By Nongma Sawadogo and Alanna Savage
Nongma Sawadogo leads work on women’s and children’s health for the FCI Program of Management Sciences for Health (MSH) in Burkina Faso, and Alanna Savage is senior communications specialist for the FCI Program of MSH.
Burkina Faso has unacceptably high national rates of maternal and newborn mortality, but health indicators are the poorest in the Sahel, North and East where many more women and children are dying from preventable causes due to poor quality of care.
With support from Johnson & Johnson and working closely with the Division of Family Health, the Ministry of Health, UNFPA, the School of Public Health and national midwifery associations, the FCI Program of MSH is leading an intensive training, supervision and mentorship program to improve midwives’ mastery of life-saving clinical skills. The training program covers three modules: (1) compassionate care for mothers and newborns, (2) Helping Mothers Survive, and (3) Helping Babies Breathe.
Prior to launching the training program, representatives from the FCI Program of MSH, the Department of Family Health, UNFPA, national midwifery and obstetrics associations, among others, reviewed and adapted the training modules to reflect current evidence and practice, and ensure they were aligned with national protocols and guidelines.
Then, the FCI Program of MSH and partners recruited and trained the facilitators who would lead the life-saving skills trainings in the Sahel and the Northern Regions.
The fundamental tenet of compassionate care is to treat a woman how you would want her to treat you in the same situation. A pregnant woman is exhausted, scared, suffering from pain, and perhaps alone.
During this session, midwives learn that they should:
- Show kindness and respect for women
- Reassure the woman, put her at ease, and ensure her privacy.
- Meet her needs
- Inform her of her status during labor. The provider should inform her what she/he will do and what will happen during labor and childbirth.
- Encourage a family member to accompany the woman in labor.
Helping Mothers Survive
The Helping Mothers Survive curriculum , developed by Jhpiego and Laerdal Global Health, equips health providers, including midwives, with critical skills to care for mothers during pregnancy, labor, and delivery.
The first module of this program, Bleeding After Birth, reviews actions for the active management of the third stage of labor and early detection and management of excessive bleeding–or postpartum hemorrhage, a leading cause of maternal death globally.
This module also emphasizes that midwives actively communicate with team members and the mother.
The participant playing the role of mother simulates movement of the baby during the third stage of labor.
Within one minute of birth and after verifying there isn’t a second baby, the midwife administers oxytocin or misoprostol to stimulate the uterus to contract, which squeezes the blood vessels to stop bleeding.
At this point in the workshop, the facilitator reviews the skills the midwife demonstrated and explains the procedure for cutting the umbilical cord.
After cutting the umbilical cord, the midwife supports delivery of the placenta. Once the placenta is delivered, the midwife verifies it is complete. Any placenta tissue left inside the uterus could lead to severe bleeding and infection.
Midwives must not depend on visual assessment of blood loss alone to determine how a woman is doing. Midwives must also assess other signs, such as sweating, panting, anxiety, thirst and dizziness. Visually estimating blood loss is a difficult skill, as the exercise below tries to demonstrate. And even if a woman loses less than the 500ml indicating PPH, her physical condition may indicate otherwise.
If the placenta is incomplete or doesn’t come within 60 minutes of birth and/or the woman is bleeding excessively, midwives must practice advanced care, as appropriate to their scope of practice, or refer mother to a provider with advanced care skills.
While checking the condition of the mother, the midwife must also ensure the baby is thriving after birth. Workshop participants learn how to help babies breathe, as illustrated in an upcoming blog post.
View more photos of the workshops.
Laerdal Global Health video of MamaNatalie simulator in action