Four Pillars of Safe Motherhood

Mother-Baby Package: Implementing Safe Motherhood in Countries
The basic principles of the Mother-Baby Package are neither new nor controversial - they are considered the “four pillars” of safe motherhood:
1. Family Planning - to ensure that individuals and couples have the information and services to plan the timing, number and spacing of pregnancies;
2. Antenatal Care - to prevent complications where possible and ensure that complications of pregnancy are detected early and treated appropriately;
3. Clean/Safe Delivery - to ensure that all birth attendants have the knowledge, skills and equipment to perform a clean and safe delivery and provide postpartum care to mother and baby;
4. Essential Obstetric Care - to ensure that essential care for high-risk pregnancies and complications is made available to all women who need it.

Maternal and newborn mortality and morbidity
Each year, more than 563,000 women worldwide die from complications of pregnancy and childbirth - that is one every minute! Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neo-natal deaths occur each year accounting for almost 40% of all deaths under 5 years. More than 75% of these deaths occur in Asia and sub-Saharan Africa. The health of the neonate is closely related to that of the mother and the majority of deaths in the first month of life could also be prevented if interventions were in place to ensure good maternal health.

Programme information
At least 80% of all maternal deaths result from five complications that are well understood and can be readily treated:

• Haemorrhage
• Sepsis
• Eclampsia
• Complications of abortion
• Obstructed labour

We know how to prevent these deaths - there are existing effective medical and surgical interventions that are relatively inexpensive.

To reduce maternal mortality, it is important that all women have access to maternal healthcare services, particularly, skilled attendance at birth and timely access to Essential (or Emergency) Obstetric Care (EOC), when an obstetric complication occurs.
Two levels of EOC can be distinguished; BEOC and CEOC:

Basic Essential Obstetric Care (BEOC)- 7 signal functions
1. Parenteral antibiotics
2. Parenteral oxytocics
3. Parenteral anti-convulsants
4. Manual removal of a retained placenta
5. Removal of retained products of conception by Manual Vacuum Aspiration (MVA)
6. Assisted vaginal surgery (vacuum extraction)
7. Resuscitation of the newborn (using bag and mask)
Comprehensive Essential Obstetric Care (CEOC) - 9 signal functions
1. All 7 BEOC functions (above)
2. Caesarean section
3. Blood transfusion