Home Births

Continuing substandard maternal and child health in developing countries, especially South Asia (Bangladesh, India and Pakistan) and Sub-Saharan Africa is of major public health concern among researchers and policy makers. Based on a demographic and health survey, the percentage of births assisted by Traditional birth attendants (TBAs) was ascertained to be highest in Asia (41%) . TBAs also provide on-going community health care services apart from assistance during delivery. There is evidence that certain practices adopted in home deliveries and delays in recognising and referral of complications can cause serious harm to mothers and babies WHO, 1999). Indeed throughout the 1970s and 1980s, the World Health Organisation (WHO) promoted the training of TBAs in Asia, Africa and Latin America to reduce the maternal mortality rate (MMR) , WHO, 2005). Traditional birth attendants training advocated safe and clean delivery through the ''three cleans'' programme (hand washing with soap, clean cord care, and clean surface), promoted awareness of the importance of breastfeeding and weighing babies, and addressed some of the unhygienic and harmful practices (WHO, 1993). Over time, training content changed and included various other aspects of reproductive health including family planning, HIV/AIDS prevention, oral rehydration, identification of risk, legal issues of female infanticide and referral. Since the 1990s TBA training has been increasingly seen as irrelevant and ineffective on the basis that the maternal mortality rate (MMR) in developing countries did not reduce. Hence, many donor agencies providing funding for TBA training withdrew funds, reallocating them to providing skilled attendants during delivery. But researchers have expressed concern that this shift in policy has taken place without adequate evidence on the relevance and effectiveness of the TBA training initiative .

Introduction: In Lao People's Democratic Republic, despite a policy to provide free maternal health services in healthcare facilities, many rural women continue to deliver at home, without a skilled birth attendant. These women are at high risk of postpartum haemorrhage, the leading cause of maternal mortality in the country. While women in remote areas continue to be unable to access facility-based birthing, interventions to reduce postpartum haemorrhage are a priority. This requires an understanding of how women and their families recognise and manage postpartum haemorrhage in home births. The purpose of Rural and Remote Health rrh.org.au

He qualified from Birmingham (UK) and trained in Paediatrics and Neonatology in Birmingham (UK), Sheffield (UK) and Melbourne (Australia). He was awarded MD in 1998. He led the HTA-funded PulseOx study between 2007 and 2011, which investigated test accuracy, health economics and the acceptability of pulse oximetry screening. He has published widely on pulse oximetry screening, including 3 systematic reviews (2007 [ADCFN] 2012 [Lancet] and 2018 [Cochrane library]). He advised the USA SACHDNC (the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children) committee prior to the introduction of screening for critical congenital heart defects in January 2011. He has worked with NIPE/NSC (the NHS newborn and infant physical examination/ National Screening Committee) UK since 2011 and was clinical lead for the UK pulse oximetry screening pilot study in 2015. He is a senior member of the European Workgroup on pulse oximetry screening, and published a European consensus statement in 2017. In the last five years, he has given over 30 overseas lectures across five continents and advised numerous organizations and countries regarding the introduction of screening. vii

Background Pakistan has a high rate of maternal and infant mortality, and a shortage of skilled birth attendants (SBAs). Many efforts have been made through the health sector and the international agencies to resolve the problem of both a high Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), but the desired outcomes have not been achieved so far. Literature shows that midwifery plays a significant role in the reduction of MMR and IMR in other parts of the world, and the implementation of a Midwifery-led Service Provider Model could help reduce these rates in Pakistan. This study aims to identify the factors affecting the development of Midwifery-led Service Provider Model in Pakistan. Methodology This was a quantitative, descriptive study conducted in the Pakistani districts of Chitral, Dera Ghazi Khan, Multan and Sahiwal. A sample of 48 midwives was selected through stratified random sampling from two health centres in Chitral, two government health centres and two private health centres in Dera Ghazi Khan, Multan, and Sahiwal, and two independent midwife practitioners in Multan were also included. Findings Factors were categorized under "Environment", "Empowerment" and "Encouragement" according to the model described by Marion-Davis. Factors identified under Environment include: autonomy, supervisor support and awards to work effectively; under Empowerment were core competencies and attitudes; and under Encouragement they were salary, opportunity for professional development, and availability of SBAs, equipment and essential drugs.

¿Es parir en casa feminista? Algunas reflexiones a partir de la atención domiciliaria al parto en Andalucía 1 La pregunta que titula esta comunicación puede considerarse una provocación. Lo que pretende señalar, sin embargo, es sobre todo la urgencia de una reflexión y de un debate acerca de la relación (problemática y altamente ambigua) entre parto en casa y feminismo. He identificado tres grandes aspectos o niveles en los que esta relación se manifiesta. Obviamente no dará tiempo en profundizar en todos ellos, pero creo que es posible trazar una panorámica suficientemente sugerente como para abrir un debate. Las fuentes utilizadas para este fin incluyen textos tanto relativos a los desarrollos teóricos feministas y producidos por colectivos feministas que actuaban en el estado español entre los años 70 y 80 del siglo pasado, como relativos más específicamente a la atención domiciliaria al parto (documentos de archivo de la Asociación Nacer en Casa 2 , contenidos en revistas especializadas, elaborados por los que constituirán los referentes teóricos para esta modalidad de asistencia). A ello se añaden las entrevistas a 19 matronas andaluzas que asisten partos en casa, cubriendo la casi totalidad de los equipos detectados en el territorio de estudio, y la observación desarrollada entre 2013 y 2015 en los cursos de preparación prenatal ofertados por un centro que se dedica a la asistencia domiciliaria al parto. Los tres aspectos que me propongo analizar son los siguientes: 1. Por un lado los usos de las palabras " feminista " y " feminismo " en el campo, por parte de las matronas que asisten en casa. 2. Por otro lado, algunos aspectos histórico-políticos, entendiendo con ello los orígenes del actual modelo domiciliario, y sus interconexiones con los movimientos feministas de los años 70-80, y en particular con aquellos grupos y colectivos que se centraban en la salud de las mujeres. 3. Por último, los relativos a la interacción entre teorías referentes para el modelo domiciliario de asistencia y los desarrollos teóricos feministas. La idea es de detenernos en cada uno, sirviéndonos de de ejemplos puntuales que puedan aclararlos.