Integrating AMTSL and immediate postnatal care for the woman and newborn

Efforts such as the Safe Motherhood Initiative and the World Health Organization (WHO) Making Pregnancy Safer Division and strategies to meet the United Nations Millennium Development Goals are supporting worldwide activities to reduce maternal and newborn mortality. Despite these efforts, hundreds of thousands of women and babies die or become disabled due to complications of pregnancy and childbirth every year.

Half of the maternal deaths occur within 24 hours of childbirth with postpartum hemorrhage (PPH) being the leading direct cause of maternal death in most developing countries. Many of the cases of PPH result from problems during and immediately after the third stage of labor.

75 percent of all neonatal deaths take place in the first week and 50 percent within 24 hours after birth. The postpartum/postnatal period, especially the early phase, is also the most neglected part of the pregnancy, delivery, and postpartum continuum of care. It stands to reason, therefore, that newborns may stand a better chance of surviving if they receive care during the period when they are at the greatest risk of dying.

Since the health and survival of the newborn are closely tied to that of the mother, it is important to integrate maternal and newborn health care into training programs, wherever possible. Although it is not feasible to integrate allaspects of maternal and newborn care, this set of materials links selected aspects, including active management of the third stage of labor with care of the baby at birth, immediate postnatal care of the woman and the baby, and counseling the woman/mother to care for herself and her newborn.

Ongoing research in various settings continues to identify the best approaches for preventing and managing postpartum bleeding and its complications as well as caring for the newborn and woman in the immediate postpartum period. By developing national guidelines, training skilled birth attendants, improving work environments of skilled providers, ensuring the application of infection prevention principles, and supporting the development of improved access to care, more women will have access to these interventions.

About the learning materials

This learning package for integrating active management of the third stage of labor (AMTSL) and immediate postnatal care (IPNC) consists of a reference manual, a participant’s notebook, and a facilitator’s guide. This learning package was developed for use by nurses, midwives, and doctors providing childbirth and immediate postpartum care for the woman and newborn in peripheral health care facilities.

These documents comprise a set and should be used together.

The Reference Manual contains the theoretical content for the training course. It is intended to serve as the “textbook” or reference for participants and facilitators.
The Facilitator’s Guide includes lesson plans, knowledge evaluation tests (pre-test, mid-course test, and post-test) and their suggested answers, answers for learning exercises, and guidelines for conducting a clinical training program.
The Participant’s Notebook assists participants throughout the training program. The notebook has the following components: overview of and agenda for the training program, learning objectives, learning exercises, practice and evaluation checklists for competencies to be evaluated, and additional printed materials.

These resources are distinguished within the series by an identifying icon located on the top of the odd-numbered pages: