The Centre has revised the guidelines for antenatal care and skilled attendance at birth by Auxiliary Nurse Midwives (ANM), Lady Health Visitors (LHVs) and staff nurses, empowering them to administer drugs and perform procedures in emergency situations, in an attempt to reduce the Maternal Mortality Ratio (MMR) , and to meet India's commitment to the Millennium Development Goal of reducing MMR to less than 100 deaths by 2015.
At present, MMR in India is as high as 254 deaths per 100,000 live births.
According to the new guidelines, the health workers, now called Skilled Birth Attendants (SBA), will possess technical competenceto administer routine care, and identify and manage complications arising during pregnancy and childbirth.
They will also assist delivery at home and during the post-partum period.
As per this new initiative, the government will empower the ANMs , LHVs, staff nurse and Multipurpose Health Worker to undertake certain life saving measures like allowing them to dispense uterotonic drugs to prevent Postpartum Haemorrhage (PPH), a major cause of death during child birth, and administering drugs during emergency to stabilise the patient prior to referral .
The guideline has been prepared keeping in mind that these workers would be providing care at the sub-centre level or in a domiciliary setting.
The SBAs will be capable of handling common obstetric and neonatal emergencies and in time detect situations beyond their expertise , in which case they will refer the mother and the child to an appropriate facility.
Delay in recognising complications , reaching the health facility and receiving treatment are the main causes of maternal and infant mortality that the new guide seeks to address.
The module can also be used by the non-governmental organisations and private sector health facilities.
Though similar guidelines were issued in 2005, MMR has shown a slow decline.
The Ministry of Health and Family Welfare has, therefore, drafted a new proposal to empower women health workers, providing them basic training in child birth.
However, Traditional Birth Attendants or dais have been kept out of the definition of SBAs.
The guidelines will now be disseminated to the States.
Increased risk
In India, 52.3 per cent of births take place at home and of these only 5.7 per cent are attended by skilled persons, increasing the chances of maternal mortality.
The presence of a SBA at every delivery, along with the availability of an effective referral system, can help reduce maternal morbidity and mortality to a considerable extent.
