Midwives, operating at two community-based, well equipped primary health care clinics, provide 24/7 services to a population of over 50,000. They independently detect and manage obstetric complications and decide when to refer cases to a higher level, better equipped facility. The organization has established contacts with referral centers to ensure that referred clients receive good quality services quickly. The referral system includes counseling, transport arrangements, accompanying women, help with admission and support during inpatient care - all of this leading to higher referral compliance rates. The clinics also provide advice related to contraceptive choices and stock contraceptive supplies.
From 2000-2008, the two health centers participating in this model have attended to 2771 women in labour and 202 maternal emergencies. There was only one maternal death in nine years.
This model, therefore, is evidence that in a human resource constrained environment, trained nurse-midwives can significantly improve access to skilled maternal and neonatal care in rural areas, and manage maternal complications with and without the need for referral.