Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings.

UNLABELLED: Key lessons can be drawn from innovative approaches that have been implemented to ensure access to better antenatal care (ANC) and postnatal care (PNC). This paper examines the successes and challenges of ANC and PNC delivery models in several settings around the world; discusses the lessons to be learned from them; and makes recommendations for future programmes. Based on this review, we conclude that close monitoring of ANC and PNC quality and delivery models, health workforce support, appropriate use of electronic technologies, integrated care, a woman-friendly perspective, and adequate infrastructure are key elements of successful programmes that benefit the health and wellbeing of women, their newborns and families. However, a full evaluation of care delivery models is needed to establish their acceptability, accessibility, availability and quality. TWEETABLE ABSTRACT: New paper examines global innovations in antenatal/postnatal care @MHTF @ICS_Integrare #MNCH #healthsystems.

Human resources and access to maternal health care.

The lack of human resources is one of the main bottlenecks to achieving the Millennium Development Goals on maternal and child health. A coherent national policy, recognized across government, needs to be in place to overcome this especially in countries severely affected by HIV/AIDS. Such a policy should cover selection of pre-service students, the qualifications of trainers and training sites, supportive supervision, career path development, a package of carefully thought-out incentives for the retention of staff, strategies for interaction with communities, and an agreed-upon health staff HIV/AIDS policy. Without such coherent human resource planning, a large number of countries will fail to reduce maternal and newborn mortality.

Violence against women--what are ICM and its member associations doing about it?

Midwives are in a key position to address issues surrounding violence against women (VAW). The International Confederation of Midwives is committed to keeping VAW on the world's health agenda and make sure all the issues receive the necessary attention.

Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands.

BACKGROUND: Pregnant women are encouraged to book for antenatal care. However, little is known about the contents of antenatal care, in particular regarding various test procedures. The present descriptive study was conducted to assess the variation in standard test procedures in antenatal care in The Netherlands. METHODS: A nationwide structured survey by mailed questionnaire was carried out among specialist obstetricians and midwives in The Netherlands. Representatives of each obstetric practice registered with the Dutch Society of Obstetrics and Gynecology (n=132) and a sample of midwives registered with the Dutch Society of Midwives (n=394) were invited to report the standard policy of tests routinely used for antenatal care in their own setting. Furthermore, they were asked to report their views on the potential impact of the antenatal care program on pregnancy outcome. RESULTS: Complete information was available from 105 specialist obstetricians (80%) and 281 midwives (71%). The assessment of maternal blood pressure and weight are reportedly the commonest procedures routinely conducted during the antenatal period. However, within each profession reported definitions and implications of abnormal findings vary markedly, especially in the fields of identification and management of hypertensive disorders in pregnancy. Serial examination of the cervix is not standard policy among both groups. With respect to laboratory tests, considerable intra- and interprofessional variations are reported, in particular those for maternal serum glucose, rubella antibody titer and urinary dipstick for glucose and protein. As to standard ultrasound policies, wide intra- and interprofessional variations are noted. Seventy-two specialist obstetricians (68%) and 92 midwives (33%) routinely estimate the duration of gestation by ultrasound in pregnant women (p<0.001). A fetal anomaly scan at about 18-20 weeks' gestation is routinely offered to pregnant women by 31 specialist obstetricians (30%) and 44 midwives (16%) (p<0.01); 29 obstetricians (28%) and 11 midwives (4%) reportedly use ultrasound in all pregnant women for the detection of fetal growth restriction (p<0.001). Overall, midwives have a more optimistic view about the impact of antenatal care on pregnancy outcome than obstetricians. CONCLUSIONS: Although the standard package of antenatal care provided by both specialist obstetricians and midwives in The Netherlands seems to be relatively uniform, wide intra- and interprofessional variations exist with respect to (1) the application of tests in terms of recommendations to test some or all pregnant women, (2) defining normal from abnormal and (3) potential implications of abnormal findings.