1. T J Mashamba (obstetrics & gynecology)

2. V Horner ( community health)

SASOG 2014 Cape Town

Midwife obstetric unit is a primary level of care for pregnant women.

Primary health care is an entry point in health care system.

The National department of health of South Africa defined what is expected from a well run midwife obstetric unit should achieve.

24 hour comprehensive obstetric unit

Management of emergencies

Antenatal care for low and intermediate risk women

On site routine blood testing

Treatment of common problems of pregnancy

Delivery service for low risk women

Postnatal checks including contraception

Referral of problems to hospital

Primary health care is essential health care that should be accessible at a cost a country and community and afford.

Applies methods that are practical, scientifically and socially acceptable.

Adopted as a basic mechanism to promote health care to the population of South Africa.

Delivered through the district health system

Should be able to take care of all patients with different diseases and stabilize emergencies.

A refer to an appropriate higher level of care.

Primary health care nurses are a pillar for efficiency.

Midwives are the corner stone for the midwife obstetric unit.

It should be the most used health care centre.

Should be accessible, affordable, receptive and user friendly to the community.

Alleviate pressure on more expensive and resource intensive acute care services

Early diagnosis of pregnancy and contraceptive advice.

Antenatal care for low and intermediate women

Pregnancy and delivery guidance.

Sexual health.

Education on breast feeding.

Child care.

Triage obstetric and gynaecology patients.

Provide emergency services for pregnant women.

Avoid occupation of limited beds unnecessarily.

Expeditious assessment of obstetric patients.

Save time, money and improve patient flow.

Referral of intermediate and high risk conditions.

Advanced midwives

Midwives

Enrolled nurses

Nursing assistants

Community health worker

Visiting or resident medical officer

Design and Methods

Because of the problems associated with accessibility and utilization of midwife obstetric unit, the study was designed to identify the profiles of patients utilizing these services.

Hope that the findings will provide insight into areas needing improvement within the health care system

This is part of the study done to evaluate the utilization of a decision support system for increasing levels of compliance of health workers to the Maternity Care Protocols and improving maternity outcomes in Tshwane North sub District, Gauteng Province, South Africa.

Ethics approval was obtained from the Tshwane/Metsweding Region Research Ethics Committee and Medunsa Research and Ethics Committee, University of Limpopo, South Africa.

Kgabo CHC in Winterveldt was study centre

A retrospective cross-sectional descriptive study on women attending antenatal care at the clinic.

Data was collected through a review of antenatal cards and labour records of patients enrolled from November 2010 till August 2011

Consent was obtained from patients at booking. Follow up at each visit until delivery. Outcome of mother and new-borns recorded. Records of patients delivered within the district

were obtained including those referred to higher level.

Characteristics Value

1. General Monthly Patient Load: [Primary Health Care, Chronic

Diseases, Child Health and Maternity Care]

13 000 patients per

month

2. Antenatal Care: average number of new bookings per month 210 patients

3. Average number of referrals in labour per month to ODI and Dr

George Mukhari hospitals

78 patients

4. Average number of deliveries per month 104 patients

5. Staffing: advanced midwives at the clinic 1

6. Staffing: Professional nurses with midwifery 36

7. Estimated unemployment levels in Winterveldt 40%

8. Estimated average household income per month in Winterveldt R500.00

Taken from: Profile of the North West Province: demographics, poverty, income, inequality and unemployment 2010

Age range in years 14 – 49 years

Average age in years 25.1 years

Age less than 18 years 9%

Age 18 to 34 years 82%

Gestational age range at booking in weeks 10 – 36 weeks

Average gestational age in weeks 23.8 weeks

Booking before 20 weeks 24%

Booking between 20 and 30 weeks 60%

Booking after 30 weeks 16%

Low risk at booking at the clinic 79.4%

High risk at booking at the clinic 20.6%

Previous caesarean section

6.2%

Miscarriage

5.3%

Neonatal loss

3.4%

Previous low birth weight

2.5%

Preterm delivery

1.5%

Young mother

4.7%

Grand multi-parity (parity>4)

2.1%

Asthmatic

1.5%

Previous pregnancy induced hypertension

2.8%

Cardiac, epileptic, diabetic and other pre-existing illnesses

3.4%

Risk markers identified from history (n=319)

Foetal lie and presentation

0%

Abnormal first reading blood pressure

5.9%

Abnormal second reading blood pressure

1.2%

Mild anaemia

13.4%

Severe anaemia

1.8%

Rhesus negative

3.4%

Syphilis serology positive

1.5%

HIV positive

18.8%

Glycosuria

0.6%

Risk markers identified from examination (n=319)

Delivered at the clinic 45.1%

Delivered at the hospital 41.1%

Delivered at home 3.4%

Delivery place not known 10.3%

Delivered by caesarean section 2.1%

Low risk patients at booking referred in labour 18.2%

Average birth weight 2.65kg

Low birth weight 6%

Perinatal losses 2.1%

Maternal and fetal outcomes

Delivered at the clinic 55.0%

Delivered at the hospital 31.2%

Referred in labour 22.9%

Delivered at home 3.9%

Delivery site unknown 9.9%

Delivery site for low risk pregnancies (n = 253)

Delivered at the clinic 21.2%

Delivered at the hospital 65.2%

Referred in labour Admitted in advanced labour

Delivered at home 1.5%

Delivery site unknown 12.1%

Delivery site for high risk pregnancies (n=66)

Kgabo clinic has high number of new patients.

Limited number of midwifes

Community is of low income indeed

Patients attend ANC at MOU

High risk patients are referred

Significant number of low risk delivered at higher level of care

A third of high risk patients referred still delivered at the MOU

A third of low risk women delivered in hospital

18.2% of low risk women referred in labour

Average birth weight is low

High risk women present in advanced labour

Unknown delivery site is a concern

Winterveldt community has low income

Women book appropriately at MOU

Significant number book late

Problems identified

Proper referrals made

Not all high risk women referred go

High risk women present in advanced labour precluding chances of referral in labour

Women with medical conditions still delivered at MOU

Lucky that there were no complications

Income not sufficient for transport to referral centre.

Significant low average birth weight

HIV prevalence lower than national

Inter-facility pre-transfer communication

Tracing of referred patients

Proper feedback from referral centres

Evaluate ability of referred patients to go to referred higher level of care

Evaluate reasons why women do not reach the referral centres

Health system changes_ provide equipment to look after high risk women at MOU’s

Inform booking centres if patients deliver at a different centre

Regional and national register to identify all patients delivered

Thank you for your attention