Conakry, Guinea—Health care providers at the Minière Urban Medical Center have increased their use of active management of the third stage of labor (AMTSL) and helped reduce women’s risk of bleeding to death during childbirth.
The progress made at Miniere and other health centers in this West African country can be attributed to a series of capacity-building initiatives on emergency obstetric and newborn care (EmONC) led by Dr. Yolande Hyjazi, who represents the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program (MCHIP) in Guinea. AMTSL is an intervention that requires use of oxytocin, controlled cord traction and uterine massage to prevent postpartum hemorrhage, which is the leading cause of maternal deaths worldwide.
The use of AMTSL at Minière was reinforced during follow-up supervision visits.
“We see very few cases of postpartum hemorrhage now that we do AMTSL,” says Dr. Hawanatou Camara, chief of maternity at Minière medical center. “Before (2008), we had two or three cases a month. AMTSL has worked here. It is not like before.”
As part of efforts to reduce maternal deaths in the developing world, MCHIP and partners are working with the Ministry of Health and Public Hygiene in Guinea to improve the quality of EmONC and strengthen health systems to save women’s lives.
It was only two years ago that a maternal health specialist visiting the Minière center observed that nurses and other key staff were unfamiliar with the components of AMTSL. The health providers at Minière, although capable, were using only oxytocin to treat a woman who began bleeding heavily after childbirth. To prevent postpartum hemorrhage, all three components of AMTSL—use of oxytocin, performing controlled cord traction and uterine massage—must be used.
Since then, the work of Hyjazi and her MCHIP colleagues has inspired change. Earlier this year, a visit to the center found that the registry for delivery care in almost all births had a notation about AMTSL (with the exception of those women who had given birth at home or had been referred to the hospital).
The success in upgrading and strengthening the capacity of health providers can be seen in other health care facilities in Guinea.
Dr. Ami Kaba, chief of maternity at Ratouma Urban Medical Center in the city of Conakry, can attest to improved outcomes: “Before AMTSL was introduced here in 2008, we had 16 cases of postpartum hemorrhage. In 2010 after we introduced AMTSL, we only had six cases, only three of whom received AMTSL—the other three gave birth at home and came in later.”
Not only were nurses and midwives adept at actively managing the third stage of labor, several midwifery students who were observed assisting in a delivery also displayed knowledge of AMTSL.
Dr. Suzanne Austin, MCHIP Technical Advisor, points out that “when providers see something that is in their interest, as well as that of their clients, they adopt it easily. AMTSL is something that helps them a lot, as they see less bleeding.”
In Guinea, where maternal mortality is still very high with close to 1,000 deaths for every 100,000 live births, AMTSL has been an innovation that is now routinely used for 86.5%of women who deliver in health facilities supported by the MCHIP project. However, MCHIP staff note the long way to go before even basic standards of care are universal and available to all women in the country. Currently, because space and beds are in short supply, women only stay in health facilities for an average of two hours after birth. Little postpartum follow-up is provided, and mothers only seek care in the case of complications.
It is encouraging that Guinea embraces the use of AMTSL; however, much work remains to be done before it is employed universally. To ensure broader and more effective use of this potentially lifesaving intervention, Jhpiego, which leads the MCHIP project, has been working with the University of Conakry’s medical school to integrate EmONC and family planning into its curricula and help strengthen the teaching skills of the school’s faculty and preceptors. Strengthening family planning services and expanding postabortion care are other key priorities.
“The involvement of site managers, close follow-up of service providers and use of performance standards for service provision were key for success,” said Hyjazi in discussing the increased use of AMTSL. “The results achieved were appreciated by the service providers, and the Ministry of Health—which was involved from the beginning. And these results motivated both groups. Nevertheless, the efforts should be maintained by all stakeholders to improve the quality of maternal health services, which includes other emergency obstetrical and neonatal care.”