From 4-6 May, the Asia Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care is being held in Dhaka, Bangladesh, with an opening ceremony and optional supplementary sessions on 3 May 2012. Organized by the Government of Bangladesh, MCHIP, and the Bill & Melinda Gates Foundation-supported Oxytocin Initiative, in collaboration with Women Deliver, VSI, FIGO, and ICM, this three-day meeting will focus on postpartum hemorrhage (PPH), pre-eclampsia/ eclampsia (PE/E) and other aspects of maternal and newborn health.

For more information on the conference, click here. A live webcast begins May 4th, and related resources -- included presentations -- can be found here. Please also connect with the conference via Facebook and Twitter!

Below is the first of a series of blogs from conference attendees. Please find other blogs in the series by:
Ms. Alice Levisay on expectations of the conference,
Rae Galloway and Dr. Justine Kavle on introducing and implementing calcium supplementation to prevent pre-eclampsia,
Dr. Nuriye Hodoglugil on misoprostol use and acceptance, and
Ms. Pashtoon Azfar on the role and importance of midwives.

---

I’m pleased that the meeting began with a sense of “congratulations” and “well done!” as the first panel of speakers discussed substantial improvements in maternal and newborn health around the world in the last decade. The global health community has worked hard to support these improvements.

In addition to improvements in Bangladesh, we learned of efforts and results in Cambodia, Nepal and Afghanistan. But we all know that more must be done to address the causes of mortality, to improve quality, and to reach more marginalized populations. As Monir Islam of the World Health Organization (WHO) reminded us, currently an estimated 358,000 women die each year from complications of pregnancy.

There is momentum and we need to seize it. A lot of the reduction in maternal death has come from Asia, making this Dhaka meeting all the more critical at this point in time. We must learn from the progress made by our colleagues here—including the Bangladesh government and community—and discuss together what more needs to be done. For instance, we discussed implementation of WHO’s new global guidelines on postpartum hemorrhage prevention and management.  Based on evidence from both well designed clinical trials and programmatic evaluations, these guidelines reflect more of what is going on in the health service delivery system and, in some cases, simplify things.

As an example, the recommendations support what we now know as the most important component of Active Management of Third Stage Labor (AMTSL) – the administration of a uterotonic immediately after birth. Also supported is the recommendation to delay cord clamping to reduce infant anemia, thus allowing more focus on the mother and the needs of the newborn. In most cases, this allows us to put the baby on the maternal abdomen and focus on elements of immediate newborn care first.

I also welcome the recommendation to make fundal massage optional. I think we must be vigilant, must check the fundus to ensure that it is well contracted, and carefully monitor the woman postpartum. But I think it is disturbing to both the mother and the newborn if we vigorously massage the fundus, even if there is no bleeding. It is painful and it doesn’t allow the mother to focus on the newborn. I often see the mother needing to pass off the baby due to the discomfort, which disrupts that early initiation of breastfeeding.

Misoprostol fits with the recommendation to ensure that every woman is given a uterotonic immediately following birth, regardless if she delivers at home or a facility. And the experiences that were described today from Nepal and Bangladesh show us that not only can this be done, but that it can be done on a large scale. This, coupled with experiences from India and Afghanistan, among other countries, is useful for mapping the way to greater impact.

We see that the WHO recommendations support the administration of the drug at the community level by lay health workers. Where their recommendations fall short, however, is in regard to advanced distribution. The new WHO guidelines state that there is not enough evidence yet to support advanced distribution for self-administration at the moment after birth. I think it will be these large and innovative programs in Asia that will help us get that much needed evidence, and in two years’ time we will see a strong recommendation in favor of the practice.


Dr. Jeffrey Smith
MCHIP Maternal Health Team Leader