Potentially life-threatening complications develop in about 15% of pregnancies, and all of these women need immediate care. Over 70% of maternal deaths are due to complications of pregnancy and childbirth, such as hemorrhage, hypertension, infection, and abortion. Most complications cannot be predicted, but providers can help women and their families be prepared for them in case they happen.

• Help women arrange for skilled attendance at birth, and ensure that they
  know how to contact the skilled birth attendant at the first signs of labor.
• Explain danger signs during pregnancy and childbirth to women and their families (see next page).
• Help the woman and her family plan how she will reach emergency care if complications arise: Where will she go? Who will take her there? What transport will they use? How will she pay for medical help? Are there people ready to donate blood?

Health facilities caring for pregnant women should have providers who are trained to:

• Monitor labor
• Care for the newborn at birth and during the first week
• Manage pre-eclampsia and eclampsia and their complications
• Manage difficult labor
• Manage postpartum hemorrhage, the leading cause of preventable maternal mortality
• Perform newborn resuscitation
• Manage preterm labor and care for preterm and small babies
• Manage maternal and newborn infections
• Communicate effectively. Providers need to be supportive, respectful, and sensitive to the needs of the pregnant woman and her family. Women should feel involved and informed so that they can make informed choices about their care.

Facilities must have a referral system in place for complications that need to be handled at a higher-level facility.