03 July 2009

South Africa fails to save mothers

Only one of the 11 recommendations by the Saving Mothers reports has been implemented over the past 11 years.


Only one of the 11 recommendations by the Saving Mothers reports by the national committee of the Confidential Enquiries into Maternal Deaths in South Africa has been implemented over the past 11 years.
Mari Hudson writes in What's New Doc

First Saving Mothers report 1998

  • Train staff in the use of spinal anaesthesia.
  • Make postgraduate training for all doctors administering obstetric anaesthetics compulsory.
  • Conduct a national human resources survey to determine the requirements for postgraduate training.

Second Saving Mothers report 1999-2001

  • All doctors administering obstetric anaesthesia should acquire skills in general and regional anaesthesia.
  • Rotate specialists at regional level for the training of junior doctors.
  • Enforce longer training in anaesthesia for interns at universities: it is now two months instead of two weeks.
  • Formally accredit resuscitation training.

Third Saving Mothers report 2002-2004

  • All medical officers at level 1 and 2 hospitals should be required to have documented obstetric anaesthesia experience and training.
  • Require a minimum case list for interns.
  • Implement outreach programmes in every province, each headed by a senior academic in a dedicated post.
  • Supply a tool kit with details of care and resuscitation in obstetric anaesthesia for all level 1 and 2 hospital doctors.

In a nutshell
Apart from increasing the duration of intern training, none of the recommendations above have been implemented in more than a decade. The good news is that a task team has recently been appointed in the Free State to curb maternal deaths. They’ve taken the first steps towards implementing three more recommendations.

Some discussion notes from the report

  1. On the lack of experience and the state’s failure to provide skilled supervision:
    “Having the senior anaesthetist on call from home is inadequate for interns, since anaesthesia-related emergencies can happen unexpectedly and rapidly and may result in death within a few minutes.”
  2. On the lack of training and postgraduate qualifications:
    “It’s inconceivable that doctors who have never administered obstetric anaesthesia before employment are being appointed to posts in which they’re expected to perform this task.”
  3. On the fact that the state expects young doctors to perform too many duties simultaneously:
    “Vital to the safe practice of obstetric anaesthesia is the quality and quantity of human resources. Of major concern is the frequency with which doctors are required to perform anaesthesia and neonatal resuscitation. At least one mother has died because a doctor had to leave the anaesthetised (spinal) mother unattended to resuscitate her baby. The number of competent doctors in theatre should be sufficient to prevent similar situations.”

These considerable inadequacies are killing patients. It has led to 12 deaths in 8090 Caesarean sections at level 1 and 2 hospitals in the rural Free State. This represents an unacceptably high mortality rate of 148/100 000. This figure is 100 times greater than in the United Kingdom.

This is an edited extract of an article first published in What’s New Doc, 2nd issue, March 2009. What’s New Doc is a publication for medical doctors, produced in association with Health24.

Read more:
Anaesthesia shock: fatal decisions
Spinal anaesthesia risks
Maternal deaths anaesthesia related
Anaesthesia related deaths in kids


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