women are as prepared as possible for delivery, whether they choose to deliver at a facility or at home.
N
Ask Px: has anyone ever helped a woman make a birth plan?N
Ask the Px who respond, recording re-sponses on a flipchart:N
What are the necessary components of a birth and complication readiness plan?N
What questions do you ask the woman?N
What roles, in your experience, have other decision makers played in birth planning?N
Building on the responses provided, have Px brainstorm the information that should be relayed to a woman and her family during birth planning. Present the following questions, recording answers on flipcharts and supplementing responses as necessary:N
What advantages of facility delivery should providers discuss with a woman and her family during birth planning?N
What important information about SBAs should the provider share with the woman and her family?N
What specific preparations should a woman and her family make for delivery in a facility?N
When should she go to the facility, and what should she bring?N
What specific preparations should a woman make if she plans to deliver Other barriers may require involvement ofother groups, such as the MOH providing incentives for facility births, or mobilization at the community level to generate funds for transport and/or facility expenses.
Discussion points for birth and complication readiness planning
When discussing birth and complication readiness plans with a woman and her family decision makers, the following key messages should be included:
N
Importance of being prepared if an emer-gency occurs;N
Advantages of delivering at a facility;N
Importance of skilled attendance in facility or at home;N
Key preparations beforehand, depending on place of delivery:N
For delivery at a facility: when to go, what to bring, money for transport and/or facility costs, and identifying willing blood donors; or
N
For delivery at home: an SBA, clean birth space, new blade and cord ties, plan to immediately breastfeed, and an emphasis on emergency transport plan.Importance of skilled attendance
Whether a woman delivers in a facility or at home, skilled birth attendance is critical. A skilled birth attendant is trained in recognizing signs of complications, including estimation of blood lost, can provide lifesaving interventions, and can make the decision to seek higher-level care if needed. SBAs do not employ harmful traditional practices, which are sometimes used by unskilled attendants and result in serious complications.
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at home? What supplies does she need to have ready?
N
Distribute Px Handout 8.4: Developing a Birth and ComplicationReadiness Plan and Px Handout 8.5: Birth Planning Card.
Methodology continues on page 143.
8.4 8.5
UNIT 8/OBJECTIVE #3
Key preparations for delivery in a facility In advance, the woman and decision makers need to identify the following:
N
Who will make the decision to go to the facility if the decision maker is not pres-ent?N
How will the woman travel to the facil-ity?N
Is there a cost for transportation to the facility? If so, how will transportation be paid for?N
How much does delivering at the facility cost? How will that be paid for?N
How soon can the woman and her family start saving for these expenses?N
Who will travel to the facility with the woman?N
Who is identified as a willing donor of blood if the woman needs it?N
While the woman is away, who will look after her other children (if she has any) and her home?When to go and what to bring: When a woman should go to the facility depends on how far she lives from the facility.
A woman who lives within easy reach of the facility should go once labor is well established (contractions regular, five minutes apart).
If a woman lives far from the facility, she should begin her journey (via previously organized transport) at the first signs of labor. If she has the resources and support to do so, she should travel to the community where the facility is located two to three weeks prior to her due date. If she has family or friends who live near the facility and are able to help her, she should stay with them until she is ready to go to the facility.
If the facility has a maternal waiting home that the woman is eligible to use, and she has the resources to do so, staying at the waiting home is also recommended.
When a woman travels to the facility, she and her support person(s) should bring:
N
Her birth planning card and/or maternal record;N
Large clean cloths, which will be used for washing, drying, and wrapping the baby and (a second set) as sanitary pads after birth;N
Clothes for both adults and the baby; andN
Food and water for the woman and her sup-port person.Preparations for delivery at home
In advance, the woman and decision makers need to identify the following:
N
Who will make the decision to go to a facil-ity if the usual decision maker is not present?N
Who will stay with the woman during labor?N
Who will be nearby for at least 48 hours after she gives birth?N
Who will help care for the woman’s other children (if she has any) and her home while she is in labor and recovering?The provider should also reiterate to the woman (and decision makers, if possible):
N
An SBA should be called at the first sign of labor; andN
If the woman needs help, she should be linked beforehand to existing community resources for help, such as community emergency transport, willing blood donors, a community fund to cover costs, etc.Some programs provide women with home-based maternal records—simple, pictorial cards that women can use to record
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UNIT 8/OBJECTIVE #3
information about pregnancy, labor, delivery, and complications. Home-based maternal records help the woman and family determine that complications are developing and facilitate sharing this critical information with a provider.
If a home-based maternal record is used, the provider should explain the sections of the card, information collected, and any signs or symbols to the woman as well as to any decision makers with her. The provider should take time to verify that the woman and her companions understand the card, especially if they cannot read. If the provider is working with the woman alone, the woman should be instructed to explain the card to her family members. If the woman is seen for multiple antenatal visits, the provider should review the home-based maternal record each time, to reinforce the importance of the record and its accurate use.
Preparations for delivery at home If a woman plans to deliver at home, she should identify where she will give birth.
This should be a clean, warm room with a clean surface covered by clean cloths.
In advance of labor, the woman and her family should also gather the following materials:
N
Clean cloths of varying sizes to be used for: the woman’s bed, drying and wrap-ping the baby, cleaning the baby’s eyes, for washing and drying the birth atten-dant’s hands, and to use as sanitary pads after the birth;N
If there is a cloth or mat of standard sized used in the community to help estimate blood loss (an adaptation ofthe kanga method), such a cloth should be acquired if possible;