Monday, June 30, 2014

Reaching all mothers and newborns with care

A mother with her one day old baby in Port Moresby Hospital, Papua New Guinea
© UNICEF/2014/Justine Nanking
A new baby is such a bundle of joy for the family. The very thing I miss about working as an obstetrician is the sheer delight of being part of the nature’s miracle. Recently, as UNICEF Maternal and Child Health Specialist, I visited a hospital in Ulaanbaatar, where I met Mandel (not her real name), a young woman suffering from obstructed labour.

She had just safely delivered her baby thanks to a chain of effective interventions which allows for early recognition and referral of pregnancy complications that UNICEF helped to put in place. In moments like this, I am most proud of what we do.

Despite immense progress around the world, still too many mothers and their newborns do not receive the services they need at the time around birth, when they are at the greatest risk of dying. In East Asia and Pacific, 253,200 newborns die each year. Most of these deaths are preventable and most occur in poor, remote, rural or minority communities.

With the launch of the Global Every Newborn Care Action Plan we hope that this will inspire stronger and concerted effort to reach all mothers and babies with improved practices that are informed by latest evidence.

The time of labour and the first few minutes of life are critical to babies’ health. Recent findings have shown that many old clinical practices in newborn care are not useful as previously believed and can be even harmful.

The new evidence suggests, for example, that delaying the cutting of umbilical cord prevents anaemia. It is now also recommended that babies are dried immediately and put in skin-to-skin contact with their mothers to stabilize the newborns’ body temperature.

These practices are not costly – in fact, they save costs of unnecessary use of hospital nurseries and baby warmers. But they definitely need a change of hearts and minds of the doctors, nurses and midwives working in the maternity units.

A mother and a newborn at Tu Du Hospital in Ho Chi Minh City, Viet Nam
© UNICEF/2014/Nabila Zaka
Even when best possible care is provided before and immediately after birth, a small percentage of babies will have medical problems that need specialized care. Some will not be able to breathe and will need resuscitation, others may have infection and would need antibiotics, and some will be born premature or at low birth weight. The global newborn action plan provides guidance on comprehensive care of all babies.

To be able to implement the global action plan so that all mothers and babies benefit from best care they can get, we need to understand what obstacles are slowing down the progress. UNICEF is supporting governments in their national assessments that will inform individual national action plans. When we know what is to be done, how it will be done and how much resources are required, this gives a push to the action on the ground.

We need to make sure that the change is sustainable so that not only mothers and babies today but also tomorrow can benefit from the best care possible. That is why, in May this year, we organized a regional training on newborn care interventions. Countries were represented by teams composed of health ministry officials, obstetricians, paediatricians and midwives, along with specialists from UNICEF and World Health Organization.

The training, which included practical, role-play exercises, and a hospital visit helped the participants understand what concrete actions were needed, so that they can start implementing their national action plans back in their home countries.

As these national plans will be rolled out, hopefully the dream of having a healthy start for every newborn will soon be a reality. As I write this, Dr. Sui Freda Walai, from Papua New Guinea Department of Health is full of hope, too, seeing the good momentum in her own country. She said, “Visiting the labour rooms was an eye opener. A lot of work has to be done but we have begun the journey for newborn survival for sure.”

The author
Nabila Zaka is Maternal and Child Health Specialist for UNICEF East Asia and Pacific

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