps in maternal health care between the developed and developing world. Obstetric fistula still exists because health care systems fail to provide accessible, quality maternal health care, including family planning, skilled birth attendance, basic and emergency obstetric care, and affordable treatment of fistula. In addition, social systems are failing to provide a safety net for girls and women. This document provides guiding principles for the clinical management and programme development for addressing obstetric fistula.

The purpose of this handbook is to describe the indicators and to give guidance on conducting studies to people working in the field. It includes a list of life-saving services, or 'signal functions,' that define a health facility with regard to its capacity to treat obstetric and newborn emergencies. The emphasis is on actual rather than theoretical functioning. On the basis of the performance of life-saving services in the past 3 months, facilities are categorized as 'basic' or 'comprehensive'. The section on signal functions also includes answers to frequently asked questions.

This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the second edition of Improving access to quality care in family planning: medical eligibility criteria for contraceptive use, published in 2000, and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization, Geneva, 21-24 October 2003.

This report contains the 2010 maternal mortality estimates developed by the World Health Organization, the World Bank, and UNICEF.

In issuing this statement, WHO, ICM and FIGO are advocating for skilled care during pregnancy, childbirth and the immediate postnatal period. This statement is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. The statement defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported.

This module begins with an explanation of abortion, including the types of abortion, the effect of abortion on maternal mortality and morbidity, the prevention of unwanted pregnancy, laws and regulations related to abortion, sociocultural and religious perspectives, and the role of midwives in abortion care, with particular emphasis on emergency abortion care. The content then covers the factors which contribute to abortion, how it can be identified and differentiated from other conditions, how it can be prevented and, if it does occur, how it can be managed. The skills specific to managing incomplete abortion include: manual vacuum aspiration, and post-abortion family planning counselling and methods. The following skills, which are also in the postpartum haemorrhage module, are included because they may be necessary when managing incomplete abortion: applying bimanual compression to the uterus; applying manual compression to the aorta; and repair of cervical and high vaginal tears. The general skills in this module include: taking and recording observations; taking blood samples for analysis; setting up and monitoring intravenous infusions; monitoring blood transfusions; administering drugs, urinary catheterization; preventing thromboembolic disorder; universal precautions for prevention of infection;and maintaining records.

To support the upgrading of midwifery skills so that countries can respond to this situation by strengthening maternal and newborn health services, a set of midwifery training modules was developed by the World Health Organization (WHO). The modules, while primarily intended for in-service training programmes for midwives and nurse-midwives, can also be used in basic and post-basic midwifery programmes. In addition, the modules can be used to update the midwifery skills of other health care professionals. This module begins with the Story of Mrs X which shows how certain social, economic and cultural factors, combined with delays in seeking and obtaining medical care put mothers at risk of complications which frequently lead to death. The theme from the story is then reinforced throughout the remainder of the module. Special emphasis is given to the role of midwives in promoting safe motherhood in the community by helping individuals, families and other community members understand and contribute to safe motherhood.There are sessions covering specific topics such as the place and value of women in society; advancing safe motherhood through human rights; traditional beliefs, practices and taboos affecting the health of women during pregnancy and childbirth; the recognition and reduction of risk factors; the concept of delay as it relates to maternal death; and HIV/AIDS and safe motherhood. Additional sessions include the use of community profiling for planning community-based care and for evaluation of that care.

This module begins with a review of the anatomy and physiology relevant to the management of prolonged and obstructed labour. On the basis of this, the module explains what makes obstructed labour more likely to occur, what happens in obstructed labour, how signs of obstructed labour can be identified, and steps to be taken for effective management. Special emphasis is placed on the use of the partograph in monitoring labour. The skills specific to preventing and managing prolonged and obstructed labour include: identification of risk factors; assessing pelvic outlet; diagnosing presentation and position of the baby; assessing descent of the fetal head; recognizing obstructed labour; and vacuum extraction. The general skills in this module include: urinary catheterization; taking blood samples for analysis; setting up and monitoring an intravenous infusion; administering necessary drugs; maintaining fluid balance; universal cautions for prevention of infection; and maintaining records.

Most antenatal care programmes in developing countries were established along the lines of those used in developed countries, with little adjustment for local conditions. In recent years, the underlying premise of much that is carried out under the heading of antenatal care has been called into question. It has emerged that few of the components of standard antenatal care regimens have been subjected to rigorous scientific evaluation to determine their effectiveness. This document explores promises, achievements and missed opportunities in antenatal care in developing countries from 1990-2001.

This handbook focuses on counselling and communicating with women, their families, and communities to promote the health of mothers and newborns.