Should Interventions Focus Exclusively on Referral of Emergencies?
The importance of access to obstetric emergency care is
undisputed (WHO 1996). However, there is also evidence to justify elective
referral for maternal and perinatal reasons, as outlined earlier (Villar & Bergsjo 1997). This is also acknowledged by the Safe Motherhood Initiative by
stating that a minimum of 15% of all pregnant women should deliver in obstetric
referral level facilities (Inter-agency group for safe motherhood 1997). Most of
these will not be emergencies. In addition there is often no clear line between
emergency and elective referral, as in the case of mild antepartum haemorrhage.
It may be sensible to start with a focus on emergency referral. Yet, there is a
need to also improve and rationalise referral for all pregnancy-related
conditions. This could be done, for instance, through locally adapted and
operational referral guidelines and related tools such as referral forms and
feedback reports, transport arrangements and special admission routines in the