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Life Saving
Anesthetic Skills for Emergency Obstetric Care
All pregnant women are at risk of obstetric complications
during labor and delivery. In India, an estimated 100,000 women die due to
causes related to pregnancy. The main causes of maternal mortality being
hemorrhage, unsafe abortions, eclampsia, sepsis and
obstructed labor. The majority of theses causes are amenable to prevention
through the provision of good quality ante-natal, natal and post natal care,
safe institutional deliveries, timely referrals and provision of emergency
obstetric care.
Under the Reproductive and Child Health program, it was
envisaged that emergency obstetric care be provided through a network of
First Referral Units (FRUs) at the sub-district and
community health centre level. A shortage of specialist man-power,
particularly anesthetists has been the main obstacle in operationalising
these FRUs. An effort was made to rope in
anesthetists from the private sector on a contractual basis and payment of
Rs.1000/- per case, but the feedback for the same has been below
expectations.
Considering this situation, the ‘Working Group on Health
Care for Women and Children for Xth Five Year Plan’ constituted by the Planning
Commission in their report observed that shortage of anesthetists is perhaps
the single most important cause of
inadequacy of emergency care in government hospitals particularly in rural
areas. Further the Steering Committee on Family Welfare for the Xth Five Year Plan have recommended that
‘posts of specialists in CHCs should be filled;
reorientation, skill-up gradation and redeployment of existing man-power
should be the method used to fill critical gaps’.
The Department of Family Welfare organized a workshop of
experts in March, 2002 to deliberate on theses issues and suggest future
course of action. An important recommendation of this workshop was that a
training programme on Anesthesia for emergency
obstetric care for general medical practitioners (MBBS) particularly in
rural/ peri-urban areas should be developed and
that an expert committee should be constituted for developing curriculum,
training material and guidelines for the training programme.
Accordingly, The Government of India constituted an Expert Group, which after
a series of consultations finalized the curriculum and decided that the
training material should be in the form of various modules along with
facilitator’s guide and logbook for trainees. With the assistance of the WHO,
five training modules have been prepared to this effect. They are as given
below:
 Report of the Expert Group on Life Saving
Anesthetic Skills for Emergency Obstetric Care: Training
Programme for MBBS Doctors
Life Saving Anesthetic Skills for Emergency Obstetric Care: Operational
Plan for Training of MBBS Doctors
Life Saving Anesthetic Skills for Emergency Obstetric Care: Guidelines
for Trainers
Life Saving Anesthetic Skills for Emergency Obstetric Care: Training
Programme for MBBS Doctors
Life Saving Anesthetic Skills for Emergency Obstetric Care: Log
Book for Trainers
The first module highlights the background situation as
has been mentioned above and emphasizes on the need to train MBBS doctors in
Life Saving Anesthetic Skills for Emergency Obstetric Care.
The Operational Plan for Training module lays down the
criteria for identification of training centers, duration of training,
selection of participants/ trainees, procedures for certification along with
the suggested weekly schedule of training.
The Guidelines for Trainers stresses on the aims and
objectives of the course, methodology for teaching and the MCI curriculum for
Anesthesia.
The Training Programme for MBBS
Doctors is actually the learning material which focuses on the relevant
anatomy/ pharmacology, physiology of pregnancy and its deviants, neonatal and
adult resuscitation as well as the legal ethical issues which might crop up
during practice.
The logbook for trainees contains Performa’s for each
procedure, which have to be duly filled in by the trainee and countersigned
by the facilitator. This has to be maintained on a daily basis for record
keeping and proficiency assessment.
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