1. WHO. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization. 2023.

2. Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, et al. Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? Am J Obstet Gynecol. 2024; 230: 1-440.

3. Hoyert DL. Maternal Mortality Rates in United States 2022. National Center for Health Statistics. Health E-States. 2024.

4. Gabbay-Benziv R. Special Issue: “Clinical Diagnosis and Management of Pregnancy Complications’’. J Clin Med. 2022; 11: 5644.

5. Shen S, Lu J, He J, Liu Y, Chen N, Yuan M, et al. Progesterone use in early pregnancy: a prospective birth cohort study in China. Lancet. 2015; 386: S58.

6. Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women. Cochrane Database Syst Rev. 2003; 2003: CD003253.

7. Bamfo JEAK, Odibo AO. Diagnosis and Management of Fetal Growth Restriction. J Preg. 2011; 2011:640715.

8. McNamara H. Problems and challenges in the management of preterm labour. Int J Obstet Gynaecol. 2003; 110: 79-85.

9. Valencia CM, Mol BW, Jacobsson B. FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth. Int J Gynecol Obstet. 2021; 155: 8-12.

10. Inducing labor unnecessarily increases risk of complications. Science Daily. University Adelaide. 2012.

11. Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, et al. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet. 2018; 392: 1358-1368.

12. Morlando M, Collins S. Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies. Int J Womens Health. 2020; 12: 1033-1045.

13. Mselle LT, Eustace L. Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. BMC Preg Childbirth. 2020; 20.

14. Till S, Mkhize M, Farao J, Shandu LD, Muthelo L, Coleman TL, et al. Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review with Stakeholder Consultation. J Med Internet Res. 2022; 25: e42161

According to the latest round of estimates, the maternal mortality ratio (MMR) has stagnated globally. In some developed countries, it seems to have increased with the urgent need for a new approach. WHO [1] and others [2] have reported that between 2016 to 2020, maternal mortality in 17 countries out of 133 countries, actually increased, mainly in Latin America, the Caribbean, Europe, North America, and sub-Saharan Africa. Hoyert [3] and others [4] have reported that in certain marginalised groups in high-income countries (HICs), particularly the USA, MMR has exceeded than those in some low-middle-income countries (LMICs). It is essential to look back and try to understand what has gone wrong and where. While newer knowledge is coming and technology is being developed for the prediction and early diagnosis of disorders, to know more about causes and the best and timely therapies of disorders but overuse brings in many issues which impact the mental health of women, and families with a lot of economic burden on society. It has created a world of ‘have and have nots’. It is essential that health scientists work with communities and learn from their worldly wisdom about real-life happenings. It is essential to recognize the missing gaps in the context of adversities during the slippery journey of pregnancy, birth, and post-birth to address maternal health challenges. A lot has been done and is still being done to prevent maternal deaths and promote maternal health, but still, women suffer because of many problems. A lot is needed not only for women in low-income (LI) and low-middle-income countries (LMIC), but HIC also. It is essential to understand the current status of maternity care, policies, programs, and services and find gaps for learning, the need for new policies, programs and services with their modalities and the expected impact on mothers as well as babies and new generations too. It is essential to know the facilitators for sustainable and safe modes for maternal health promotion with increasing challenges of choice and cost, which further affect the physical and mental health of women and families. Some unlearning and new learning are essential to try to understand the visible and the invisible too, with a critical look at pregnancy, birth and postpartum care.

• Maternal health

• Maternity care

• Maternal mortality ratio

Chhabra S (2024) For Best of Maternal Health, U-Turn Essential in Maternity Care with Stars of Newer Knowledge and Modern Technology. Ann Pregnancy Care 6(1): 1015.

Pregnancy care is increasingly being medicalised in modern maternal care with many interventions, some unnecessary too, which have an impact on cost, mental and physical health of the mother, baby, and even the future health of both. These interventions cost a lot to society. And many questions remain unanswered. Whether Indicated or not, medicalization starts from the care during early pregnancy with medication including progesterone to women, even with no abnormalities [5]. Cervical stitch is applied for reasons difficult to understand [6]. Diagnostic and management challenges persist in women with intrauterine fetal growth restriction [7]. A lot of research is needed, not only for early and appropriate diagnosis but also for interventions in cases with FGR. Preterm labour, spontaneous as well as iatrogenic, both need a critical look and new learning. Gaps-based research is essential [8]. A lot of research is needed for the prevention of preterm births and to find ways of reducing iatrogenic preterm births [9]. Induction of labor is increasingly being done for various reasons. Some really difficult to understand. And a lot of thinking is needed for evidence-based practices [10]. Around the world, there are increasingly high rates of cesarean sections (CS) with well-known sequelae, including higher mortality for mothers with cesarean births (CB). Many CS are performed for non-progress of labor without understanding whether women were in labor. Another indication for CS is foetal distress, with a vigorous crying baby at birth. A baby born with CB suffers at birth and over decades [11]. With increasing CBs, there is an increased risk of placenta accreta spectrum (PAS) which also affects women’s health over the years [12]. Women report being pressured into having CS, without clear justification. While efforts continue to reduce CS rates, the pace is slow because of the complexities involved. Various birthing positions, including lateral lying down position, traditionally used by traditional birth attendants have been replaced with births in the Supine Position on tables of labor rooms in hospitals, with no family around and no friends with a lot of mental stress [13]. Now birth attendants are coming back and different birthing positions too. But it will take time to return, which may not occur in many places because of the complexities of maternity care. New approaches have to be with local evidence.

There is plenty of evidence that the impact of modern maternity care is too much to leave things as they are. The reduction in maternal deaths, promotion of maternal health and wellbeing are complex tasks. It will require broader actions that go beyond biomedical factors. Community engagement is essential. Till et al. [14], did a review and reported that interventions often did not include communities early, leading to persisting gaps. There is a need for maternal health care that reflects the understanding of local culture, policies, programs, services and politics too! It also seems that with the U-turn in maternity care there is a real opportunity to reverse the pattern of health care by formalising health care with local culture, taking U-turn with newer knowledge and modern technology with the emphasis on building relationships including women in decision-making processes, and learning from communities. Healthcare providers in the field of maternal health must ensure their practices and interactions reverse patterns. There is an undeniable need as well as opportunity for maternity care with policies and programmes that prioritize cultural and local contexts, and areas for repurposing various aspects of pregnancy and birth care. Also, overdependence on technology is deskilling maternal health providers, history taking, and clinical examinations, disappearing. It is essential to think of the right management at this stage when maternal care is at the edge of being dehumanized.

Re-look at the technical management of maternity is essential as it is being over-medicalized and made technology-dependent, forgetting that pregnancy and birth are physiological events and nothing should be done which makes them pathological as there is always a ripple/cascade effect. Aldous Huxley, English writer and philosopher said ‘Medical Science has made such tremendous progress that there is hardly any healthy human left ‘so true for pregnant women in modern maternity care!