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Obstetric and Delivery Care

Technical Publications and Resources

Balancing the Scales: Expanding Treatment for Pregnant Women with Life-Threatening Hypertensive Conditions in Developing Countries
This landmark report examines the barriers to treating eclampsia, one of the most common yet most treatable killers of pregnant women worldwide, and probes why this serious medical condition kills 14 times as many pregnant women in the developing world as it does in developed nations. The report, along with an international "call to action" about treatment, is a collaboration with the University of Oxford, in consultation with representatives from the World Health Organization (WHO), UNICEF, and others.
(2007) Available for download: the report (PDF, 74KB) and the call to action (PDF, 27KB)

Improving Partograph Use in Uganda through Coaching and Mentoring
Since 2010, Fistula Care has collaborated with the Reproductive Health Department of the Ugandan Ministry of Health to strengthen partograph use. This Fistula Care technical brief describes the challenges and achievements of developing and implementing a new approach to support partograph use in five facilities across three districts and makes recommendations for future partograph programming at the national, district, and facility levels.
(2013) English (PDF, 2.8MB), French (PDF, 2.6MB)

Increasing Access to Maternity Services in Rural Bangladesh: Sustainable Facility-Community Links
The Ad-din Hospital for Women and Children and the LAMB Project in Bangladesh have established community-level services for women in rural, underserved communities. This Fistula Care technical brief describes their noteworthy programs, which ensure community ownership and sustainability. One program is integrated into a microfinance program to enable financial independence; the other empowers community members to truly own and manage its services.
(2012) English (PDF, 1.1MB), French (PDF, 1.2MB)

Integrating Fistula Treatment and Prevention: The Launch of a Maternity Unit in Sierra Leone
The Aberdeen Women's Centre maternity unit began offering delivery services in May 2010. Today, its dedicated staff provide hundreds with women high-quality maternity services each year. This Fistula Care technical brief details the challenges of opening a maternity centre, and the factors that have led to the success of the clinic today.
(2012) English (PDF, 2.3MB), French (PDF, 1.6MB)

Preventing Postpartum Hemorrhage: Community-Based Distribution of Misoprostol in Tangail District, Bangladesh
Deaths related to postpartum hemorrhage (PPH) present a major challenge to health systems, particularly in rural areas of Bangladesh, where infrastructure is poor and health facilities often lack skilled staff, drugs, and equipment. Misoprostol is a proven uterotonic drug that is increasingly used in clinical and home delivery settings to prevent and manage PPH. This project brief discusses the implementation of a pilot project in the Tangail District of Bangladesh to determine the effectiveness of using government and nongovernmental field workers at the community level to distribute misoprostol tablets and ensure that women take the drug immediately postpartum. In addition to the programmatic intervention strategies, it looks at health outcomes, women's views and experiences, as well as lessons learned and recommendations for moving forward.
(2010) Download as a PDF (3MB) from the RESPOND Project

Payments in the Public Sector for Reproductive Health Services in Eastern Europe and the Caucasus
Informal payments for health care services that clients are entitled to receive for free are highly prevalent in Eastern Europe and the Caucasus (EE&C). This report reviews relevant literature on the financial cost to clients in this region and describes the results of a secondary analysis of data from the Demographic Health Surveys and Reproductive Health Surveys conducted in Armenia, Azerbaijan and Georgia, to examine how financial and nonfinancial factors may affect the provision of family planning and obstetric services.
(2010) Download as a PDF (1.9MB) from the RESPOND Project

Community-Based Distribution of Misoprostol for the Prevention of Postpartum Hemorrhage: Evaluation of a Pilot Intervention in Tangail District, Bangladesh
The leading causes of maternal mortality are hemorrhage, eclampsia, abortion, injuries, sepsis, and obstructed labor. Deaths related to postpartum hemorrhage (PPH) present a major challenge to health systems, particularly in rural areas of Bangladesh, where infrastructure is poor and health facilities often lack skilled staff, drugs, and equipment. Misoprostol is a proven uterotonic drug that is increasingly used in clinical and home delivery settings to prevent and manage PPH.  In 2008, the Mayer Hashi/RESPOND Project implemented a pilot project in the Tangail District of Bangladesh to determine the effectiveness of using government and nongovernmental field workers at the community level to distribute misoprostol tablets and ensure that women take the drug immediately postpartum. This evaluation report discusses the process, approaches, and strategies followed in the implementation of the pilot project and uses a review of relevant project documents and activity reports, as well as interviews and focus group discussions with clients, service providers, supervisors, and program managers. The overall goal of the evaluation was to assess the effectiveness of the community-based misoprostol intervention program strategies and to gather lessons learned and provide recommendations for the national scale-up.
(2010) Download as a PDF (2.4MB) from the RESPOND Project

Active Management of The Third Stage of Labor (AMTSL) Poster
This wall chart outlines the steps in active management of third stage of labor (AMTSL). This job aid is for use by service providers with the aim of standardizing the steps of AMTSL and preventing postpartum hemorrhage. It was produced jointly by EngenderHealth, PATH, and RTI International on behalf of the Prevention of Postpartum Hemorrhage Initiative (POPPHI). (2006)
Download this publication:
English (MCH-07P) (PDF, 428KB)
French (MCH-07PF) (PDF, 407KB)
Spanish (MCH-07PS) (PDF, 419KB)

Active Management of the Third Stage of Labor for Prevention of Postpartum Hemorrhage: A Fact Sheet for Policy Makers and Program Managers
This fact sheet describes active management of third stage of labor (AMTSL) for the prevention of postpartum hemorrhage, and outlines steps that can be taken by policy makers and program managers to increase the use of AMTSL at the advocacy, training, and service-delivery levels. It was produced jointly by EngenderHealth, PATH, and RTI International on behalf of the Prevention of Postpartum Hemorrhage Initiative (POPPHI).
Download this publication:
English (MCH-07F) (PDF, 70KB)
French (MCH-07FF) (PDF, 52KB)
Spanish (MCH-07FS) (PDF, 88KB)

Quality Improvement for Emergency Obstetric Care: Leadership Manual and Toolbook
The purpose of this newly revised manual and accompanying toolbook is to assist health care providers working in emergency obstetric care (EmOC) settings to improve the quality of services within their facility. The manual describes a continuous, four-step quality improvement process that is based on participatory principles of staff involvement and ownership and that focuses on clients' rights and needs. The accompanying toolbook contains the information-gathering instruments used as part of the QI process, along with instructions for their use. The revised manual and toolbook are updated versions of the 2001 working drafts Emergency Obstetric Care: Leadership Manual for Improving the Quality of Services and Emergency Obstetric Care: Toolbook for Improving the Quality of Services. Major revisions to the manual include more information about the intended audience, some alternative methods for facilitating the QI process, and an enhanced definition of the "EmOC team." Revisions to the toolbook include simplified questions in the EmOC Assessment and expanded instructions for each tool. Produced by EngenderHealth and the Averting Maternal Death and Disability (AMDD) Program at the Mailman School of Public Health, Columbia University.
(2003) English. Leadership manual: MCH-04M. Free. / Toolbook: MCH-04T. Free. Download this publication:
Leadership Manual: in English (PDF, 525KB), French (PDF, 550KB), and Spanish (PDF, 1MB)
Toolbook: in English (PDF, 1MB), French (PDF, 441KB), and Spanish (PDF, 780KB)

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