Dar es Salaam, Tanzania—A three-wheeled scooter sputtered to a stop outside the Buguruni Hospital, after maneuvering through the notorious downtown traffic, dodging potholes and shoppers who spilled into the narrow streets. In the back, Rehema Selemani Omary was in labor, perilously close to giving birth.
“Her water had broken and she was pushing—right there,” recalls Beatrice Mziray, the nurse-midwife at Buguruni who managed Rehema’s complicated birth. “You could feel and see the child’s head.”
It was a highly urgent situation, Beatrice knew, but was more complicated than just a street-side delivery.
“We have a shoulder dystocia,” Beatrice remembers shouting to her fellow health care providers as they immediately leapt into action. She was referring to an obstetric complication in which the baby’s shoulders cannot make it through the birth canal. The midwives realized that they had little time to save the baby’s life.
The midwives rushed Rehema as quickly as possible into the hospital, where they could use their skills in emergency obstetric and newborn care (EmONC) to intervene immediately and help deliver the baby safely.
The situation facing Beatrice that day is not uncommon. Approximately 15% of expected births worldwide will result in life-threatening complications for the mother before, during or after birth, and perhaps as many present complications for the newborn. Because of this, “universal access to EmONC is considered essential to reduce maternal mortality,” according to a review of three flagship maternal health programs spanning 16 years and more than 30 countries.
The review, “Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care,” appears in a newly published special supplement to the International Journal of Gynecology & Obstetrics (June 2015). The article discusses seven important services that should be available to women and babies in order to manage complications at birth. These services include administering medications to fight infection, treat hypertension-related convulsions and prevent life-threatening bleeding after birth; performing an assisted vaginal birth; manually removing a placenta or remnants of it; and resuscitating a newborn.
- Beatrice Mziray holds a newborn she helped bring into the world at Buguruni Hospital in Dar es Salaam, Tanzania.
Beatrice and her fellow midwives at Buguruni Hospital learned these skills through the United States Agency for International Development’s Mothers and Infants, Safe, Healthy and Alive (MAISHA) program, led by Jhpiego. The program trained nearly 1,000 health care providers like Beatrice in EmONC techniques. As well, more than 7,000 health workers across more than 3,500 facilities were trained in focused antenatal care—an innovative approach to prenatal care ensuring that mothers have access to comprehensive health services tailored to their specific needs.
In the supplement article, the authors cite Tanzania’s MAISHA program as a clear example of how these interventions have led to notable improvements in care during and immediately following childbirth. “For example, 60% of women received active management of the third stage of labor (AMTSL) according to the current guidelines and standards in 2012—an increase of 19% from 2010,” the review notes.
As for Rehema and her baby, Beatrice remembers using her EmONC skills to manage the complicated delivery. She realized that the baby’s shoulders had become stuck, so she and her colleagues supported Rehema to flex her hips as she lay on her back, helping to open her pelvis a bit more and give the baby more space. Another colleague applied pressure above the pubic bone to help dislodge the shoulder, and, using gloved hands, Beatrice rotated the newborn’s shoulders while applying gentle pressure, smoothly delivering the baby from its stuck position. While one midwife attended to the mother, Beatrice quickly assessed the baby and noted that the baby was not breathing, a result of the difficult delivery. She confidently and competently resuscitated the newborn and helped the baby breathe, making a successful transition to life after a rough start.
“Before the EmONC training, we were not confident to intervene the way we did,” Beatrice says. Thanks to the Jhpiego-led training, she and her team are now equipped to handle a range of obstetric complications and can act decisively to save mothers and newborns.
And the competency shows—since the trainings began, Buguruni has recorded zero pregnancy-related deaths while referring fewer and fewer mothers to higher-level facilities, lessening the strain on those facilities and saving more mothers and newborns. That’s a lot of joyful families riding three-wheeled scooters back to their homes.
Read about the lessons learned and opportunities to save more lives in the full article in the International Journal of Gynecology & Obstetrics: http://bit.ly/AboutEmONC