Helping Mothers Survive: Using Evidence to Help the Nursing Workforce Improve Maternal Survival

Tibaijuka, Gaudiosa

Purpose: Post partum hemorrhage (PPH) is the leading cause of maternal mortality globally, accounting for approximately 30% of maternal deaths in Africa and Asia. The majority of these deaths occur in low-resource settings, where skilled birth attendants are limited—particulary at the periphery of the health system—and access is limited to timely interventions when emergencies arise. Helping Mothers Survive is a new and innovative training initiative to equip nurses and other frontline workers with the knowledge and skills they need to prevent mothers from dying of preventable causes on the day of birth.

Methods: Building on the success of Helping Babies Breathe, a successful and effective training program on neonatal resuscitation, Helping Mothers Survive (HMS) is designed to be provided at all levels of the health system but targeted to the periphery in order to address the major causes of preventable maternal deaths. Using a simple, one-day training format, HMS utilizes evidence-based educational techniques culled from an extensive literature review[1]—including clinical simulation, case-based learning, and immediate practice and feedback.

Results: Responding to often-cited challenges with workshop-based trainings that do not reach all providers and result in absenteeism at health facilities, HMS is designed for all levels of workers who attend births at a facility and training is conducted at the worksite with all members of the health care team. Building on a growing body of evidence about the effectiveness of new “low dose, high frequency (LDHF)” approaches to health worker training, the Helping Mothers Survive approach provides sustained and targeted follow up with every participant after training using weekly LDHF peer-led practice sessions at the facility. When implemented with current supervisory practices, HMS can reduce training costs and improve retention of knowledge and skills. One Helping Mothers Survive training module, Bleeding after Birth (BAB), has already been developed, involving consultations with technical global experts, international stakeholder groups including WHO, ICM, FIGO, AAP and ICN, and an extensive three-country validation prior to roll out of the training.[2] HMS BAB focuses on improving competencies necessary to prevent, detect and manage PPH to WHO standards. Ongoing implementation research is currently being conducted in 12 districts and 125 health facilities in Uganda to assess the impact of this training on skills retention and clinical outcomes, with results expected later this year.

Conclusion: Because of its simple, portable design, HMS is able to reach higher numbers and a greater range of the frontline health workers who attend births at hard-to-reach urban and rural communities, including nurses who are often tasked with intrapartum and post-partum care. The LDHF practice sessions conducted at the facility ensure consolidation of skills and further foments a culture of teamwork.

[1] Bluestone, J., Johnson, P., Fullerton, J., Carr, C., Alderman, J., & BonTempo, J. (2013). Effective in-service training design and delivery: Evidence from an integrative literature review. Human Resources for Health, 11:51.

[2] Evans, E.L., Johnson, P., Bazant, E., Bhatnagar, N., Zgambo, J., & Khamis, A.R. (2014). Competency-based training “HelpingMothers Survive: Bleeding after Birth” for providers from central and remote facilities in three countries. International Journal of Gynecology & Obstetrics,126:286–290.