This book provides an authoritive guide to the essential services that need to be in place at first-referral facilities in order to manage the major life-threatening complications of pregnancy, labour and the puerperium. Adopting a problem-orientated approach, this book concentrates on the main causes of maternal mortality and morbidity likely to require emergency care, addressing each condition in terms of the essential procedures, skills, equipment, and supplies needed for effective management. The objective is to help hospital administrators, clinicians, and other decision-makers understand what a decision to upgrade obstetric services will mean in terms of organization, logistics, staffing, training and demands on resources. While noting the need for sweeping changes in the district health systems of most developing countries, the book identifies a number of simple changes that can bring immediate improvements in obstetric care, without the need for added resources or staff.