Following improvement in the quality of delivery and newborn care in the Comprehensive Emergency Obstetric and Newborn Care (CEmONC) centres of Tamil Nadu, the number of complicated cases in these centres has gone up significantly.
The number of complicated cases has gone up since 2004-05 when the CEmONC centres were first established at the district headquarters hospital, taluk and sub-taluk hospitals.
It was only 17. 2 per cent of the total admissions in that year, but climbed up steadily over the next few years to over 57 per cent of total admissions in 2008-09.
Several types of complications, including anaemia, haemorrhage, big baby, complications of abortions, elderly mothers, foetal anomalies and jaundice-related problems could frustrate a pregnancy and also lead to death of the mother and/or the baby. Such women will have to be referred to a specialised centre for further treatment and care to a higher institution, public health experts say.
“About 15 per cent of all deliveries are likely to have some complications,” explains P. Padmanabhan, Advisor, National Health Systems Resource Centre. “The thing is we do not know who will run into complications, which can arise even without pre-existing risk factors. So, the public health approach is to assume that every delivery will lead to complications and be prepared. The key to avoiding deaths is to recognise the danger signs early and refer patients,” he adds.
In an ideal situation, all normal deliveries should be conducted at the lower level, allowing the specialised centres to perform their task of taking care of emergencies and complications. For this, all arms of the health care network, including primary and secondary care centres, emergency transportation and blood banks must be in place and functional, Dr. Padmanabhan says.
“This is in place in Tamil Nadu,” says S.Vijayakumar, Project Director, Tamil Nadu Health Systems Project. While services in PHCs have been spruced up, staff members have also been trained to take care of normal deliveries and refer cases immediately to a higher institution as signs of complications emerge.
Simultaneously, the CEmONC centres have been retrofitted with state-of-the-art theatres, blood banks and other equipment. Obstetricians have been posted, as have paediatricians and anaesthetists, so that specialists are available round-the-clock. He says the key to the success of the programme is the tie-up with EMRI, the ambulance service.
“Women who start post-partum bleeding [accounting for 25-30 per cent of maternal deaths] on the table too can now be rushed to a CEmONC centre by an EMRI ambulance under medical supervision. If blood transfusions are provided within two hours, life can be saved,” Dr. Vijayakumar adds.
“The direct measure of people's confidence in a government hospital is when they forsake a private clinic even if they can pay for it, in favour of a public facility. Women who come to the CEmONC centres for the free scan, stay on there,” he explains.
