Maternal health

EMTs provide adequate and respectful reproductive, maternal and neonatal health care in any deployment.

Maternal health refers in this context to care organized for, and provided to, all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during pregnancy, labour, childbirth and immediate puerperium.

1. Basic emergency obstetric and neonatal care

• • Provide care for any uncomplicated normal delivery (midwifery level of care). Midwives and doctors experienced in maternal and child health should form an integrated part of each team.
  • Transfer complicated maternal cases (see chapter on referral) to Type
    2 or 3 facilities or equivalent for comprehensive emergency obstetric and neonatal care.
  • Dedicate private area for stabilization, emergency delivery (if required),
    or protection management. This area fulfils minimum criteria for privacy, protection, temperature, light, space and access to equipment and supplies.
  • Document labour and care in general, for example, by using the WHO partograph. EMTs register births as per national protocol and give at a minimum a birth-notification form to the mother.
  • Be able to provide parenteral antibiotics, uterotonics, eclampsia treatment, and carry out basic maternal and neonatal resuscitation.
  • Support joint accommodation of mother and newborn and breastfeeding immediately after birth.

2. Comprehensive emergency obstetric and neonatal care.

Type 2 and 3

• • Carry out assisted vaginal delivery and caesarean section, manual removal of placenta and management of incomplete abortion (medical or surgical).
  • Manage common obstetric complications: pre-eclampsia, eclampsia, multiple pregnancy, malpresentation, malposition, perineal repair, sepsis, antepartum haemorrhage, postpartum haemorrhage, neonatal resuscitation, and the complications of those who have undergone genital mutilation. Type 3 can manage all major obstetric complications.
  • Provide an antenatal and postnatal inpatient area and outpatient antenatal care area as well as a private dedicated area within the EMT for maternity care, close to the operating theatre and paediatric ward, including a specific maternity delivery bed. These areas fulfil minimum criteria for privacy, protection, temperature, light, space, and access to equipment and supplies.

Type 3

• • Offer both neonatal and maternal intensive care support and an ICU with the potential to manage maternal and neonatal patients including appropriate climate control, the ability to screen off or darken/quieten an area for severe eclampsia, and the inclusion of a neonatal or paediatric nurse on the team.
  • An obstetric specialist and two midwives are also included in the team.

3. Care for survivors of sexual assault

• • Offer or ensure access to emergency contraception to the fullest extent of the law in the context within which the team is operating.
  • Provide post-exposure prophylaxis for HIV (PEP)26 and tetanus vaccines.
  • Be aware of protection-related services, specifically surrounding sexual and gender-based violence (SGBV). All staff has received awareness training on SGVB.

1. Consider extended stay care needs as labour may take place at any time and may take longer than the operating hours of dawn to dusk provision (Type 1 Fixed).
2. EMTs with appropriate competences and capacity are encouraged to include simple perineal repair, manual vacuum aspiration, manual removal of placenta and assisted vaginal delivery as part of the services available at Type 1 level.
3. Ultrasound skills and equipment.
4. Provide a warmed neonatal resuscitation table.
5. Consider contraceptive provision in some form if allowed in-country. If not provided by EMT, direct patients to the nearest appropriate family-planning services available.
6. Provide long-acting reversible contraception (LARC), including intrauterine devices (IUDs), if usually available in the context where deployed, particularly for EMTs working beyond the initial emergency phase.
7. Though it is accepted that a general surgeon trained and experienced in performing caesarean sections is on the team, it is strongly recommended that Type 2 EMTs also include an obstetric specialist and two midwives.

Develop SOPs for conditions with which the team is less familiar and ensure adequate references are available for the clinical team, including support for survivors of SGBV.