The 26th Conference on Priorities in Perinatal Care in South Africa was held under the auspices of the Priorities in Perinatal Care Association and sponsored by Abbott Laboratories sa (Pty) Ltd

Staffing norms were set for this context that included the training of 1600 obstetric nurses, 600 midwives and 100 daulas and more obstetricians by 2006 and the setting of an education policy for the training and formation of skilled staff through a 18 months internship. Girot, et al (2005) report a reduction in maternal mortality when the style of maternal care was altered in collaboration with international support.

Conclusion

The conclusion is that South Africa has 54,000 registered midwives. The number of midwives directly involved in midwifery is unknown. SA does not have an evidence-based strategy or norms and standards development for the midwifery workforce, suitable for the needs of the context. The lack of a reliable database of midwives that are directly involved in maternal healthcare makes the efforts to determine norms and standards nil and void and impact negatively on the ability to meet the MDG’s for 2020.

Recommendations

It is imperative that South Africa determines the required philosophy of care suitable and in line with international trends. This includes a collaborative approach of the three main pillars for effective workforce governance of the WHO (2006a: 123) in ‘Formulating National health workforce strategies’ namely command and control approach (institutional regulation), self-regulating professional societies, and civil society organizations as aspects of governance of the workforce. The health care system, the profession and civil society need to be involved in the decision-making of the type of services and midwifery needed for this context to create the enabling environment conducive for quality of care. The specification of an enabling environment should result in improved levels of satisfaction, cost effective service delivery and the reduction of maternal mortality. This should be enforced through regulation. Many evidence-based options have been tested, is operational and available.

SESSION 5: PAPER 8
ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR: A CLINICAL TUTORIAL CD-ROM
James A. Litch, MD, DTMH, PATH; Dolly Nyasulu, PATH; Joseph Titus, MBChB, KwaZulu-Natal Department of Health; Claire Mooideen, PATH; Steve Brooke, MBA, PATH; Rachel A. Bishop, MBChB, DTMH, University of Washington; and Michael Tuggy, MD, Swedish Medical Center
Postpartum haemorrhage is unpredictable, so every woman is at risk. The active management of the third stage of labour (AMTSL) is a combination of actions to speed the delivery of the placenta and prevent postpartum haemorrhage. Through simple actions, trained providers can prevent postpartum haemorrhage and play a vital role in saving women’s lives. There are three key steps to ATMSL: (1) Having first palpated the uterus to check there is no other baby, give a uterotonic drug within 1 minute of delivery. Oxytocin is the drug of choice given intramuscularly. (2) Apply controlled cord traction. Apply firm pressure on the lower segment of the contracted uterus in an upward direction, while at the same time pulling with a firm, steady tension on the cord in a downward direction. (3) Immediately after the delivery of the placenta and membranes, begin to massage the uterus and continue until it is firm. Remembering these steps with every delivery will save women’s lives. Two large trials in the United Kingdom have consistently shown that active rather than physiologic management reduces the length of the third stage, the incidence of postpartum haemorrhage, and the need for blood transfusion. For every 12 women receiving active management, one postpartum haemorrhage is prevented.
Active Management of the Third Stage of Labour: A Clinical Tutorial CD-ROM was created by the PATH Maternal and Newborn Technology Initiative (MNTI Project) in partnership with the KwaZulu-Natal Department of Health to standardize the intrapartum care provided by birth attendants in South Africa to save the lives of mothers and newborns. The CD-ROM presents the key information, skills, and practices required of birth attendants to routinely offer women AMTSL for the prevention of postpartum haemorrhage in the context of normal labour. The material is presented in two sections: the first, a 12-minute clinical tutorial that describes and demonstrates the steps of this simple, lifesaving procedure, using actual clinical sequences and supporting illustrations, and a second, 14-minute tutorial of supporting resources broken down into five core topics that provide essential information to deliver this procedure safely and effectively during routine intrapartum and immediate postpartum care. The core topics are Evidence and Review of AMTSL, Causes and Prevention of Postpartum Haemorrhage, Uterotonic Drugs, Infection Prevention, and Essential Newborn Care. This clinical training CD-ROM was made possible through support provided by The Atlantic Philanthropies to PATH in partnership with the KwaZulu-Natal Department of Health.

SESSION 6: PAPER 1
EVALUATION OF KANGAROO MOTHER CARE IN MALAWI
Reuben Ligowe¹, Anne-Marie Bergh,² Elise van Rooyen,² Joy Lawn,³ Evelyn Zimba,¹ George Chiundu<sup>1

1</sup> Save the Children Malawi Country Office; ² MRC Unit for Maternal and Infant Health Care Strategies and University of Pretoria; ³ Save the Children/Saving Newborn Lives

Background

Of the 1.2 million annual infant deaths in Africa in the first month of life, 27% are directly due to low birth weight (LBW) and/or preterm birth. Infections are also a major risk factor for the death of these infants. Malawi has a LBW rate of 20% and although remarkable progress has been made in reducing under-five mortality, there has been very little reduction in neonatal deaths (27/1000 live births).

Many LBW and preterm infants could be saved without intensive care, by keeping them warm in the skin-to-skin position, feeding them regularly, preventing infections and recognising and managing complications such as respiratory distress syndrome, infections and jaundice timely. Kangaroo mother care (KMC) is a well-known low-cost and feasible method of caring for babies, especially those that are preterm, at all levels of care and in all settings. Scaling up the implementation of KMC and Essential Newborn Care (ENC) to district level is one of the Malawian Ministry of Health’s (MoH) key priority responses in their Road Map for Maternal and Newborn Health, which is linked to the national Essential Health Package.

Malawi is one of the few African countries with a history of systematic implementation of KMC. In 1999 a KMC unit was established at the Zomba Central Hospital with European Union (EU) funding. Between 2002 and 2004, Save the Children worked with the MoH to develop an ENC course, which included a brief introduction to KMC. This course was widely implemented in Malawi and incorporated into pre-service training at the College of Nursing. At the same time seven hospitals received some form of additional support for the introduction of KMC. Furthermore, a five-day KMC workshop was offered separately at Zomba Central Hospital (ZCH) and in 2005 a national policy for KMC was developed.