Maternity waiting facilities for improving maternal and neonatal outcomes in low-resource countries

The chances of women dying because of complications of pregnancy and childbirth are still high in many parts of the world. The main direct causes of maternal and perinatal deaths are unsafe abortion, eclampsia, haemorrhage, obstructed labour, infections and sepsis. Most of these deaths can be prevented with early identification and treatment of complications. The poor utilisation of maternal health services and antenatal care in areas where deaths are high is mainly the result of barriers to access.

A maternity waiting home is a facility that is within easy reach of a hospital or health centre that provides antenatal care with skilled birth attendants and emergency obstetric care. The facility may also provide women with health education about pregnancy, giving birth and infant care. It is mostly women with high-risk pregnancies or those that are living far away that are encouraged to stay in these facilities at the end of their pregnancy. The extent to which women are cared for in the homes and the help that is available to them differs from country to country. A further difficulty is that home delivery is less expensive and women may not be willing to leave their families, who depend on their care, or their farms which are their means of existence.

The review authors could not find any individual or cluster-randomised controlled trials that evaluated the outcomes for women using a maternity waiting facility in low-resource countries. The fact that women who develop a serious obstetric complication need appropriate care in order to survive is clear. The effectiveness of maternity waiting homes in decreasing maternal deaths and stillbirths has been described in general terms in six retrospective population cohort studies. These are likely to describe women who were referred to stay in maternity waiting homes because of risk factors and compared them with women who came to the hospitals for other reasons. The control groups may have been self selected by disaster or women’s ability to access the hospitals in time. The outcomes of births for the women who stayed at home were not known. There is insufficient evidence on which to base recommendations about the effectiveness of maternity waiting homes, and well controlled trials are needed.

Authors' conclusions: 

There is insufficient evidence to determine the effectiveness of maternity waiting facilities for improving maternal and neonatal outcomes.

Read the full abstract...

A maternity waiting home (MWH) is a facility within easy reach of a hospital or health centre which provides emergency obstetric care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and giving birth can be assisted by a skilled birth attendant. The aim of the MWH is to improve accessibility to skilled care and thus reduce morbidity and mortality for mother and neonate should complications arise. Some studies report a favourable effect on the outcomes for women and their newborns. Others show that utilisation is low and barriers exist. However, these data are limited in their reliability.


To assess the effects of a maternity waiting facility on maternal and perinatal health.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 January 2012), CENTRAL (The Cochrane Library 2011, Issue 4 of 4), MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), African Journals Online (AJOL) (January 2012), POPLINE (January 2012), Dissertation Abstracts (January 2012) and reference lists of retrieved papers.

Selection criteria: 

Randomised controlled trials including quasi-randomised and cluster-randomised trials that compared perinatal and maternal outcome in women using a MWH and women who did not.

Data collection and analysis: 

There were no randomised controlled trials or cluster-randomised trials identified from the search.

Main results: 

There were no randomised controlled trials or cluster-randomised trials identified from the search.