The aim of the Safe Birth Place project is to develop an effective, risk based referral process for pregnant women in rural Ethiopia so that they can deliver their babies safely and in the most appropriate location. The project began in October 2011.
Ability to access timely and appropriate care from skilled maternal health professionals is central to reducing maternal mortality and reducing obstetric complications. At present 91% of deliveries in Ethiopia take place at home and information is not available on how many of these women would benefit from a higher level of care. The World Health Organisation (WHO) gives an estimated caesarean section need of 5-15%. Statistics for the region where our pilot project is located give a caesarean section rate of only 0.4% indicating lack of availability and/or of take up of the procedure.
Although women in Ethiopia are encouraged to deliver their baby in a health facility, just one in ten women actually manage to achieve this. This is not surprising as many women have to walk for 2-3 hours just to reach their nearest health centre. If they are suffering from serious complications of pregnancy they may need to travel a further 3 hours on very limited public transport in order to reach a hospital.
At May 2012, over 600 women have been seen at the ‘risk clinics’ with 238 identified as being at risk of a potentially life-threatening condition during childbirth
The Safe Birth Place project has developed and implemented a straight forward 10 item risk probability scoring system which is being used to direct women into the most appropriate level of maternity care. The scoring system is evidence based and has been developed by internationally recognised experts in obstetrics. Women are assessed at their 36 week antenatal appointment. Risk factors include blood pressure, foetal presentation, placenta position, previous obstetric history, head engagement and multiple pregnancy.
The project is based in the West Wollega area of Ethiopia and covers the four health districts of Homa, Haru, Nole and Genji.
Two or three times a week, the Maternity Worldwide volunteer project manager travels to community based health centres and health posts, working with locally based staff to deliver the antenatal risk clinic. Information about the woman’s previous and current pregnancy is considered alongside clinical measures, such as the blood pressure, urine test and findings from an ultrasound scan. Whilst Ethiopian community health centres are not equipped to provide high-tech care, the Maternity Worldwide volunteer travels with a portable ultrasound machine, which is only slightly larger than an iPhone. This is used to identify risks such as twins and poor baby or placenta position. The added bonus of offering women an ultrasound scan encourages them to make the long journey by foot to attend for antenatal care.
Women identified as being at medium or high risk of a complication are advised of the exact nature of the risk, with the information being made very relevant to her individual situation. The woman is told why it is important for her to deliver in either the health centre or the hospital and, where necessary, funding arrangements are provided to allow her to easily access the care that she needs. By providing this care, women are more likely to accept the advice and make arrangements for their delivery to be in a ‘safe birth place’.
The pilot project is currently following up the women identified as medium and high risk to find out where they delivered their baby and the outcome from this. So far, there have been some very positive findings with women seemingly accepting the advice and as a result, having a safe delivery. Over the next few months we will be carrying out further analysis to help get a better understanding of the effectiveness of what initially appears to be promising work.