Global Health

By DONALD G. McNEIL Jr. 
NOV. 7, 2016

Women should see a doctor, nurse or trained midwife at least eight times during each pregnancy, with five of those visits in the last trimester, the World Health Organization said Monday as it issued 49 recommendations to prevent deaths in childbirth.

Previously, the agency had advised women to visit clinics four times per pregnancy. It also acknowledges the important role of local midwives in poor countries where mothers must travel long distances to see doctors or nurses.

But each visit should be with someone with at least two years’ medical training, “not a traditional birth attendant or a community health worker trained for a few weeks,” said Dr. Metin Gülmezoglu, W.H.O’s coordinator of maternal and perinatal health.

About 300,000 women die in pregnancy or childbirth each year, the agency said, and more than six million babies die in the womb, during birth or within their first month. Many of those deaths can by prevented through simple interventions.

Another recommendation is that every pregnant woman have one ultrasound scan before the 24-week mark to detect fetal defects and twin or triplet pregnancies and determine accurate gestational ages. Many clinics lack ultrasound machines and even electricity, Dr. Gülmezoglu said.

The agency also recommended that all women get:

■ Daily iron and folic acid pills to prevent anemia, sepsis and premature birth.

■ A tetanus shot to prevent neonatal tetanus.

■ Blood-sugar testing to detect diabetes.

■ Antibiotics when bacteria are detected in the urine.

■ Counseling about what affordable local foods contain vitamins and minerals, about the dangers of alcohol and tobacco, and about the need for exercise.

Other recommendations directed to women at higher risk for problems included calcium to prevent pre-eclampsia; vitamin A to prevent night blindness; deworming drugs; and prophylactic doses of drugs to prevent malaria or H.I.V.

The W.H.O. also recommended a spate of home remedies, like bran for constipation, compression stockings for leg swelling, antacids for heartburn and exercise or acupuncture for back pain.