Maternal care goals: life and good health.

Maternity care should prevent mortality and improve women's health different interventions are required for prevention and improvement. Healthy pregnancies require well-nourished women, free of infectious diseases, and under treatment for chronic treatable diseases. obstetric emergencies, however, can occur among healthy women also. Management of obstetric emergencies means access for women in need; services should include the ability to cross-match and transfuse blood for hemorrhage, to perform caesareans for obstructed labor, to administer antibiotics for infection, and to treat eclampsia. Prevention of unwanted and unplanned pregnancies reduces obstetric complications. Prenatal care is supposed to improve the health of pregnant women and to prepare women and their care providers for emergencies. Improvement in health is related to monitoring nutrition, hemoglobin levels, micronutrients such as iodine, and weight gain. Malaria and other endemic diseases need to be screened and treated. Risk assessment as a screening tool may mislead and create a false sense of security. Sexually transmitted diseases must be screened and treated. Studies need to be conducted to ascertain cost-effectiveness of screening. Preparation for unexpected problems in delivery must include a plan for transport, clearance of permission from a husband, or care in a maternity waiting home. Postpartum care can be improved with careful compliance with aseptic procedures and monitoring of labor. Delivery facilities should include an operating room, anesthesia, blood, other IV fluids, and drugs. Speed and competence must be assured. Accessible care means defining problem areas and addressing short, medium, and long-term problems, and assessing causes within the social structure, community, health system, or hospital. Goals of interventions must be clearly defined, and the probable impact determined. Evaluations of interventions that have multiplied since the Safe Motherhood Initiative began can lead to sustainable, effective services.