cation and interpersonal skills can be the determining factor in whether skilled attendants are accepted in communities and their services utilized.

In addition, it is important for skilled attendants to use cognitive skills that facilitate problem solving and quick, decisive action. In the context of identifying essential competencies for skilled attendants, the International Confederation of Midwives has developed a “framework for decision-making.” This framework calls on skilled attendants to take the following actions to ensure high-quality care:

• Gather information—through interviews, dialogue, observation, and clinical examination—and decide what is relevant to the situation(s);

• Identify signs and symptoms of serious and/or life-threatening conditions and develop a plan of care, balancing speed with attention to details; and

• Evaluate the effectiveness of actions taken and modify or adapt the plan of care when needed, in individual cases and when a similar situation arises in the future.

Excerpted with permission from Skilled Care During Childbirth Information Booklet. New York: Family Care International, Inc. 2002. Prepared by Mia MacDonald with Ann Starrs.