The major challenge in achieving Millennium Development Goal 5 (maternal health) was the limited availability of skilled birth attendants. Skilled birth attendants are crucial for managing complications during labor and delivery, thereby reducing maternal mortality. Their presence ensures timely interventions, appropriate use of surgical procedures like cesarean sections, and effective neonatal resuscitation. Without adequately trained personnel, preventable maternal deaths due to hemorrhage, sepsis, and obstructed labor remain high. Thus, increasing the number and accessibility of trained healthcare providers directly impacts maternal survival rates.

Reference: Obstetrics by Ten Teachers, Keith Edmonds, 20th Edition.