WK 10- Childbearing and the health of women

Question 1

What factors impact negatively on women in pregnancy

Answer 1

• Lifetime of malnutrition leading to limited skeletal development (small pelvic outlet)
• Micronutrient deficiency and competition between mother and fetus for nutrients
• parasitic diseases–> ie hookworm and malaria–> contribute to anaemia and worsen haemorrhage in labour
• multiple pregnancies-> predispose to complications
• early marriage/lack of education/barriers to health care

Question 2

What is maternal mortality

Answer 2

The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes

Question 3

How is maternal mortality calculated

Answer 3

→ Maternal Mortality Ratio:

=deaths during pregnancy & 42 days post-partum/ per 100,000 live births

Question 4

What are the reasons maternal death occurs

Answer 4

• unsafe abortions/retaining of conception material (no access to dilation and curate)
• violence
• diseases→ HIV, malnutrition, anemia
• hypertension→ post-partum haemorrhage
• infection
• blod clots and embolism

Question 5

What is prolonged labour and what complications can this cause

Answer 5

• mother can labour for days if the fetus is too large to pass through the pelvic opening
• fetal head will be placing pressure against the tissue→ causes ischemic tissue→ leading to necrosis and development of the fistula between the vagina and bladder and/or rectum
• if it persists for such a long time the mother can go into heart failure and die

Question 6

What morbidities can result from pregnancy and labour

Answer 6

• long term pelvic infection/inflammation, breast abscess, UTI, skin, vaginal and kidney infection
• anaemia
• fistulas/damage to pelvic floor
• depression and psychosis
• worsening renal/heart condition

Question 7

What is the burden of maternal morbidity on the mother, family and child

Answer 7

• effect on mother→ loss of employment, wages, social marginalisation
• effect on household→ loss of income, increased health cost, family disruption (child nutrition, child mortality)

Question 8

What are the 3 contributing factors to maternal mortality (3 D’s)

Answer 8

• Delay in seeking care (recognising a complication and deciding to act)→ issues with traditional midwives wanting to deal with complications at home
• Delay in arrival at health care facility→ related to distance and availability of transport
• Delay in the provision of adequate care→ unable to manage complications at local facility/ill-equipped/poor sanitation

Question 9

What is the program that is aimed at limiting maternal morbidity and mortality

Answer 9

The Safe Motherhood program

Question 10

What are the 3 main factors that the program aims to implement in order to reduce maternal mortality and morbidity

Answer 10

1. Skilled birth attendants
2. Birth preparedness
3. Facilities for BEOC (basic essential obstetric care) and CEOC (comprehensive essential obstetric care)

Question 11

What are the 2 types of birth attendants found in low resource countries

Answer 11

traditional and skilled birth attendants

Question 12

What is a traditional birth attendant

Answer 12

Traditional= these people are from the local community and have no formal training and are often illiterate. They are trained apprenticeship style and are influenced and guided by social practices-> there is minimal focus on antenatal care and infection control and traditional birth attendants often have limited experience in dealing with difficult births.
-There are programs currently developed that aid in upskilling the TBA and developing skills aimed atenatal care, recognition of complications and referral to larger health care centres

Question 13

What is a skilled birth attendant

Answer 13

• these are trained and educated health professionals that have access to equipment and medications
• they are found mainly in referral centres and develop birth and emergency plans and monitor progress of the birth and are able to identify complications early
• SBA are also able to provide antenatal care including antiretroviral care in HIV pt

Question 14

What is the negative of using a SBA instead of a TBA

Answer 14

The SBA is not a community member so there may be feelings of disparity, abuse, dispassion of the carer

Question 15

What are the factors needing to be considered when preparing for a normal birth (ie. birth preparedness aspect of the program)

Answer 15

• place of delivery
• access to a skilled attendant
• nutrition of the mother- cultural practices may limit the food pregnant women are able to intake
• Essential items
• Finance- will the woman have enough money to travel/receive care if needed–> do they have emergency funds in case of emergency
• do they have transport if they need to travel to the net time
• are there blood donors available if the mother haemorrhages

Question 16

What are the objects needed to provide basic essential obstetric care

Answer 16

Parenteral antibiotics –amp/gent

• Parenteral oxytocic drugs (causes uterine contraction→ given to prevent haemorrhage)
• Parenteral sedatives for pre-eclampsia and eclampsia (MgSO4) ( to control convulsions that may occur- prevent eclampsia related death)→ example of a best-buy
• Manual removal of placenta
• Removal of retained products of conception (need pain relief)
• Assisted vaginal delivery –vacuum extraction

Question 17

What are the extra factors needed to provide comprehensive essential obstetric care

Answer 17

All of the basic care equipment plus:

• Surgery
• Anaesthesia
• Safe blood transfusio

Question 18

What SDG’s are relevant to childbearing and the health of women

Answer 18

SDG 3: Good health and Well-being
Target 3.1= By 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births
SDG5; Achieve gender equity and empower women and girls
–> these were initially part of MDG–> MDG5=Improve maternal health

Question 19

What is a fistula and why does it occur

Answer 19

Fistula→ abnormal connection→ most commonly between the bladder and vagina and potentially the rectum and the vagina→ causing fecal and urinary incontinence
-occurs due to prolonged and complicated labour

Question 20

What are the complications of fistulas

Answer 20

• causes social isolation and shame→ women face barriers in receiving care due to distance, lack of services (lots of hospitals turn these women away) and financial costs
• severely decreases QOL → decreases womens ability to work and provide for her family, causes mental depression (combination of loss of baby, loss of normal physiological functions and loss of ‘being a women’)
• can also predispose to infection

Question 21

What are the health implications of human trafficking

Answer 21

Physical= STI, physical abuse, malnutrition, reproductive issues, infectious diseases
Psychological= PTSD, Anxiety, Depression
Social= exclusion and isolation, poverty, homelessness

Question 22

What are the immediate health implications of FGM

Answer 22

Severe pain, trauma, haemorrhage and shock, infection (tetanus), abnormal wound healing (scarring/keloid)

Question 23

What are the long term complications of FGM

Answer 23

pain (urinary and menstrual), UTI, STI, prolonged labour, postpartum haemorrhage, perineal trauma, maternal and infant mortality, anxiety, depression, PTSD

Question 24

The drug of choice for managing post partum haemorrhage

Answer 24

oxytocic

Question 25

Using 2 examples compare and contrast the work of a skilled birth attendant and a traditional birth attendant

Answer 25

• limited antenatal care with TBA
• SBA are able to handle complications
• TBA practice within cultural norms→ deliver holistic care