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Strengthening Myanmar’s Midwifery Education

Midwifery instructor Tin Ma Ma Nyein with her students during a break from their studies.
Midwifery instructor Tin Ma Ma Nyein (center) with her students during a break from their studies.

Pyay, Myanmar—A chorus of studious girls recites the best practices for a healthy birth. The students at the Pyay Nursing and Midwifery Training School prepare for their final exams.

The students at Pyay—dressed in traditional red longyi skirts and white caps—represent the next generation of frontline health care workers. Their education includes the most recent information in lifesaving interventions and advocates respectful treatment and care of pregnant women that lets women decide how and with whom they give birth.

The 114 midwifery students at the Pyay school are Myanmar’s investment in healthy women and strong families. The Ministry of Health is strengthening the country’s 24 midwifery schools as part of a commitment to accelerate the delivery of high-quality health services, especially to the poorest and most vulnerable communities in Myanmar. Policymakers, district health officers and midwifery educators share a vision for midwifery education that supports a strengthened health system to serve the country’s 51 million people.

With support from the Three Millennium Development Goal Fund, Jhpiego is providing technical assistance to the health ministry. The assistance is focused on strengthening policies and regulatory guidelines related to midwifery and enhancing instruction at the schools where midwives are trained before they begin their lifesaving work. 

Hands-On Practice

Like in so many countries in the developing world, in Myanmar, childbirth and pregnancy are among the leading causes of death for women. Severe bleeding after birth—postpartum hemorrhage—and pregnancy-related hypertension are the two leading causes of maternal deaths worldwide. Having a midwife skilled in managing these complications is the single best way to prevent women from dying. At the government of Myanmar’s request, Jhpiego is guiding capacity-building workshops for faculty and senior midwives who then share these updated and strengthened skills by training colleagues, other midwives and students.

To support midwifery students, Jhpiego has revitalized skills labs with the latest equipment, supplies and techniques to foster hands-on learning as part of a midwife’s two-year course of study. The skills lab gives students an opportunity to demonstrate respectful maternity care. Using a lifelike simulator, they can practice assisting a woman in giving birth, managing complications that arise for the mother or baby and providing essential care to the newborn and mother to help them be ready to maximize their learning when they move to the clinical part of their educational experience.

Myanmar midwife training
Midwifery instructor Tin Ma Ma Nyein (left) watches as students at the Pyay Nursing and Midwifery Training School role play a birth in a refurbished clinical skills lab supported by Three Millennium Development Goal Fund and Jhpiego.

“I didn’t know anything about the birth process aside from what I learned in the books,” says first-year student Aye Thazin Pwint.Now, we are more skilled because we practice again and again. And because we are more skilled, we have more confidence in what we do.”

A key new feature in the Jhpiego-supported lab is a soft, maroon-colored birth simulator—called MamaNatalie—that mimics childbirth and allows students to have a more realistic experience of assisting in a birth. Students take turns playing the roles of midwife and mother using the simulator, which was designed by Laerdal Global Health with assistance from Jhpiego.

Khin Moh Moh Oo, the principal at the school for 14 years, says reinforcing clinical skills in an interactive way benefits faculty, students and—most importantly—the client. “In the past, we had a demonstration room [for clinical skills training],” says the 55-year-old nurse-midwife. “Now the equipment, with support from Jhpiego, makes it very close to the real situation. For example, the simulators can monitor the fetal heart rate and lung function. This can facilitate teaching and learning activities and can ignite the students’ interest.”

MamaNatalie Lends a Hand

With the help of MamaNatalie, the aspiring midwives gather in the new skills lab of the Pyay school and observe as three students manage the steps of a normal delivery, including the birth of a lifelike baby with umbilical cord. One student poses as the pregnant woman, wearing the MamaNatalie with a cloth draped over her for privacy. A second student acts as the mother’s companion and coach.

A third student plays the role of midwife, properly outfitted in safety apron, boots, gloves and mask. She moves from one step to the next, according to a checklist of actions intended to ensure a safe birth.

Newborn Care Station
The newborn care station in the refurbished clinical skills lab at the Pyay midwifery school.

Student May Thin Htike says the newborn simulator, NeoNatalie, has made the difference in learning to resuscitate a baby because she has been able to practice repeatedly and gauge her improvement. “With the NeoNatalie, you can practice suctioning mucus from the baby and see it breathing and hear the heartbeat,” she says.

Tin Ma Ma Nyein, a teacher and Jhpiego-supported trainer, says students retain information better through an interactive experience.

“The group discussion and the hands-on skills practice with the model are very good and supportive. The checklist is being used routinely. If the students practice again and again to master the skill, it will improve their confidence and decrease their stress when the time comes to face a real client.”

Caring for the Community

After passing a final exam, the newly graduated midwife will be posted to a rural health center or within a community and will be expected to deliver babies, detect and manage complications such as high blood pressure, vaccinate children and identify those patients who need to be referred to a higher-level care facility.

“Everyone wants the mother and the child to be safe and healthy after birth,” says Oo. “Midwives are the frontline health workers for the whole health system. The midwife has to look after all members of the family, not just the mother. If they can improve the health of the individual and the community, they can impact the poverty of the country.”

“With the help from the Three Millennium Development Goal Fund and Jhpiego, we can improve the capacity [of midwifery students and teachers]. I believe that in a way we can help reduce the rate of maternal and child mortality.”

Midwifery student Pwint recognizes the impact she can have on Myanmar’s women and families.

“One day, with what I’ve learned at this training school, I want to take care of the patients like my own family, with compassion and empathy,” she says.