Who delivers and where?

Understanding at a population level where women deliver and who assists them helps us to identify the main things needed to ensure that women and newborns with complications receive care, the key issues likely to arise, and necessary improvements to healthcare services.

As you watch the video, pay close attention to the thought experiment proposed by Oona and consider the potential experiences of the two women, Joanna and Sarah. We highlight some of the key information about each woman and her situation below, so try to focus on possible outcomes resulting from their respective situations.

A thought experiment

Joanna is 34 and lives in the UK. She is expecting her second baby, has had 8 antenatal visits and 1 visit with a doctor. She delivers with a midwife at a hospital maternity ward capable of providing caesarean sections and blood transfusions. She will receive postnatal visits from a midwife at home.

Sarah is 25 and lives in Ethiopia. She is expecting her fourth baby and has 2 antenatal appointments which involve a 1 hour walk to a health centre. She delivers at home with the help of an older aunt.

• What is the most likely outcome for Joanna and her baby and for Sarah and her baby?

• What do you think would happen to Joanna if she had a complication during delivery? What about Sarah?

You may wish to consider who would recognise the complication. Are they trained or untrained? Who would organise transport and other provisions? If it was needed, who would provide emergency care or treat a complication?