Clinical officers across Africa have improved service delivery in areas such as obstetric surgery and anaesthesia but they are not the silver bullet.
Challenging the presumption that doctor-led obstetric units are the best places for the birth of a child will not be straightforward – 90% of mothers currently choose this option, no doubt because they feel safer amid the reassuring presence of doctors and technology.
It is important to be assessed as being fit for a home birth – any medical conditions such as bleeding disorders, heart disease, diabetes, epilepsy as well as any previous complications in a pregnancy such as a caesarean section, high blood pressure or haemorrhage may result in being recommended to opt for a planned birth at an obstetric unit.
The National Health Service provides the highest level of care available to patients in respect of maternal obstetric services.
Community midwife units have lower medical intervention rates and rates of transfer to obstetric wards than those in hospitals but many have been closing recently.
The Dr Foster hospital guide, which the Observer publishes exclusively today, discloses that tens of thousands of patients were harmed in hospital last year when they developed avoidable blood clots, suffered from obstetric tears during childbirth, had objects left inside them after operations or were not given immediate treatment after a stroke.
■ More than 13,000 mothers suffered an obstetric tear while giving birth.
The Dr Foster hospital guide, published exclusively in the Observer this weekend, also discloses that tens of thousands of patients were harmed in hospital last year when they developed avoidable blood clots, suffered from obstetric tears during childbirth, had objects left inside them after operations or were not given immediate treatment after a stroke.
For women not giving birth for the first time they also have a lower rate of transfer to an obstetric ward than mothers who planned to give birth at home.
It has done so in several ways: by encouraging women to give birth in hospitals and clinics; by giving better training to the women who act as informal midwives for those who give birth at home; and by improving obstetric treatment when things go wrong.
Informed decisions regarding prenatal testing rely upon clear and open communication between patients and their obstetric and genetic health care providers.
