Maternity and Gynecology

Maternity services are the largest clinical focus for LAMB.  Core services provided are

• Antenatal care
• Delivery care
• Management of complicated referral patients

and these are provided at

• Community clinics and safe delivery units (SDU)
• LAMB Hospital

Attendance at antenatal clinics – LAMB or other – in encouraged by Village Health Volunteers, as we seek to reduce the high rate of maternal and infant mortality in Bangladesh.  The mortality rates fall significantly when antenatal care is accessed.

Antenatal Care

The care given at antenatal clinics focuses on birth preparedness for all families and identifying high-risk or complicated pregnancies.  Services are provided 6 days per week, following WHO guidelines which promote no less than 4 visits during pregnancy.

In community clinics, care is provided by community midwives trained at LAMB Hospital following the curriculum of a joint UN and Government of Bangladesh ‘Skilled Birth Attendant’ training program.

The LAMB Hospital Antenatal Clinic is staffed by highly-trained Advanced Nurse Midwives, whose standard nurse-midwifery training is followed by a LAMB-designed course to expand clinical skills.

Whether in community or LAMB antenatal clinics, protocols define when high-risk or complicated patients require referral to obstetric doctors, at LAMB or other hospitals.

Deliveries

LAMB has 22 Community Safe Delivery Units staffed 24 hrs./ day by on-site community midwives.  In 2011, more than 2,200 babies were born in these LAMB SDUs.  As with ANC patients, clear guidelines specify under what circumstances the expectant mother must be dispatched to a hospital.

LAMB Hospital handles the cases which have been identified during antenatal clinics as high risk.  It also is a referral center for a catchment area of approx. 2 million people.  There were nearly 4000 babies born at LAMB Hospital in 2011, with a 20% Caesarean section rate.  The Hospital has approx. a 20 minute response time for C-sections which are available at all times.  LAMB policy is not to provide C-sections on demand, but only when there is a clear clinical need.

Postnatal Care

The time period immediately following birth is most risky for a newborn, in terms of feeding and potential consequences of difficult births or low birth weight.  It continues to be risky also for a mother.  To assess for possible risks, LAMB aims to provide a home visit to newly-delivered mothers within 48 hrs., 24 hrs. if possible, giving special emphasis to exclusive breastfeeding and looking for danger signs of illness.  Clinic visits are encouraged at 6 weeks postnatal to encourage family planning, immunization of children, and to treat dangerous levels of anemia which might have resulted from excessive bleeding.

Gynecology

With resident obstetrician-gynecologists, as well as visiting volunteers from Bangladesh and other countries, a wide range of gynecology services are provided.  We do not have laparascopic capability, but do elective vaginal and abdominal hysterectomies, obstetric fistula repair surgery, emergencies as needed (D&C, ERPC, ectopic pregnancy, etc.).