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Table 7 Allocation of tasks to cadres

From: The ‘Dream Team’ for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need

Intervention Auxiliary midwife/nurse-midwife Midwife/ Nurse-midwife Medical officer Doctor (generalist) Obstetrician/Gynaecologist
Pre-pregnancy
 Family planning advice     
 Delivery of condoms, vaginal barrier, vaginal tablet, other     
 Delivery of contraceptive pills, injectables     
 Delivery of contraceptive implants      
 Delivery of intrauterine devices (IUDs)      
 Female and male sterilisation      
 Prevention of HIV in all women of reproductive age      
 Prevention of other sexually transmitted infections (STIs) in all women of reproductive age      
 Syphilis management      
 Gonorrhoea management      
 Chlamydia management      
 Trichomoniasis management      
 HIV management      
 Folic acid fortification/supplementation      
Pregnancy
 Iron and folic acid supplementation, zinc supplementation, advice to increase dietary energy and protein intake/microsupplementation/interventions to increase frequency and ease of defecation      
 Tetanus toxoid vaccination      
 Prevention of malaria with insecticide treated nets (ITNs) and antimalarial medication      
 Management of malaria with ITNs and antimalarial medication      
 Screening for HIV for prevention of mother-to-child transmission      
 Treatment of HIV for prevention of mother-to-child transmission      
 Prevention of STIs as part of antenatal care      
 Gonorrhoea management      
 Chlamydia management      
 Trichomoniasis management      
 Screening for syphilis      
 Treatment of syphilis      
 Antibiotics for treating bacterial vaginosis      
 Antibiotics for treating asymptomatic bacteriuria      
 Treatment for symptomatic urinary tract infections      
 Any topical treatment for vaginal candidiasis      
 Calcium supplementation to prevent hypertension      
 Interventions for cessation of smoking     
 Antihypertensive drugs to treat high blood pressure (including low-dose aspirin to prevent pre-eclampsia)      
 Magnesium sulphate for eclampsia (nurse or midwife)      
 Magnesium sulphate for eclampsia (ob/gyn)     
 Antibiotics for prevention of preterm premature rupture of membranes      
 Corticosteroids to prevent respiratory distress (nurse or midwife)      
 Corticosteroids to prevent respiratory distress (generalist doctor)      
 Safe abortion (vacuum aspiration or dilation & curettage)      
 Post-abortion care (auxiliary)     
 Post-abortion care (nurse or midwife)      
 Post-abortion care (ob/gyn)     
 Reduce malpresentation at term with external cephalic version*      
 Induction of labour to manage pre-labour rupture of membranes at term      
 Digital perineal massage      
 Interventions intended to promote breastfeeding     
 Anti-D administration in pregnancy for preventing rhesus alloimmunisation      
 Antiplatelet agents for preventing pre-eclampsia and its complications      
 Interventions for preventing and treating pelvic and back pain in pregnancy      
 Psychological and psychosocial interventions for preventing postpartum depression      
Labour and birth
 Normal labour and delivery management and social support during childbirth (nurse or midwife)      
 Normal labour and delivery management and social support during childbirth (ob/gyn)     
 Any perineal technique during the second stage of labour      
 Immersion in any bathtub or pool during labour      
 Upright positions assumed by women in first stage of labour      
 Acupuncture or acupressure for pain management in labour      
 Massage, reflexology and other manual methods for pain management in labour      
 Relaxation techniques      
 Restrictive episiotomy      
 Any inhaled analgesia during labour      
 Active management of third stage labour (to deliver placenta) to prevent postpartum haemorrhage (including uterine massage, uterotonics and controlled cord traction)      
 Oxytocin given prophylactically for third stage of labour      
 Prophylactic use of ergot alkaloids in third stage of labour      
 Rapid versus stepwise negative pressure application for vacuum extraction      
 Screen for HIV during childbirth if not already tested     
 Manage HIV during childbirth if not already tested      
 Caesarean section for maternal/foetal indication (including prophylactic antibiotic for C-section) - auxiliary     
 Caesarean section for maternal/foetal indication (including prophylactic antibiotic for C-section) - nurse or midwife      
 Caesarean section for maternal/foetal indication (including prophylactic antibiotic for C-section) – ob/gyn     
 Induction of labour for prolonged pregnancy (midwife or nurse)      
 Induction of labour for prolonged pregnancy (ob/gyn)     
 Management of postpartum haemorrhage (PPH) (manual removal of placenta and/or surgical procedures and/or oxytocics)-auxiliary     
 Management of PPH (manual removal of placenta and/or surgical procedures and/or oxytocics)-nurse or midwife      
 Management of PPH (manual removal of placenta and/or surgical procedures and/or oxytocics)-ob/gyn     
 Interventions intended to promote breastfeeding     
 Alternative institutional birth environment      
 Midwife-led continuity models of care      
 Labour assessment programmes aimed at delaying admission to the labour ward      
Postnatal: mother      
 Postnatal preventive care      
 Detect and treat postpartum sepsis (auxiliary)     
 Detect and treat postpartum sepsis (nurse or midwife)      
 Continuous versus interrupted sutures for episiotomy/ second degree tears      
 Psychological and psychosocial interventions for preventing postpartum depression      
 Single administration of paracetamol for early postpartum pain      
 Any type of approved analgesia for after-birth pains (vaginal birth)      
 Antibiotic regimens for endometritis after delivery      
 Analgesic rectal suppositories for relief of perineal pain      
Postnatal: newborn
 Neonatal resuscitation with bag and mask      
 Kangaroo mother care      
 Skin-to-skin contact between mother and baby     
 Immediate thermal care      
 Extra support for feeding small and preterm babies      
 Management of newborns with jaundice     
 Initiate prophylactic antiretroviral therapy (ART) for babies exposed to HIV     
 Presumptive antibiotic therapy for newborns at risk of bacterial infections      
 Surfactant to prevent respiratory distress syndrome in preterm babies      
 Continuous positive airway pressure (CPAP) to manage babies with respiratory distress syndrome      
 Interventions intended to promote breastfeeding     
 Exclusive breastfeeding for at least 6 months