5 - 1 - Video 4.1 Introduction (6 17)

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• Index
• 5047A LA07, 5047A Introduction to Installing and Managing Microsoft Exchange Server 2007
• 5047A LA05, 5047A Introduction to Installing and Managing Microsoft Exchange Server 2007
• 5047A LA08, 5047A Introduction to Installing and Managing Microsoft Exchange Server 2007
• 5047A LA02, 5047A Introduction to Installing and Managing Microsoft Exchange Server 2007
• 5047A LA04, 5047A Introduction to Installing and Managing Microsoft Exchange Server 2007
• 5047A LA03, 5047A Introduction to Installing and Managing Microsoft Exchange Server 2007
• 4 - 10 - Pros and cons of 'labeling ', Childbirth A Global Perspective
• 4 - 7 - Oral language impairment, Childbirth A Global Perspective
• 4 - 11 - Week 3 Round-up, Childbirth A Global Perspective
• 5 - 5 - Subject specific science, Childbirth A Global Perspective
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5 - 1 - Video 4.1 Introduction (6 17), Childbirth A Global Perspective

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This program is brought toyou by Emory University.>> Welcome to Week 4 ofChildbirth: A Global Perspective.My name is Sydney Spangler.I am a Certified Nurse Midwife andAssistant Professor atEmory University here in the NellHodgson Woodruff School of Nursing.I also have a secondary jointappointment in the Hubert Department ofGlobal Health Rollins Schoolof Public Health.This week of the course, we will becovering emergency obstetric care,which I will define morespecifically momentarily.But for now will broadly refer to asan intervention that takes place inhealth facilities, and supports maternalhealth and survival throughout the world.A quick note of syntax,during the lecture,I will often refer to as emergencyobstetric care by its acronym EmOC.The specific objectives forthis lecture are as follows.First, to define EmOC, and describewhy this intervention is essential forimproving maternal health andsurvival worldwide.Next, to identify the EmOCsignal functions,which are specific clinicalservices that have been proven toreduce maternal mortality,and save women's lives.Third, to review the United Nations' EmOCprocess indicators.These are indicators that serve to monitorprogress in the provision of the EmOC,both at the country level as well aswithin regions, provinces, states, anddistricts in countries.Fourth, to discuss monitoring,assessment, andquality improvement for EmOC, includingspecific tools that can be used toevaluate the EmOC implementationin local health facilities.Finally, to recognize some of the keychallenges to the implementation ofEmOC in developing countries contexts.So for example,what issues stand in the way of makingthe service available to all women?Can these issues berealistically resolved and how?Prior to the mid 1980s, maternal healthwas not a global health priority,and was rather overlooked as a significantproblem in many Maternal Child Health orMCH programs at the time.This issue was brought to light in theglobal community when Deborah Maine andAlan Rosenfield published their 1985article, Where is the M in MCH?As a result of the growing awarenessabout this problem, which was inpart motivated about this article, a groupof international agencies, national policymakers and expert in health anddevelopment, gathered in Nairobi Kenya,at the first international meetingfocused on improving maternal health.This meeting marked the initiation ofthe Safe Motherhood Initiative, a globalmovement specifically committed toreducing the burden of maternal death anddisability in developing countries.In the past 25 plus years sincethe Safe Motherhood Initiative launched,considerable efforts have beenmade to improve the health andsurvival of pregnant andchildbearing women.This issue has remained a global healthpriority as indicated by the inclusion ofmaternal health as one of eight UnitedNations' Millennium Development Goals,which are also known as the MDGs,to be achieved by the year 2015.More specifically, MDG-5A aims toreduce the maternal mortalityratio by three quarters globally,and MDG-5B aims to achieve universalaccess to reproductive health.Some amount of progress hasbeen made towards these goals.Global maternal mortality has declinedan estimated 47% between 1990 and 2010,with declines in Southeast Asia andNorth Africa being closer to 2 3rds.In addition, more women seem tobe receiving antenatal care infamily planning than theywere in previous decades.However, MDG-5 is still falling short.The maternal mortality ratio in developingregions remains 15 times higher than thatof developed regions.Sub-Saharan Africa alone accounts forover half of all maternal deaths.One of the reasons for this state ofaffairs is a lack of functioning healthsystems that addresses the problemhorizontally or systematically,as opposed to interventions that takemore targeted or vertical approaches.Saving women's lives at birthrequires multiple components,including professional health workersproficient in basic midwifery, andadvanced obstetrical skills.Technical supports that allow forthe provision of essential services atevery level, and referral andtransportation systems thathelp women who do have complicationsto reach higher level care.So, in conjunction withalleviating the shortage andmaldistribution of maternal healthworkforce in developing countries, whichwas covered in week three of this course,health systems must be strengthened toenable the reliable provision of specifichealth services for pregnant women.Collectively known as emergencyobstetric care, or EmOC, these servicesare implemented within existing healthsystems to treat the most common,life-threatening complications arisingduring pregnancy and childbirth.By improving the implementationof EmOC in Health Systems, andensuring that this care is made availableand accessible to all women who need it.It should be possible togreatly reduce the partic,the persistent problem of highmaternal mortality and morbidity.And then to better understandthis evidence that we have forEmOC in reducing maternal mortality,please refer tothe Paxton articles fro 2005 and 2006that are included in the reading list.So to review for week one,the most common cause of maternalmortality include obstetric hemorrhage,especially postpartum hemorrhage which isthe excessive bleedingthat occurs after birth.Preeclampsia and eclampsiaare hypertensive disorders of pregnancy.Prolonged or obstructed laborwhich can result in hemorrhage.Severe infection or sepsis.Unsafe abortion,which can also result in hemorrhage orsepsis, andthen HIV/AIDS related complications.Currently, EmOC, is primarily focusedon addressing the first five ofthese conditions, most of which,very often present asemergencies that cannot bereliably predicted for prevented.The specific clinical services thatcomprise EmOC will be covered inthe next section of this lecture. 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