Gaps in the management of the third stage of labour, the period between the delivery of the baby and the delivery of the placenta, are raising the risk of maternal mortality in Tamil Nadu, according to a study.

The study undertaken in eight villages as part of a Health and Population Innovation Fellowship granted by the Population Council, Delhi, found that the practice of the standard Active Management of Third Stage Labour (AMTSL) was very poor. And, where they were put into practice the measures did not adhere to guidelines, the study said.

AMTSL is the primary intervention that could reduce by 50 per cent the incidence of Post Partum Haemorrhage (significant blood loss in the first 24 hours of delivery) which is the leading cause of maternal deaths.

“The study generated enough evidence to show that the simple intervention was not accessible or available to women in a Government setting,” said Subha Sri, who authored it.

The study aimed to promote AMTSL at the level of providers and the community. One of the findings was that providers in the project area seemed resistant to change and apathetic to adopting evidence-based preventive practices.

The community-level intervention assessed 13 parameters which were ticked by women as indicators of good quality maternal health care. The responses were collated into a report card on 72 births in the community and showed that only 16 women received an injection to augment uterine contraction after delivery as laid down in AMTSL protocol.

The study also found that in spite of a Government Order allowing birth companions into the Labour Room, only 21 women were allowed an attendant. Significantly, a section of women reported verbal or physical abuse by health care staff and complained about corruption. Equally notable was, respondents felt that quality of care was better at PHCs.

The important recommendations of the study included developing quality of care standards and ensuring adherence, involving community in evidence-based care, providing continuing medical education on practices such as AMTSL and equipping pregnant women with skills to demand evidence-based practices.

In her remarks, Girija Vaidyanathan, Mission Director, National Rural Health Mission, said the Government had initiated AMTSL sensitisation programmes starting with nurses. Health institutions in Dharmapuri and Vellore had taken the lead in implementing these practices, she said.

Shireen Jejebhoy from Population Council, said though Tamil Nadu’s healthcare sector fared much better than those in other States there were gaps to be addressed.

Rakhal Gaitonde of the NGO Community Health Cell said the statistical mean of health indicators in a State may not always represent the true picture. Desegregations of data would expose critical gaps in the delivery of optimum healthcare, he said.

Asha Oumachigui, former professor, department of O&G, JIPMER, Puducherry chaired the session. Earlier, R. Porkai Pandian, additional director of public health, released the study report.