The maternal death that occurred in the municipality of Asipulo in Ifugao in October 2011 was so disheartening for its health care service providers that it prompted them to reflect on what had gone wrong and how they could prevent a similar incident from happening again.

The maternal death was of a 43-year-old woman who suffered from severe hemorrhage. She had had 13 pregnancies and 11 childbirths. Other risk factors identified for the death were too close pregnancy intervals and home-based delivery unattended by a skilled birth professional. The woman also lived in a geographically isolated village and didn’t have immediate access to a health facility.

When the opportunity came, the municipal health office spearheaded the conduct of its first Maternal Death Review (MDR) which aimed to assess the circumstances leading to the occurrence of a maternal death and come up with recommendations on how to prevent it in the future.

The review highlighted the need for active pregnancy tracking by public health workers especially in the geographically isolated and disadvantaged areas.

“The pregnancy tracking would enable them to identify and subsequently refer a pregnant woman in need of specialty obstetric care the earliest possible time,” explained Dr. Rhodora Miliano-Montesa, the rural health physician of Asipulo. High risk pregnancies that must be referred to hospitals for appropriate intervention include cases with previous caesarean section, placenta previa, multigravida, multiple pregnancies and preeclampsia.

The maternal death in 2011 also prompted the health system to once again weigh in on the vital function of the community health team (CHT) in pregnancy tracking and conduct home visits to every pregnant woman.

Dr. Miliano-Montesa said three crucial needs have been emphasized: strengthening and mobilization of CHTs in emergency situations, strengthening networking and functional two-way referral system, and intensifying information and education campaign on family planning and underscoring its impact to the health of mothers and the whole family.

“Couples should be made aware of the value of proper birth spacing for mothers to fully recuperate from the pressures brought about by pregnancy.  Another recommendation from the review was to strengthen the Responsible Parenthood and Family Planning Program of the local government by incorporating it into the sessions on premarital counselling, family development, parents’ classes and general assemblies,” Dr. Miliano-Montesa said.

The United Nations Population Fund, which is supporting Ifugao in its maternal health programme, reiterated the need to regularly track the status of pregnant mothers and to functionally bridge maternity care services from communities to referral centers.

During the review, culture-sensitive maternal and child health program was also emphasized as one of the strategies to persuade pregnant women from indigenous communities to deliver in health facilities. Local governments are encouraged to conduct regular Maternal Health Reviews along with Continuous Medical Education through lectures and discussions of maternal health issues for health workers.

The provincial and municipal administration expressed their commitment and support to maternal health programs, such as ensuring the availability of at least one midwife per barangay catering to the basic health needs of the people, as well as continuously work on enhancing facilities for maternal and child health.

“In conducting a Maternal Death Review, we can't help but feel a certain guilt with what else should have been done to save the life of the mother who died. Going through the process, we realized that the MDR helped us move on and become better health service providers in the end,” Dr. Miliano-Montesa admitted. “It was a day not to pin down who were at fault but to share insights and wisdom, to renew our commitment towards the attainment of MDG 5, a day to remind each one that ‘No woman should die giving life.’”

The MDR was attended by the mayor, Sangguniang Bayan chair for the Committee on Health, representatives from the governor's office, the Provincial Health Office, the Department of Health, Ifugao General Hospital, an obstetrician and all municipal health workers.