86% of the world's births and 99% of all maternal deaths occur in Africa, South and East Asia, and Latin America. Indeed most of these deaths happen to rural or poor urban women. Further Africa has the highest maternal mortality rates in the world--the risk being at least 1:15. Midwives are key members of any maternal health care team and an integral link in the maternity care hierarchy. In fact, traditional birth attendants (TBAs) are present at about 50% of all deliveries in developing countries. Developing countries aim for 1 midwife/around 200 deliveries. Yet there is a shortage of midwives. For example, at least 16 African countries need 21,000 more midwives than they already have. Health services can address maternal mortality and morbidity by setting up primary maternal health care at the village, dispensary, and health center levels. This requires the help of the family and the community. The well trained midwife is essential in solving maternal related problems. Health services also need to implement obstetric 1st aid services at the 1st referral level provided by trained midwives. Some of these lifesaving procedures include properly removing a placenta, intravenous injections, and vacuum extractions. Postpartum hemorrhage is responsible for most maternal deaths and referrals in developing countries. Another leading problem is obstructed labor. Midwives can train and follow u on TBAs since TBAs can bridge the gap between the rural population and health personnel. Further midwifery training is a high priority of the Safe Motherhood Initiative. It emphasizes the role of midwives not only in delivering of babies, but also in contraception distribution.
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