Providing Skilled Birth Care in a Resource-Poor

Setting: Training Midwives in Rural Haiti

Poster Presentation

Purpose for the Program

To introduce health care professionals to life-sav-

ing methods that are necessary to save the lives

of mothers in childbirth in resource-poor setting.

Proposed Change

Nurses and midwives possess skills that can save

the lives of mothers and infants and can join the

e¡orts to reduce maternal mortality in the global

community. The methods of caring for women and

newborns in the childbearing year require adapta-

tion when resources are limited.

Implementation, Outcomes, and Evaluation

The complications most often responsible for death

or serious injury to mothers in the childbearing

years in developing countries are preventable and

increased in Haiti because of an insu⁄cient num-

ber of skilled birth attendants.

This presentation will describe a training program for

skilled birth attendants as de¢ned by the International

Confederation of Midwives and the World Health Or-

ganization. In Haiti the challenges of providing skilled

care are complicated by a lack of basic needs such

as clean water, basic nutrition, and electricity. How to

create a clean and safe environment in this setting

and the essential medications and equipment needed

will be discussed. This presentation addresses e¡orts

tomake skilled birth attendants an integral part of Hai-

ti’s health care system with government recognition.

This presentation also describes a mobile prenatal

clinic program that uses graduate Haitian midwives

and a customized vehicle to bring accessible care to

hundreds of women in rural villages.

Implications for Nursing Practice

Nurses will recognize the importance of preventative

and emergency care in pregnancy regardless of

where a woman lives. They will be able to adapt the

high-tech skills they use now in caring for mothers

andnewborns toa settingwith limitedbasic resources.

Code H Obstetrical Hemorrhage: Development of a

Team Approach

Poster Presentation

Purpose for the Program

New York State Department of Health issued a

health advisory in 2009 stating the following:

� Maternal mortality rate is higher than the na-

tional average and hemorrhage the leading

cause of mortality.

� Providers canprevent maternal deaths by improv-

ing recognition and response to hemorrhage.

� Blood loss is frequently underestimated.

� The causes of death are multifactorial, and pre-

vention requires a multidisciplinary response.

� Hospitals with rapid and coordinated responses

to extreme blood loss can limit morbidity and im-

prove survival.

Proposed Change

Although we had implemented interventions to re-

duce the risk of morbidity and mortality secondary

to maternal hemorrhage, we needed to further

develop a multidisciplinary team response and

identify system factors that result in delay in recog-

nition and treatment.

Implementation, Outcomes, and Evaluation

Step1çWe performed aneeds assessment. Step 2ç

How do we improve estimation of blood loss? Litera-

ture search reveals improving visual estimation and a

weight-based conversion method.We also quanti¢ed

the average amount of laps used in a Cesarean birth.

Step 3çCollaborate with anesthesia, blood bank,

maternal fetal medicine, and gynecologic oncology

departments to develop guidelines for team response,

a hemorrhage resource guide, and emergency equip-

ment cart. Step 4çEliminate barriers to rapid blood

access and laboratory testing. Step 5çFacilitate

communication with hemorrhage team. Step 6çEdu-

cation and implementation of what we named Code

H, a multidisciplinary coordinated response to mater-

nal hemorrhage.

Nadene Brunk, CNM, MSN,

Midwives for Haiti,

Richmond, VA

Keywordsskilled birth attendantsHaitimaternal mortality

Professional

Issues

Margaret T. Celenza, MS, RN,

CNS, Obstetric Department,

Winthrop University Hospital,

Mineola, NY

Mary Lynn Brassil, MS, RN,

CES, Maternal Child Nursing,

Winthrop University Hospital,

Mineola, NY

Keywordshemorrhage teammaternal hemorrhageestimating blood loss

Professional

Issues

S46 JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention