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When information on maternal deaths is collected as part of a larger verbal autopsy study not specifically designed to study maternal mortality in detail, additional data extraction may be necessary to avoid misclassification of exposures of interest (such as planned place of birth, skill attendance).
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The data presented here demonstrates that a supportive, registered midwife provided appropriate mentorship and feedback to SBAs on a targeted birthing skill.
This binary variable was chosen instead of 'assisted deliveries' to emphasise the use of institutional delivery services and to avoid the potential problem of inaccurate reporting of birth attendant skills.
In the current study, women's evaluation of their and their baby's perceived medical safety was not only based on the availability of the TBAs during and after labour, but also on the woman's perception of the birth attendants' skills.
The maternal mortality ratio (MMR) also dropped from 871 in 2000 to 673 in 2005 per 100,000 live births, but remained the same in 2011, which is due to the chronically low skill birth coverage and delay in expansion of health centers with emergency obstetric care [ 10].
And they are being welcomed with open arms - by the government at least - because Germany has a significant skills gap, and a worryingly low birth rate.
NRHM also envisages empowering non-specialist medical officers to undertake emergency obstetric procedures and administer anesthesia; promoting delivery by skilled birth attendants; strengthening the skills of auxiliary nurse midwives to provide life-saving care during delivery; and stimulating demand for safe delivery through the Janani Suraksha Yojana (JSY) incentive scheme.
This was also the case when motor skill, birth weight and mothers' education were controlled for (Ps < 0.05).
Research is needed to explore [ 1] the approach that will be cost effective and scalable to overcome the barriers to utilization of skill birth attendant services in Nepal.
This gate keeping role mainly includes counseling and referral for skill birth attendance and travel arrangements for emergency obstetric care (if required).
Another respondent suggested, "…it [the services] can be improved if the staff get skill birth attendance training, new equipment and can handle a complicated case…caesarean section, breech delivery.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com