Table 1 Definitions of interventions and packages for care during labor and childbirth

Comprehensive Emergency Obstetric Care ( CEmOC )

Full package of CEmOC as per UN definitions [12, 14], includes all six BEmOC functions PLUS:

• Caesarean section

• Blood transfusion

Basic Emergency Obstetric Care ( BEmOC )

UN definition of the 6 signal functions of BEmOC [12, 14]

• IV/IM antibiotics

• IV/IM uterotonic drugs/oxytoxics

• IV/IM anticonvulsants for pre-eclampsia and eclampsia (ie. magnesium sulfate)

• Manual removal of placenta

• Assisted vaginal delivery (episiotomy, instrumental delivery (forceps or vacuum extraction), advanced skills for manual delivery of shoulder dystocia, breech)

• Removal of retained products (manual vacuum extraction, dilation and curettage)

* Assuming no access to Caesarean section or blood transfusion

Skilled childbirth care

Skilled birth attendant defined by WHO, ICM, and FIGO as “an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.” [13]

The core intrapartum skills that should be provided include:

• Clean delivery care

• Monitoring onset and progress of labor with partograph

• Monitoring maternal and fetal well-being during labor, identify maternal/fetal distress and taking appropriate action including referral

• Manage normal vaginal delivery (including releasing a cord around the neck, delivery of shoulders, assisting a breech delivery)

• Active management of third stage of labor

• First line management of hemorrhage and hypertension in labor, referral as needed

• Pain relief, hydration

* For the purposes of this estimate assuming no access to instrumental delivery (forceps or vacuum extraction), Caesarean section or blood transfusion

Trained Traditional Birth Attendant

Traditional birth attendant defined by WHO as “a person who assists the mother during childbirth and who initially acquired her skilled by delivering babies herself or through an apprenticeship to other TBAs”[15]. A “trained TBA” is “any TBA who has received a short course of training through the modern health sector to upgrade her skills” [61]. TBAs may range from family members attending only occasional births to women with considerable expertise attending 20+ births/year. TBAs are not usually salaried, and typically not civil servants or employed by Ministry of Health.

Timing of intervention and effect:

These packages include care provided during labor and birth, but in order to be effective, the care may have been initiated during the antenatal period (e.g., screening for abnormal lie and decision for elective Caesarean section, or screening and management of hypertensive disease of pregnancy/eclampsia). Some interventions are primarily intrapartum in timing such as management of acute intrapartum events including antepartum hemorrhage, cord prolapse and obstructed labor.

Not included in these effect estimates:

The effects on neonatal survival of specific interventions after birth for the baby are not included here as they are treated as single additional interventions in LiST and have been considered in detail in other reviews:

- Stimulation and neonatal resuscitation at birth,

- Postnatal healthy practices (breastfeeding, hygienic cord and skin care, thermal care).

In addition, a few specific obstetric interventions which are in LiST but affect other neonatal causes of death have been considered in detail in other reviews including the following:

- Corticosteroids for preterm labor (affects preterm deaths),

- Antibiotics for preterm premature rupture of membranes (affects deaths from infections).