SECOND EDITION OF THE ALARM INTERNATIONAL PROGRAM

SYLLABUS
Preface for ALARM International Syllabus
In the 1990s, the Society of Obstetricians and Gynaecologists of Canada (SOGC) joined the international
moement for Safe !otherhood and committed to "or# to"ard the red$ction of maternal mortality and morbidity
"orld"ide%
SOGCs commitment to this iss$e coincided "ith recognition internationally that the strategies &romoted in the
last decade to red$ce maternal mortality "ere not yielding the e'&ected res$lts% (here "as a gro"ing consens$s
that adocated for the incl$sion of )s#illed attendance at birth*
1
as a #ey interention in all Safe !otherhood
initiaties, to ens$re the &reention and management of obstetrics com&lications%
SOGCs commitment to Safe !otherhood also coincided "ith a call for the increased &artici&ation of ob+gyn
associations in maternal mortality red$ction initiaties as leaders, adocators, trainers and mobili,ers of reso$rces
to ens$re healthy and safe &regnancies for all "omen% -s stated by .r% (omris (/rmen from the 0orld 1ealth
Organi,ation2
It is not enough to be clinically competent. It is not enough to be socially aware and socially conscious.
The obstetrician and gynaecologist must be a champion for ALL womens health, welfare and rights
(they) must become the oices of the oiceless, the champions of the neglected, the militants of the poor.
Their leadership and their social and economic clout are needed to ma!e essential obstetric care
aailable to all women. Their actions and oices are necessary to shift resources at the national
leel...to improe health systems. It is timeto moe beyond the consulting room, beyond the hospital
ward, to play a prominent part in the reitali"ation of the health system as a whole.
#
(he -3-4! International 5rogram is a 6 or 7 day training and mobili,ing tool designed for health &rofessionals
inoled in the deliery of essential obstetrical care in deelo&ing co$ntries% (he &rogram "as deelo&ed and
&iloted "ithin a &artnershi& &roject "ith the ob+gyn associations of G$atemala, 1aiti and 8ganda% It is th$s
sensitie to the realities, conditions and e'&ectations of local &ractice and f$rther &roides am&le o&&ort$nity to
integrate local concerns% It is c$rrently aailable in 9nglish, :rench and S&anish%
(he -3-4! International 5rogram recogni,es that training ; by itself ; is not s$fficient to im&act the high rates
of maternal mortality and morbidity fo$nd in many deelo&ing co$ntries% (he &rogram th$s adocates a range of
interentions2 red$cing gender ine<$ality, im&roing the n$tritional stat$s of "omen and girls, increasing girls
access to ed$cation, strengthening referral systems, &romoting &rofessional deliery of care, ens$ring emergency
maternal care for all "omen, enco$raging and facilitating district leel and comm$nity &artici&ation and ens$ring
the monitoring and eal$ation of Safe !otherhood initiaties% (o this end, the Society see#s to delier the
5rogram in conj$nction "ith national medical associations "ho commit to ens$re that the 5rogram is offered
"ithin a com&rehensie maternal mortality red$ction &rogram that is in s$&&ort of the co$ntrys Safe !otherhood
strategy%
(he content and recommendations of the -3-4! International 5rogram are deried from eidence=based
medicine and are c$rrently maintained by SOGCs -3-4! International Committee% International g$idelines
and standards of &ractice from the International :ederation of Gynaecology and Obstetrics (:IGO), the 0orld
1ealth Organi,ation (01O), 8nited >ations 5o&$lation :$nd (8>:5-), the 8nited >ations Childrens :$nd
(8>IC9:), the International Confederation of !id"ies (IC!) and SOGC hae been integrated into the co$rse
material and form the basis of the &rogram% It is also intended as a tool to disseminate the information aailable in
1 S#illed care refers to the &rocess by "hich a &regnant "oman and her infant are &roided "ith ade<$ate care d$ring labo$r,
birth and the &ost&art$m and immediate ne"born &eriods, "hether the &lace of deliery is the home, health center, or hos&ital%
In order for this &rocess to ta#e &lace, the attendant m$st hae the necessary s#ills and m$st be s$&&orted by an enabling
enironment at ario$s leels of the health systems, incl$ding a s$&&ortie &olicy and reg$latory frame"or#? ade<$ate s$&&lies,
e<$i&ment, and infrastr$ct$re? and an efficient and effectie system of comm$nication and referral+trans&ort% (So$rce2 S#illed
Care .$ring Childbirth ; Information @it &re&ared and distrib$ted by :amily Care International% A00A)%
A (/rmen, (%, )9mergency Obstetric Care for -ll 0omen ; - Social 4es&onsibility for Obstetricians*, (:IGO 5re=Congress
0or#sho&, 01O 5resentation, 0ashington .%C%, -$g$st A000%)
ALARM INTERNATIONAL * Preface *
SECOND EDITION OF THE ALARM INTERNATIONAL PROGRAM
SYLLABUS
the 01O reso$rce entitled )$anaging %omplications in &regnancy and %hildbirth, A 'uide for $idwies and
(octors%*
)
It is ho&ed that li#e its &redecessor, the second edition of the SOGCs -3-4! International &artici&ants man$al
"ill contin$e to deelo& and gro" as the &rogram e'&ands in the deelo&ing "orld% Its tr$e &otential lies in the
commitment of SOGC and its &resent &artners ; the -ssociation of Obstetricians and Gynaecologists of 8ganda
(-OG8), the Asociacion de 'inecologia y *bstetricia de 'uatemala (-GOG), the @osoar Obstetricians and
Gynaecologists -ssociation (@OG-) and l-ssociation +oci,t, -aitienne d*bst,tri.ue et 'yn,cologie (S1OG) ;
and f$t$re &artners, to contin$e this "or# and more im&ortant, remain foc$sed on the real needs of health
&rofessionals assisting "omen at childbirth in deelo&ing or in transition co$ntries%
(he recent !illenni$m .eelo&ment Goals hae once again committed the international comm$nity to "or#
collaboratiely in an effort to red$ce maternal mortality by B7C bet"een 1990 and A017 and identified the
&ro&ortion of births attended by s#illed &ersonnel as an indicator for this goal% 1ere lies the real challenge for all
of $s? one "hich SOGC and its &artners are committed to contin$e to address and "or# thro$gh in the years ahead%
-ndrD E% 3alonde, !. :erd 5a$ls,
!.
9'ec$tie Fice 5resident, SOGC
Chair, -3-4!
International Committee,
SOGC
6 01O+414+00%B%
ALARM INTERNATIONAL * Preface *
SECOND EDITION OF THE ALARM INTERNATIONAL PROGRAM
SYLLABUS
(he information and recommendations in this syllab$s reflects the emerging clinical and scientific adances as the
date of iss$e and is s$bject to change "itho$t notice% (he information sho$ld not be constr$ed as dictating an
e'cl$sie co$rse of treatment or &roced$re to be follo"ed% (he &ro&er dr$g dosages sho$ld also be erified%
ALARM INTERNATIONAL * Preface *
USE OF THE ALARM INTERNATIONAL SYLLABUS
(he objectie of the -3-4! International Syllab$s is to &roide a &ractical tool for hel&ing red$ce
maternal mortality aro$nd the "orld and th$s be instr$mental in increasing access to <$ality of health
care%
It recogni,es that health care serices are not $niform thro$gh o$t the )deelo&ing* "orld and th$s can
ary from co$ntry to co$ntry according to the reso$rces aailable, ty&e and location of facilities (i%e% $rban
or r$ral)%
In order to ma#e this man$al &ractical for most settings in "hich it is ho&ed it "ill be $sed, "e hae
attem&ted to clearly identify those interentions and+or &roced$res "hich are &ossible in lo"er reso$rce
settings and those in higher reso$rce settings%
:inally, the -3-4! International Syllab$s "ill become more al$able as "e deelo& an international
reference base% (he references, "hich are &resently incl$ded in the man$al, reflect the major in&$t from
Conse<$ently, it is im&ortant to note that all, "hich has
been highlighted thro$gho$t the man$al, are interentions
and +or &roced$res, "hich are &ossible in higher reso$rce
settings%