Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities – A qualitative case study in Bangladesh

Abstract

Background: Prompt and efficient identification, referral of pregnancy related complications and emergencies are key factors to the reduction of maternal and newborn morbidity and mortality. As a response to this critical need, a midwifery led continuum of reproductive health care was introduced in five teagardens in the Sylhet division, Bangladesh during 2016. Within this intervention, professional midwives provided reproductive healthcare to pregnant teagarden women in the community. This study evaluates the effect of the referral of pregnancy related complications. Methods: A qualitative case study design by reviewing records retrospectively was used to explore the effect of deploying midwives on referrals of pregnancy related complications from the selected teagardens to the referral health facilities in Moulvibazar district of the Sylhet division during 2016. In depth analyses was also performed on 15 randomly selected cases to understand the facts behind the referral. Results: Out of a total population of 450 pregnant women identified by the midwives, 72 complicated mothers were referred from the five teagardens to the facilities. 76.4% of mothers were referred to conduct delivery at facilities, and 31.1% of them were referred with the complication of prolonged labour. Other major complications were pre-eclampsia (17.8%), retention of the placenta with post-partum hemorrhage (11.1%) and premature rupture of the membrane (8.9%). About 60% of complicated mothers were referred to the primary health care centre, and among them 14% of mothers were delivered by caesarean section. 94% deliveries resulted in livebirths and only 6% were stillbirths. Conclusions: This study reveals that early detection of pregnancy complications by skilled professionals and timely referral to a facility is beneficial in saving the majority of baby’s as well as mother’s lives in resource-poor teagardens with a considerable access barrier to health facilities.

Assessing the effect of the Expanding Maternal and Neonatal Survival program on improving stabilization and referral for maternal and newborn complications in Indonesia

“…These factors make it hard to disentangle the contribution of each component of the intervention. A recent study in Bangladesh, also highlighted that important factors in a successful referral included early detection of complications experienced by mothers, quality support by a midwife, and quick transfer to the referral center. Our study findings were consistent with these findings and provide further evidence for the utility of an automated electronic communication system to serve as an assist in the timely referral and management of obstetric and newborn complications along with the overall positive impact of the EMAS‐related referral interventions.…”

“…A recent study in Bangladesh, 34 also highlighted that important factors in a successful referral included early detection of complications experienced by mothers, quality support by a midwife, and quick transfer to the referral center. Our study findings were consistent with these findings and provide further evidence for the utility of an automated elec-…”

Presence of doctors and obstetrician/gynecologists for patients with maternal complications in hospitals in six provinces of Indonesia

“…These challenges are not unique to Indonesia. A study conducted in Bangladesh found an absence rate of 40% for doctors in subdistrict‐level hospitals and 74% in health centers. A study in 78 CEmONC facilities across Afghanistan found that only 49% reported having at least one ob/gyn on staff while 95% had at least one medical doctor on staff.…”

Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus

“…Furthermore, some additional proxy indicators measure whether cases are managed better, which is assumed to improve outcomes, for example, early referral if prolonged labour or antenatal transfer to higher level of neonatal care. 108 In practice, they will need to be mapped to the local context, as the appropriate time for referral in case of, for example, prolonged labour varies depending on the location and context (availability of medication and of the facility.…”

“…108 Examples of proxy indicators are: antenatal transfer to higher level of neonatal care, early identification of danger signs predicting severe new-born illness to be assessed during postnatal contacts (predictive for need for hospitalisation).…”