In low-income and some middle-income settings where
there is a shortage of midwives and specialist and general
medical practitioners, there is a focus on ‘skilled birth
attendants’,181 defi ned as accredited health professionals
educated and trained to profi ciency in the skills needed to
manage uncomplicated pregnancies, childbirth, and the
immediate postnatal period, and in the identifi cation,
management, and referral of complications in women
and newborn infants. The implementation of skilled birth
attendants over the past decade has contributed to the
overall decrease in maternal mortality.18 However, its
implementation in practice varies widely across countries,
and skilled birth attendants have uneven levels of
profi ciency, restricted scope of practice, and varying levels
of training. They might not work across the continuum of
care or be trained to deal with unexpected complications,
all of which can result in harm.5,23,182–184