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Department of Reproductive Health and Research (RHR), World Health Organization

Managing Complications in Pregnancy and Childbirth

A guide for midwives and doctors 

 


Section 1 - Clinical Principles


Talking with women and their families

Pregnancy is typically a time of joy and anticipation. It can also be a time of anxiety and concern. Talking effectively with a woman and her family can help build the woman’s trust and confidence in her health care providers.

Women who develop complications may have difficulty talking to the provider and explaining their problem. It is the responsibility of the entire health care team to speak with the woman respectfully and put her at ease. Focusing on the woman means that the health care provider and staff: 

  • respect the woman’s dignity and right to privacy; 

  • are sensitive and responsive to the woman’s needs;

  • are non-judgmental about the decisions that the woman and her family have made thus far regarding her care.

It is understandable to disagree with a woman’s risky behaviour or a decision which has resulted in a delay in seeking care. It is not acceptable, however, to show disrespect for a woman or disregard for a medical condition that is a result of her behaviour. Provide corrective counselling after the complication has been dealt with, not before or during management of the problem.

 

RIGHTS OF WOMEN

 Providers should be aware of the rights of women when receiving maternity care services:

  • Every woman receiving care has a right to information about her health.

  • Every woman has the right to discuss her concerns in an environment in which she feels confident.

  • A woman (or her family, if necessary) should know in advance the type of procedure that is going to be performed.

  • Procedures should be conducted in an environment (e.g. labour ward) in which the woman’s right to privacy is respected.

  • A woman should be made to feel as comfortable as possible when receiving services.

  • The woman has a right to express her views about the service she receives.  

When a provider talks to a woman about her pregnancy or a complication, s/he should use basic communication techniques. These techniques help the provider establish an honest, caring and trusting relationship with the woman. If a woman trusts the provider and feels that s/he has the best interests of the woman at heart, she will be more likely to return to the facility for delivery or come early if there is a complication. 

 

COMMUNICATION TECHNIQUES

Speak in a calm, quiet manner and assure the woman that the conversation is confidential. Be sensitive to any cultural or religious considerations and respect her views. In addition, providers should:

  • Encourage the woman and her family to speak honestly and completely about events surrounding the complication.

  • Listen to what the woman and her family have to say and encourage them to express their concerns; try not to interrupt.

  • Respect the woman’s sense of privacy and modesty by closing the door or drawing curtains around the examination table.

  • Let the woman know that she is being listened to and understood.

  • Use supportive nonverbal communication such as nodding and smiling.

  • Answer the woman’s questions directly in a calm, reassuring manner.

  • Explain what steps will be taken to manage the situation or complication.

  • Ask the woman to repeat back to you the key points to assure her understanding.

If a woman must undergo a surgical procedure, explain to her the nature of the procedure and its risks and help to reduce her anxiety. Women who are extremely anxious have a more difficult time during surgery and recovery. 

For more information on providing emotional support during an emergency

 

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Clinical principles

Rapid initial assessment

Talking with women and their families

Emotional and psychological support

Emergencies

General care principles

Clinical use of blood, blood products and replacement fluids

Antibiotic therapy

Anaesthesia and analgesia

Operative care principles

Normal Labour and childbirth

Newborn care principles

Provider and community linkages

Symptoms

Shock

Vaginal bleeding in early pregnancy

Vaginal bleeding in later pregnancy and labour

Vaginal bleeding after childbirth

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure

Unsatisfactory progress of Labour

Malpositions and malpresentations

Shoulder dystocia

Labour with an overdistended uterus

Labour with a scarred uterus

Fetal distress in Labour

Prolapsed cord

Fever during pregnancy and labour

Fever after childbirth

Abdominal pain in early pregnancy

Abdominal pain in later pregnancy and after childbirth

Difficulty in breathing

Loss of fetal movements

Prelabour rupture of membranes

Immediate newborn conditions or problems

Procedures

Paracervical block

Pudendal block

Local anaesthesia for caesaran section

Spinal (subarachnoid) anaesthesia

Ketamine

External version

Induction and augmentation of labour

Vacuum extraction

Forceps delivery

Caesarean section

Symphysontomy

Craniotomy and craniocentesis

Dilatation and curettage

Manual vacuum aspiration

Culdocentesis and colpotomy

Episiotomy

Manual removal of placenta

Repair of cervical tears

Repair of vaginal and perinetal tears

Correcting uterine inversion

Repair of ruptured uterus

Uterine and utero-ovarian artery ligation

Postpartum hysterectomy

Salpingectomy for ectopic pregnancuy

Appendix

 

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