Emergency Obstetric and Newborn Care

Timing is critical in preventing maternal and newborn mortality and morbidity. PPH can kill a woman in less than 2 hours; for most other complications, a woman has 6 or more hours to receive emergency care. Most perinatal deaths occur during labor and delivery or during the following 48 hours. A majority of the maternal and early newborn deaths can be avoided by ensuring availability of EmONC services within reasonable travel distance. To manage obstetric complications, a facility must have at least two skilled attendants and trained support staff on duty at all times. For surgeries, facilities must have a functional operating theater and must be able to administer blood transfusions and anesthesia. Basic EmONC (BEmONC) has seven components; comprehensive EmONC (CEmONC) has two additional components. Birth attendants need to be skilled in essential care of the newborn at birth and basic resuscitation. Helping Babies Breathe (HBB) is a simplified basic resuscitation curriculum developed by the American Academy of Pediatrics, appropriate for birth attendants from peripheral facilities. The HBB Development Alliance is a public-private partnership of USAID, the National Institute of Child Health and Human Development, Saving Newborn Lives/Save the Children, Laerdal Medical, the American Academy of Pediatrics, and USAID implementing partners to work toward achieving a significant reduction in neonatal mortality by increasing the availability of resuscitation to manage newborn asphyxia during birth.

Basic EmONC (BEmONC)

  1. Parenteral treatment of infection (antibiotics)
  2. Parenteral treatment of severe pre-eclampsia/eclampsia (e.g., MgSO4)
  3. Treatment of PPH (e.g., uterotonics)
  4. Manual vacuum aspiration of retained products of conception
  5. Assisted vaginal delivery (e.g., vacuum-assisted delivery)
  6. Manual removal of placenta
  7. Newborn resuscitation[1]

Comprehensive EmONC

All components of BEmONC plus:

  1. Surgical capability, including anesthesia (e.g., Cesarean section)
  2. Blood transfusion

Key Resources for EmONC:

[1] All newborn signal functions except for resuscitation are proposed as additions to the existing UN signal functions. Gabrysch S, et al. New Signal Functions to Measure the Ability of Health Facilities to Provide Routine and Emergency Newborn Care. PLoS Med 2012; 9(11): e1001340. doi:10.1371/journal.pmed.1001340.