Table 7 Allocation of tasks to cadres
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 | ✓ | ||||