While most pregnancies and births are uneventful, all pregnancies are at risk. Around 15% of all pregnant women develop a potentially life-threatening complication that calls for skilled care and some will require a major obstetrical intervention to survive. This manual is written for midwives and doctors at the district hospital who are responsible for the care of women with complications of pregnancy, childbirth or the immediate postpartum period, including immediate problems of the newborn.

In addition to the care midwives and doctors provide women in facilities, they also have a unique role and relationship with:

• the community of health care providers within the district health system, including auxiliary and multipurpose health workers;

• family members of patients;

• community leaders; 

• populations with special needs (e.g. adolescents, women with HIV/AIDS).

Midwives and doctors:

• support activites for the improvement of all district health services;

or efficient and reliable referral systems;

• monitor the quality of health care services;

• advocate for community participation in health related matters.

A district hospital is defined as a facility that is capable of providing quality services, including operative delivery and blood transfusion. Although many of the procedures in this manual require specialized equipment and the expertise of specially trained providers, it should be noted that many of the life-saving procedures described can also be performed at
health centres.

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