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 | ✓ | ||||