Women should see a doctor, nurse or trained midwife at least eight times during each pregnancy, with five of those visits in the last trimester, the World Health Organization said Monday as it issued 49 recommendations to prevent deaths in childbirth.

Previously, the agency had advised women to visit clinics four times per pregnancy. It also acknowledges the important role of local midwives in poor countries where mothers must travel long distances to see doctors or nurses.

But each visit should be with someone with at least two years’ medical training, “not a traditional birth attendant or a community health worker trained for a few weeks,” said Dr. Metin Gülmezoglu, W.H.O’s coordinator of maternal and perinatal health.

About 300,000 women die in pregnancy or childbirth each year, the agency said, and more than six million babies die in the womb, during birth or within their first month. Many of those deaths can by prevented through simple interventions.

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