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Safety Practices for Maternal Health: Ensuring a Secure Journey



Safe motherhood is a fundamental aspect of healthcare, encompassing a range of initiatives, protocols, and service guidelines designed to provide comprehensive care to women before, during, and after pregnancy. The aim is to optimize the health of both the mother and the child, reducing maternal and infant mortality and morbidity. In this article, we delve into the critical importance of safety practices in maternal health, their impact, and the responsibilities of healthcare providers in ensuring a secure journey for every expectant mother.


Importance of Safety Practices


The significance of safety practices in maternal health cannot be overstated. These practices are instrumental in decreasing maternal and infant mortality and morbidity rates. Many maternal and infant deaths can be prevented through the diligent implementation of safe motherhood practices. Worldwide, millions of women are affected by maternal mortality and morbidity resulting from preventable causes. It is crucial to recognize that the health challenges women face often emerge during pregnancy, and these morbidities have the potential to leave lasting scars on women's health.


Safety in maternal health becomes paramount when we consider the global commitment to achieving a Maternal Mortality Ratio (MMR) of less than 70 by the year 2030, which is just eight years away. To achieve this goal, we must ensure that no pregnant woman ever finds herself in a life-threatening situation, underscoring the vital role of safety.


The Safety Commitment


Beyond achieving the MMR target, we are also committed to creating a healthy society by addressing intrauterine and intrapartum influences that can lead to a population affected by noncommunicable diseases (NCDs). NCDs are on the rise in India, with statistics revealing that 58 lakh Indians die due to NCDs. Fetal growth restriction and premature births are potential risk factors for developing NCDs in adulthood. Therefore, practicing nutritional assessment and guidance during pregnancy and lactation can significantly contribute to curbing the menace of NCDs. This commitment is not just about the health of the mother but also the well-being of future generations.


A Human Rights Issue


Pregnant women are entitled to special protection and care during pregnancy, childbirth, and the postpartum period. Childbearing is a contribution to society and humanity, and no woman should suffer harm or death while giving birth to the future of humanity. It is the right of every fetus and newborn to be brought into this world without morbidity or deformity, and all measures should be taken to ensure that a healthy baby is born to a healthy mother.


Responsibility of Healthcare Providers and Facilities


With an increasing number of deliveries occurring in healthcare facilities, the responsibility for ensuring safety is mounting. The triad of safety, productivity, and quality has gained colossal importance as childbirth and maternity care take place in healthcare facilities. Designing and implementing safety processes have become critical. While resource limitations and accessibility challenges persist, healthcare providers must strive to provide timely care and encourage compliance among pregnant women.


Defining Safety


Safety, as defined by the Oxford dictionary, is the state of being safe and free from danger. In the context of maternal health, safety refers to measures and practices that preserve the life, health, and bodily integrity of individuals. Safety encompasses all actions taken to prevent and control harm caused by accidents while respecting the physical, material, and psychological integrity of individuals. In the field of maternal health, safety is assessed through metrics that track near misses, comorbidities, and deaths. It is crucial to recognize that safety practices are not obstacles but rather contributors to operational efficiency. Research shows that safety practices result in improved quality and productivity.


Core Tools for Safety Practices


Several core tools have been demonstrated to enhance the quality and safety of maternal care:


  • Triggers

  • Bundles

  • Protocols

  • Checklists


These evidence-based tools facilitate measurable improvements in the quality of care by aiding in timely diagnosis and treatment, thereby preventing or limiting the severity of morbidities. Safety practices are not only essential components of healthcare but also a culture that must be nurtured.


Safe Practices for Maternal Health


The following are essential areas where safety, quality, and productivity converge to ensure maternal and newborn safety:


  • Pre-pregnancy counseling and optimization: Managing chronic medical conditions, such as diabetes, and ensuring good nutrition and immunization status can protect against birth defects and their consequences.

  • Antenatal checklists: Implementing specific antenatal checklists during the initial patient visit helps identify risk factors and take proactive measures to ensure safety and prevent perinatal complications.

  • Forbidden medications and contraindications to pregnancy: Safety involves identifying situations that pose potential threats to the mother's life. Antenatal care should focus on addressing prominent issues such as anemia, preeclampsia, preterm births, placental abnormalities, and postpartum hemorrhage to reduce their prevalence and implement preventive measures.


Tools to Increase Safety in Maternal Health


Several checklists and protocols can be used to enhance safety in maternal health, including:


  • The World Health Organization (WHO) Safe Childbirth Checklist: This checklist supports the delivery of essential birth practices for preventing maternal and newborn deaths.

  • The ACOG Safe Motherhood Initiative & Maternal Safety Bundles: These bundles focus on the leading causes of maternal death, including maternal sepsis, obstetric hemorrhage, venous thromboembolism, and severe hypertension in pregnancy.

  • WHO PPH care bundles: These bundles provide stepwise action plans for preventing postpartum hemorrhage and are validated and useful.


Additionally, the Federation of Obstetrics and Gynaecologists of India (FOGSI) offers several checklists and protocols on its official website, www.fogsi.org, to assist clinicians in providing safe maternity services.


Escalation of Care and Early Warning Signs


Objective maternal health assessment involves checking vital signs, systemic conditions, and specific signs and symptoms. Identifying early warning signs can guide healthcare teams in escalating care appropriately and ensuring temporization and stabilization when necessary.


Safety for Healthcare Providers


Ensuring safety for healthcare providers involves understanding their qualifications and roles within the healthcare facility. Working as a team and adhering to facility protocols are essential. Commitment, prompt responses, active participation in patient care, seeking opinions when needed, and understanding the long-term implications of actions are crucial. Healthcare providers should actively contribute to the creation of standard operating procedures, participate in audits, engage in debriefing sessions, and provide regular feedback. Proper documentation and record-keeping are paramount.


Continual skills enhancement, staying updated with research, and adapting to advances in the field are vital for improving safety in maternity health. Patient education, guidance, and effective communication, both with patients and within the healthcare community, are essential. Proactive promotion of safety practices can contribute to a better society and save mothers, allowing them to nurture their offspring.


Safety in maternal health is not merely a program but a value that must be integrated into the work culture for lasting improvements. It should be embraced as a fundamental aspect of healthcare, not just as a new priority or procedure to be followed. Maternal health safety practices play a pivotal role in ensuring the well-being of mothers and newborns, contributing to healthier societies and a brighter future for all.

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