Barriers to Obstetric Care among Maternal Near Misses

Background. There are several factors in the healthcare system that may influence a woman's ability to access appropriate obstetric care.Objective. To determine the delays/barriers in providing obstetric care to women who classified as a maternal near-miss. Methods. This was a descriptive observational study at Steve Biko Academic Hospital; a tertiary referral hospital in Pretoria; South Africa. One hundred maternal near-misses were prospectively identified using the World Health Organization criteria. The 'three-delays model' was used to identify the phases of delay in the health system and recorded by the doctor caring for the patient.Results. One or more factors causing a delay in accessing care were identified in 83% of near-miss cases. Phase I and III delays were the most important causes of barriers. Lack of knowledge of the problem (40%) and inadequate antenatal care (37%) were important first-phase delays. Delay in patient admission; referral and treatment (37%) and substandard care (36%) were problems encountered within the health system. The above causes were also the most important factors causing delays for the leading causes of maternal near-misses - obstetric haemorrhage; hypertension/pre-eclampsia; and medical and surgical conditions.Conclusions. Maternal morbidity and mortality rates may be reduced by educating the community about symptoms and complications related to pregnancy. Training healthcare workers to identify and manage obstetric emergencies is also important. The frequency of antenatal visits should be revised; with additional visits in the third trimester allowing more opportunities for blood pressure to be checked and for identifying hypertension

The JC Coetzee Memorial Lecture : Maternal Health in Primary Care: are we Providing Safe Maternity Units?

The Service Level Agreement of the Minister of Health provides; as one of its aims; to reduce the number of deaths of pregnant women and their babies. Over 60 of the births in South Africa; one third of all maternal deaths; and 62 of the perinatal deaths; occur at the prilevel of care. The numbers are far too high for a service which is supposed to cater to low-risk maternity cases. The Lives Saved Tool is a programme which can model the potential number of lives that can be saved depending on the pattern of disease; interventions used and coverage of these interventions. This tool has been used to select which interventions would be most effective in reducing maternal and perinatal mortality. If the effects of human immunodeficiency virus are excluded; the intervention that would save the most lives would be that of improving maternal and neonatal emergency care. A survey was conducted on the ability of healthcare facilities in 12 districts to provide essential emergency care services to pregnant women and their babies. It was found that the vast majority of the community healthcare facilities could not provide the seven lifesaving services needed for basic emergency obstetric care; and less than half of the district hospitals could provide the nine life-saving services required for comprehensive emergency obstetric care. Lack of knowledgeable and skilled staff; inadequate equipment and human resources; as well as poor emergency transport services at the sites are the main reasons for these unsafe maternity units. Realignment of the services might improve the ability of the districts to provide a safe maternity service