Role of the family physician in reducing deaths due to obstetric hemorrhage

Abstract

Family Medicine became a registered specialty in 2007. A consensus was reached on the core competencies that were needed for a family physician (FP). These competencies were encapsulated in the 5 unit standards that are exit outcomes for FPs. The re-engineering of primary health care (PHC) and the introduction of the National Health Insurance by the South African Department of Health has created the opportunity for the FP to work in district clinical specialist teams (DCSTs) and the district health system. The FP is expected to work with ward based teams as a health advocate to ensure essential messages dealing with areas of maternal health are addressed in the municipal ward. Community interventions in dealing with obstetric haemorrhage have to be provided by working with community health workers. Women and their families need to be given advice on the need for ante natal care, delivering in health facility and dealing with haemorrhage if delivery occurs unexpectedly. Clinical guidelines such as the basic ante-natal care package should be correctly and consistently used for all antenatal attendees to primary health care clinics (PHC) clinic. The FP will ensure that appropriate training of professional midwives and doctors occur at PHC clinics and district hospitals (DH). Recommendations of the 5th Saving Mothers Report must be implemented and monitored in DHs. The FP is expected to audit maternal morbidity and mortality and develop quality improvement plans to ensure that outcomes are optimized. The WHO near miss approach for maternal health needs to be introduced and monitored at all DH. The roles of the FP are seen as a family medicine expert, a communicator, a collaborator, a manager, a health advocate, a scholar and a professional.

Obstetrics & Gynaecology Forum • August 2013