The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirths
Open Access
- 13 April 2011
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Public Health
- Vol. 11 (S3), S7
- https://doi.org/10.1186/1471-2458-11-s3-s7
Abstract
Of the global burden of 2.6 million stillbirths, around 1.2 million occur during labour i.e. are intrapartum deaths. In low-/middle-income countries, a significant proportion of women give birth at home, usually in the absence of a skilled birth attendant. This review discusses the impact of skilled birth attendance (SBA) and the provision of Emergency Obstetric Care (EOC) on stillbirths and perinatal mortality. A systematic literature search was performed on PubMed/MEDLINE, Cochrane Database and the WHO regional libraries. Data of all eligible studies were extracted into a standardized Excel sheet containing variables such as participants’ characteristics, sample size, location, setting, blinding, allocation concealment, intervention and control details and limitations. We undertook a meta-analysis of the impact of SBA on stillbirths. Given the paucity of data from randomized trials or robust quasi-experimental designs, we undertook an expert Delphi consultation to determine impact estimates of provision of Basic and Comprehensive EOC on reducing stillbirths if there would be universal coverage (99%). The literature search yielded 871 hits. A total of 21 studies were selected for data abstraction. Our meta-analysis on community-based skilled birth attendance based on two before-after studies showed a 23% significant reduction in stillbirths (RR = 0.77; 95% CI: 0.69 – 0.85). The overall quality grade of available evidence for this intervention on stillbirths was ‘moderate’. The Delphi process supported the estimated reduction in stillbirths by skilled attendance and experts further suggested that the provision of Basic EOC had the potential to avert intrapartum stillbirths by 45% and with provision of Comprehensive EOC this could be reduced by 75%. These estimates are conservative, consistent with historical trends in maternal and perinatal mortality from both developed and developing countries, and are recommended for inclusion in the Lives Saved Tool (LiST) model. Both Skilled Birth Attendance and Emergency/or Essential Obstetric Care have the potential to reduce the number of stillbirths seen globally. Further evidence is needed to be able to calculate an effect size.Keywords
This publication has 29 references indexed in Scilit:
- Standards for CHERG reviews of intervention effects on child survivalInternational Journal of Epidemiology, 2010
- 60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?International Journal of Gynecology & Obstetrics, 2009
- 3.2 million stillbirths: epidemiology and overview of the evidence reviewBMC Pregnancy and Childbirth, 2009
- Trends in stillbirths, early and late neonatal mortality in rural Bangladesh: the role of public health interventionsPaediatric and Perinatal Epidemiology, 2008
- The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countriesActa Obstetricia et Gynecologica Scandinavica, 2007
- The burden of caesarean section refusal in a developing country settingBJOG: An International Journal of Obstetrics and Gynaecology, 2007
- Reproductive health in rural Malawi: a population-based surveyBJOG: An International Journal of Obstetrics and Gynaecology, 2003
- Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scoresActa Obstetricia et Gynecologica Scandinavica, 1994
- Effect on mortality of community-based maternity-care programme in rural BangladeshThe Lancet, 1991
- How Chinese clinicians contribute to the improvement of maternity careInternational Journal of Gynecology & Obstetrics, 1989