Skilled Birth Attendance
WHO advocates for an SBA, or health professional (a doctor, nurse, or midwife), to be present at every birth—whether the birth occurs in a facility (preferred) or at home—because complications can arise even in a normal pregnancy. Moreover, emergency obstetric and newborn care (EmONC, described later) should be available if complications arise. The SBA’s ability to monitor a woman closely, support the normal birth process, recognize complications as they develop, and give rapid, appropriate care, including referral to a setting with EmONC services, if not already available, is critical.
An SBA should attend home births with a traditional birth attendant (TBA), a family member, or both also present. If it not possible for an SBA to be present, the TBA or designated person attending the birth should be able to recognize signs of PPH and take rapid action if needed. If immediate transport to a health center is not a feasible or practical option, the attendants should consider immediate actions at the household level to slow or stop the bleeding. This can mean using a uterotonic, such as misoprostol.[i]
Clean delivery practices should always be used—both during facility and home births—regardless of an SBA’s presence.
- Clean hands of the birth attendant
- Clean cutting of the umbilical cord
- Clean delivery surface
- Clean water and soap
- Clean string to tie the cord
- Clean cloth for the mother and for the baby (one to dry and one to wrap)
Maternity Waiting Homes to Increase Skilled Birth Attendance
To increase access to SBAs and EmONC, some programs have developed maternity waiting homes (MWHs) or alternative birth locations. MWHs provide pregnant women with a place to await their delivery; shortly before delivery. If complications arise, they are moved to a nearby health facility. Anecdotal evidence suggests that MWHs are successful in reducing mortality; however, little quantitative evidence is available to prove their efficacy.[i]
Key Resources for Maternity Waiting Homes:
- Van Lonkhuijzen L, et al., 2012. Maternity Waiting Facilities for Improving Maternal and Neonatal Outcomes in Low-Resource Countries
- Wild K, et al., 2011. The Tyranny of Distance: Maternity Waiting Homes and Access to Birthing Facilities in Rural Timor-Leste
[i] Africare, 2012. Maternity Waiting Homes. http://www.mchipngo.net/Lib/Components/documents/learningbrief-public/Africare%20Liberia_MWHs.pdf
 Should be done in a sterile manner at facilities.
[i] MCHIP, 2012. WHO recommendations on prevention and treatment of postpartum haemorrhage. https://www.mchip.net/sites/default/files/PPH%20Briefer%20%28General%29.pdf