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Ekeroma A. Pacific Journal of Reproductive Health 2015;1(2):48-49. DOI: 10.18313/pjrh.2015.910



Quality intrapartum care and partnerships. Alec EKEROMA Dr Alec Ekeroma, Pacific Women’s Health Research Unit, Department of Obstetrics & Gynaecology, South Auckland Clinical Campus, University of Auckland. [email protected] Citation: Ekeroma, A. Editorial - Quality intrapartum care and partnerships. Pacific Journal of Reproductive Health 2015; 1(2): doi: 10.18313/pjrh.2015.910 Copyright: © 2015 Ekeroma, A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The PSRH conference is Suva Fiji last July was a huge success. The largest number of reproductive health workers from all over the Pacific Islands participated in the most comprehensive programme of educational workshops, research presentations and breakout sessions. The theme of the conference was ‘Partnerships for Improved Results’. The theme of this issue of the Journal is ‘Better Intrapartum Care’. The two themes were arrived at separately but they seemed to have coalesced and are unsurprisingly complimentary, as illustrated by Dr Baravilala’s delivery of the Brian Spurett Oration1 and published in this issue.

Dr Baravilala effectively wove a piece of history with the importance of partnerships in care. He recounted how the British royal succession to the throne would have been different to that of today, if there were better pregnancy care for the Princess Charlotte Augusta of Wales who died of postpartum haemorrhage in 1817. Dr Baravilala stressed the importance in the partnership of carers, an “interdisciplinary collaboration”, and working with the key principles of “clarity, openness, trust, shared goals and regular communication between partners”. The core team of carers in the referral hospital settings would be midwives, obstetricians, anaesthetists and paediatricians, although in remote health centres, there may be a nurse or a midwife and in Papua New Guinea (PNG), a health extension officer. But whatever the setting, Dr Baravilala implored that the whole team needs to work and learn together, as in the Pacific and PSRH model of learning. Working and learning together improves the quality of relationships and effective communication which is essential to safe practice.2 Dr Baravilala alluded to the strained relationship between doctors and midwives but his references were from developed countries such as Australia and New Zealand. There is an abundance of anecdotal evidence that the Pacific Islands are indeed

blessed with the camaraderie between health care professionals and there should be every effort at enhancing those relationships. The most important partner during labour however, is the woman, her partner and family. Confidence of the woman in the ability of the care team is not completely garnered by a demonstration of higher technical training, for as important as that may be, it is the ability of the team to listen and demonstrate involvement and concern.3 Engaging the woman in her care poses challenges where there is a lack of health literacy, hence the importance of cultural competence and training of local teams, who have inherent understanding, to look after their own communities.4 And that is where our biggest problem with pregnancy and intrapartum care lies in the Pacific – there is an outrageous underinvestment in training opportunities to increase the numbers of nurses, midwives and doctors. We simply do not have enough nurses, midwives and doctors to have engaging discussions on relationships and guaranteeing every woman in labour has a skilled health personnel practitioner. In 2011, it was estimated that 5000 newborns and 1500 women died in childbirth in PNG per annum and there were only 152 practicing midwives.5 Australian government investment in capacity building has seen 500 midwives trained in PNG in the last four years and a paper from the University of Technology Sydney team tasked with building capacity is published in this issue. Moores et al,6 surveyed a group of students studying midwifery and found that the majority had altruistic intentions for studying midwifery. Overseas Aid that targets training of essential health workforce such as midwives is smart investment. The evidence is overwhelming – the most effective interventions for reducing intrapartum related newborn deaths is to guarantee a skilled health personnel for every woman in labour.7, 8


Ekeroma A. Pacific Journal of Reproductive Health 2015;1(2):48-49. DOI: 10.18313/pjrh.2015.910

Clinical audit is an essential tool that all clinicians should be encouraged to participate in so as to measure whether the service they provide is to the best standards. Governments, professional organisations, local authorities and quality research evidence define standards. We have published two clinical audits in this issue to illustrate how they are done (methods) and how important they are. Staff must be reassured that the purpose of an audit is not to apportion blame but it is to improve clinical care.9 The audit of breech deliveries in two hospitals in the Gulf province of PNG10 made interesting reading and again highlighted the problems with the lack of trained staff attending to women with a high risk labour; and this time, it is the absence of a doctor skilled at doing breech and caesarean section deliveries. It is always helpful to have the staff involved comment and learn from the findings but the audit suffered from a paucity of recorded data and the views of those who were there. The high rate of perinatal deaths associated with vaginal breech deliveries was evident and this audit has highlighted the need for training and for making sure that the women with breech babies are transferred expeditiously to another hospital where there was skilled health personnel who could perform a caesarean section if need be. Nowadays in developed countries, the media would be reporting on poor clinical practices resulting in maternal and neonatal deaths and there would be a public vilification of the carers followed by an investigation to the circumstances of every preventable maternal and perinatal death - and quite rightly so. Corrective actions would have been recommended and that is already happening in some Pacific Island states. However, for the majority of developing countries, mothers and babies die in the intrapartum period without much of a question as to why or how it happened. We need to learn from every death so that the next one can be prevented. REFERENCES 1. Baravilala W. The critical partnership in reproductive health. Pacific Journal of Reproductive Health 2015; 1(2). 003 3. Attree M. Patients’ and relatives’ experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care. Journal of Advanced Nursing 2001; 33(4): 456-66. 4. Williams D, Jackson C. A smoother pathway to birth. Pacific Journal of Reproductive Health 2015; 1(1): 31-3. 5. PACNEWS (PINA). Not enough midwives in PNG. Post Courier. 2011. 6. Moores A, Catling C, West F, et al. What motivates midwifery students to study midwifery in Papua New Guinea? Pacific Journal of Reproductive Health 2015; 1(2). 7. Lawn JE KK, Enweronu-Laryea C, Bateman OM. Newborn survival in low resource settings - Are we delivering? . BJOG An Int J Obstet Gynaecol 2009; 116: 49-59. 8. Obara H, Sobel H. Quality maternal and newborn care to ensure a healthy start for every newborn in the World Health Organization Western Pacific Region. BJOG 2014; 121(Suppl. 4): 154-9. 9. Drife J. Perinatal audit in low-and highincome countries. Seminars in Fetal & Neonatal Medicine 2006; 11; 29e36. 03. 10. Carpenter R, Mola G. Audit of singleton and twin breech deliveries over a ten-year (2005 to 2014) period at two rural hospitals in Papua New Guinea’s Gulf Province. Pacific Journal of Reproductive Health 2015; 1(2).

2. Hunter B, Berg M, Lundgren I, Ólafsdóttir ÓÁ, Kirkham M. Relationships: The hidden threads in the tapestry of maternity care. Midwifery 2008; 24(2): 132-7.