Itaosy, Madagascar – Odile Razafinganahary had just given birth to twin boys when Midwife Agnes Haingo noticed that she was bleeding heavily. When two cotton cloths quickly became soaked with blood, the hospital midwife knew she had to act immediately. After ensuring that no fragments of the placenta had remained inside the mother, Haingo began to massage the woman’s uterus, a technique to combat excessive bleeding after the birth of a baby.
Excessive bleeding, known as postpartum hemorrhage, is preventable and easily treated. However, in Madagascar, it is the leading cause of women’s deaths: 498 per 100,000 live births. In an effort to save women’s lives, the Maternal and Child Health Integrated Program (MCHIP)—led by Jhpiego through funding from the U.S. Agency for International Development (USAID)—targets this area in all its trainings. Midwife Haingo learned the uterine massage procedure last summer during a Jhpiego-supported training. Despite the midwife’s use of this technique, the young mother Odile was still bleeding. Haingo remained calm. She continued to press firmly on Odile’s abdomen, over the aorta, to help stanch the bleeding—another technique she learned in the training. As she worked, Haingo explained to Odile what she was doing, keeping her informed and reassuring her so the mother wouldn’t panic. After several minutes of compression, the bleeding finally stopped.
Jhpiego’s work in Madagascar began in 2003 with USAID support to expand pregnant women’s access to malaria prevention and treatment services. Jhpiego’s efforts to prevent the needless deaths of women and families in Madagascar have included building the capacity of health care workers; developing performance standards for family planning, sexually transmitted infection, child health and MIP services; and strengthening health services. The organization develops innovative, low-cost technologies to address today’s global health challenges and works with communities and partners to increase frontline health workers’ ability to deliver lifesaving care.
Odile is now the proud mother of two healthy three-month-old boys, Damas and Calist, and she speaks highly of Midwife Agnes and her experience giving birth at the local hospital. The birth of her five-year-old son Angelo at another facility did not go as smoothly. During and after the 18-hour labor, the health care provider attending her did not listen to Odile’s needs or explain what she was doing. “My mother and my sisters had to take care of me,” Odile recalls.
During her second pregnancy, Odile specifically sought out Haingo at the recommendation of her sister-in-law. During her prenatal visits, Odile and the midwife established a rapport that carried into the delivery room. So when Haingo worked swiftly to stop the bleeding, Odile had confidence in her and followed her instructions, even though the pressure on her abdomen was unpleasant. “I trusted Agnes and everything was simple with her,” says Odile. Haingo adds, “I know that compression hurts, which can make the work difficult. So I always tell the woman what I am doing.”
As part of the MCHIP trainings, there is a focus on strengthening the interpersonal communication skills of doctors and midwives by continually reinforcing that they must always reassure the woman and describe what they are doing. In fact, all skills checklists used to evaluate the competency of providers during the trainings prompt them to maintain open communication and a positive attitude toward the woman. Myrta, a retired midwife who helped train Haingo, said, “With each lesson we teach providers that they must greet the woman warmly and prepare her for what is coming. We then evaluate them during role-play exercises to see if they talk to the woman and smile at her during each step—a smile is very important for comforting the woman during birth—she is more likely to get better.”
Odile is among the 51 percent of women in Madagascar who give birth with the assistance of a skilled health professional. Thanks in large part to the skills Midwife Agnes learned during the USAID-funded MCHIP training, Odile received excellent care that saved her from a life-threatening condition.