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Last Updated: Saturday, 2 September 2006, 00:56 GMT 01:56 UK
Doctors aim to make global births safer
By Jane Elliott
Health reporter, BBC News

Nigerian ward
They hope the manual will enable safer births

About 60m mothers in the developing world give birth at home every year without a skilled person to help.

More than half a million women die each year through pregnancy-related conditions, because they do not have access to the most basic care.

In an effort to make pregnancy and giving birth safer, three leading medical organisations have teamed up to produce a practical birth manual to be used by health workers in the developing world.

The manual has been produced by the Liverpool School of Tropical Medicine (LSTM) with the Liverpool Associates in Tropical Health and the Royal College of Obstetrics and Gynaecology (RCOG).

They hope the simplicity of the guide will ensure it can be used by everyone.


This is particularly important in some of the most rural areas, where one midwife could be struggling to cope with a variety of complicated pregnancies alone.

Dr Nynke van den  Broek
More than 80% of these deaths are caused by conditions which we are very able to prevent or treat - bleeding, obstructed labour, eclampsia, infection and unsafe abortions
Dr Nynke van den Broek

In addition, the partnership hopes to raise awareness about clinical standards and to encourage RCOG members to volunteer their expertise to developing countries.

They hope this will help improve the quality of antenatal delivery and postnatal services.

The organisations are already involved in a variety of safe motherhood programmes including in Nigeria, Kenya and Malawi, countries with some of the highest maternal mortality rates in the world.

Health workers are also trained in reproductive medicine.


Dr Nynke van den Broek, senior clinical lecturer in reproductive health at the LSTM, said she hoped that by pooling resources they could cut maternal mortality.

"I was in Northern Nigeria recently and I saw a woman lying in a bed with pre-eclampsia.

"She and the baby did survive, but the doctors took some time to get the drugs she needed to treat her. If the doctors had been on the course and had the manual they would have known how to treat her sooner."

She said the women needed to know they would get the best possible care.

"More than 80% of these deaths are caused by conditions which we are very able to prevent or treat -bleeding, obstructed labour, eclampsia, infection and unsafe abortions.

"We hope our alliance will help to mobilise efforts so that we can make a dent in these horrific figures.

"The issue of women's health comes on and off the global agenda.

"What is clear is that all women need to have access to essential obstetric and gynaecological care. They need to have a skilled birth attendant - not just a relative.

"They also need to have a facility to which they can go if a problem develops. For a lot of women this is not yet available.

"Almost half the members of the RCOG are in developing countries. We hope that by pulling together our expertise, we can achieve something meaningful."

Dr van den Broek said they were currently training midwives, doctors and clinicians from over 10 different countries in how to use the skills from the manual.


Dr Monir Islam, of the World Health Organisation said the manual would be a vital resource for developing countries.

"It will make a significant difference. We can really prevent some of these deaths. If we can prevent the mothers from dying then the outlook is much better for the babies."

Charles Ameh, a Nigerian hospital medical doctor, who has been trained to use the manual said it would be very useful to medics at home.

Weighing babies
The manual is written in simple language

"I think it is a very good initiative.

"This is a small booklet with simple language. it will be easily understood and will be of a practical use for Africa."

Professor Jim Dornan, RCOG Vice President, agreed, saying the vast majority of maternal deaths were preventable by simply having appropriately trained staff with the correct equipment at the bedside.

"This will improve quality where it is needed by producing guidelines, standards of care and lifesaving skills courses that provide technical knowledge to empower those who have the ability to change health systems."

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