Setsan, Myanmar–Ma Kay Thi Aung will never forget that morning 11 years ago when tragedy struck. Her aunt had endured a long labor, but the baby was not coming. All efforts by the village traditional birth attendant were failing. Her aunt’s condition only worsened. Finally, it was decided to take her to the nearest rural health center in Setsan. Travel from their village in Ayeyarwady Region was not easy with streams crisscrossing the countryside. A 3-hour boat ride, while more feasible, depended on the tides but the family, accompanied by a traditional birth attendant, pushed ahead.
While en route, Aung’s aunt gave birth to a stillborn baby and started bleeding uncontrollably. By the time she reached the health center, she had lost too much blood, a life-threatening condition called postpartum hemorrhage. She was referred to a bigger hospital in town, which meant yet another boat ride. Aung’s aunt died before she could reach the hospital.
The incident proved to be a wakeup call for the entire community. “Looking back now, there was one positive impact. The village people learned about how things could easily go wrong during childbirth. It prompted them to make a timely visit to the regional health center and consult the midwives there.”
Her aunt’s death also brought about a sense of purpose for Aung. After high school, she decided to pursue a career in midwifery. “My aunt’s tragedy was still fresh and it haunted me very much,” she said. She enrolled in the 2-year midwifery course at the Nursing and Midwifery Training School in Pathein.
As part of her first-year program, Aung was introduced to innovative and effective teaching methods designed to build confident, skilled midwives through hands-on practice in the school’s clinical skills lab. Across Myanmar, 23 such skills labs have been established in schools through the “Improved Midwifery for Maternal, Newborn and Child Health Services” since 2014. With support from the 3MDG Fund, Jhpiego has worked with the Ministry of Health to strengthen scalable midwifery education and training systems to ensure consistent, competent and safe clinical care for future mothers and newborns. The donors of the 3MDG Fund have demonstrated a longstanding commitment to maternal health in Myanmar, believing that midwives are at the core of a strong, accessible health system.
As part of this effort, Jhpiego has trained 68 master mentors and 345 faculty and clinical staff on how to standardize clinical skills and 51 faculty members from nursing and midwifery training schools on how to use the skills lab in practical sessions with their students. A total of 105 faculty members received training to strengthen their teaching skills and conduct competency-based performance assessments.
Skills labs give student midwives and nurse trainees the opportunity to practice skills and achieve competency on anatomic models before caring for actual clients in a clinical setting. Methods students learn at the skills lab are quite different from traditional methods, Aung recounted. “For instance, our village traditional birth assistant used to cut the cord with unsterilized bamboo sticks,” Aung explained. “After that, she would put turmeric powder to the cord stump. Since the materials used were not sterilized, it was very infectious and therefore dangerous.”
“I have learned how to manage third stage of labor, applying best practices to save mother and babies,” Aung continued. The hands-on practice with anatomic models has helped make Aung confident to deliver with a real woman.
Daw Nan Moe Win Aye, one of Aung’s teachers and a lecturer with over 15 years of service, spoke about her own nursing training, saying, “We learned theoretical aspects first, and then we went on to practice delivery. So much so that we feared sometimes that we would do it incorrectly, with fatal consequences.”
Honing her skills at the lab prepared Aung for her second year of field training, during which she assisted with two deliveries at Pathein General Hospital and managed four deliveries as part of a mobile team of midwives in Pathein’s outlying poor neighborhoods. Aung stressed the importance of treating a woman in labor with kindness, respect and tenderness, referring to the respectful maternity care practices she learned through the skills lab.
After graduating, Aung intends to apply for a government posting, saying she’d like to work in her own neighborhood or anywhere in the region because Ayeyarwady Region has one of the country’s highest rates of infant and maternal mortality. Midwifery graduates like Aung would indeed be driving forces in strengthening the provision of basic health care as well as upgrading the country’s national health standards.
“I have changed. Just a couple of years ago, I was just a rural girl, eager to learn but still lacking strong conviction or purpose,” Aung says. “Now, I have a purpose. Life has never been so meaningful to me. I must help and educate my people.”