First posted on Jhpiego.org
Nabunturan, Philippines — Jessa Mae wasn’t breathing.
She was born prematurely one evening at the Nabunturan Rural Health Unit, and the local health officer advised her parents to prepare for the worst. Jessa Mae’s heart rate was low, and though the birth attendant had placed the baby against her mother’s chest for skin-to-skin contact—routine post-birth care to ensure a baby stays warm in the first hours of life—there was no response.
Nurse Reymund Lumantas stepped in to help. He had recently participated in a training course in essential intrapartum and newborn care (EINC) organized by the U.S. Agency for International Development’s MindanaoHealth Project, which is implemented by Jhpiego, and the local non-profit organization Kalusugan ng Mag-ina, Inc. (translated as “Health of Mother and Child”) in partnership with the Department of Health’s regional offices.
Lumantas quickly set to work, preparing a space and equipment to resuscitate the baby. He set her gently on her back on a flat surface, and began pumping air into her lungs with an Ambu bag—a common handheld device used to help patients breath.
Her chest began to rise and fall.
And then Jessa Mae cried.
Lumantas was thrilled. “It is very fulfilling to revive a baby,” he said. “I saved a baby’s life.” Lumantas is among more than 600 health care providers who have improved their newborn care skills through the MindanaoHealth Project. As the International Council of Nurses meets in Seoul, Korea, June 19-23 for their 2015 conference, the new skills gained by Lumantas underscore the importance of strengthening the capacity of nurses worldwide and increasing their numbers to meet the health needs of women and families.
“Because I underwent the EINC training, I am confident that I am doing the right thing, and I am going to save the lives of more babies,” Lumantas says.
Before the training, “blue babies” like Jessa Mae had little chance to survive. Lumantas and fellow health workers lacked the confidence and knowledge to perform newborn resuscitation. They didn’t understand the importance of the “Golden Minute”—a window of time in which health workers must act to save a newborn’s life.
Lumantas himself was apprehensive going into the EINC training. He was participating with a wide range of health care providers, many of whom had more experience than he did. But he knew that the skills he would learn there would complement and refresh his previous training in basic emergency obstetric and newborn care (BEmONC), so he persisted, listening and learning, and gaining valuable hands-on experience in practice sessions and simulations.
Nabunturan Health Officer Dr. Daniel Rubillos pledged to send all of the health workers in the birthing facility to update their skills in this valuable maternal and newborn care program. “I believe that a training of excellent quality requires practice more than theories,” he said. “Demonstration and practicum, which are included in the EINC training, are vital.” Lumantas has benefited personally and professionally. “I wanted to be confident when I went back to the facility, so I would know how to deal with emergency cases,” he said. “Now, I am confident that I can handle emergency cases during delivery. I was trained on BEmONC, and refreshed through EINC, plus I was able to successfully handle real cases and revive two sick babies.
“Now, I see Jessa Mae and although she was delivered prematurely, she is healthy. We were not expecting she would live. It is very fulfilling,” he said.
By Maharlika Filipina Cossid-Gomez
Kesang, 21, receives an Infant Kit at Prasthuti Griha maternity hospital, Kathmandu, Nepal. Kesang now lives in a tented settlement after her home was destroyed by the earthquake.
"We only have a plastic sheet to cover us and the ground easily becomes flooded - we have to stay standing all night. Disease spreads easily in these conditions, I'm really worried that my baby and I will get sick".
The number of people currently affected by humanitarian emergencies is unprecedented, and is increasing by approximately 10 million people every year. In these fragile settings, mothers and their vulnerable newborn babies are even more at risk. We know that even outside of emergencies, the time of birth is the most dangerous in the lifecycle. While there are many competing concerns during a disaster, we need to recognize that maternal and newborn health must be prioritized in order to achieve global goals to reduce neonatal mortality.
As the number of people affected by conflict, natural disasters, and other emergencies increases, the gap between needs and resources is growing, and there is little extra room to focus on newborns. Yet there is a growing demand from responders and governments to provide for the most vulnerable groups. When a baby is born in an emergency, the number of risks that are encountered in the first days of life may seem insurmountable – but even in these precarious situations, many of the deaths that occur around the time of birth are preventable. We can do something to help.
There are proven interventions that have been shown to decrease incidence of stillbirths and neonatal deaths. Providing training for families and all birth attendants on simple actions, such as warming and drying the baby, and support for early and exclusive breastfeeding, can save many lives. For the sick and small babies, interventions such as kangaroo mother care, infection prevention with chlorhexidine, and timely identification and treatment of sepsis, can prevent deaths without requiring expensive, intensive care. Already, big gains have been made in maternal health with basic and comprehensive emergency care – we can mirror these efforts to see the same improvement for the health outcomes of their newborn babies.
In Liberia, we looked at routinely collected data on health visits by pregnant women during the Ebola outbreak. There was a dramatic decrease in visits that correlated with the peak of the outbreak in health care worker deaths. These data demonstrate the likely scenario in most emergencies – as the Ebola virus spread, the health system couldn’t cope with the excess patients and overburdened staff. Mothers were unable or unwilling to access health facilities, and the use of essential services decreased during pregnancy and delivery. This may have resulted in many preventable deaths and adverse outcomes for mothers and newborns, indirectly adding to the many deaths already directly resulting from the outbreak.
Ensuring that services -- like care during pregnancy and delivery -- are provided with appropriate staff and supplies during an emergency is difficult, but almost as critical as the acute response. We will likely never know the number of women who were forced to deliver without access to care, or the number of resulting stillbirths and neonatal deaths during the Ebola outbreak; but we can safely assume that newborn deaths that could have been prevented occurred during those terrible months, likely due to the decreased access to essential health care services.
Newborn babies have come into focus as a group where the expected survival gains have not been reached. If we want to achieve our goals in reducing neonatal mortality and stopping preventable deaths, we must increase our efforts to provide equitable, quality care in humanitarian emergencies. We should use the knowledge we have to stop preventable newborn deaths in all settings – and we must remember this as we respond to emergencies in the future.
Originially published on Maternal Health Task Force (MFTF) by Caroline Kenner, CEO, and Marina Boykova, Research Coordinator, Council of International Neonatal Nurses,, Inc. (COINN)
Having worked as neonatal nurses and educators for more than three decades collectively, we know that newborns who are born prematurely or sick are linked to either maternal perinatal health or the intrapartum experience. According to WHO, 45% of all under five deaths occur during the neonatal period (the first 28 days of life). Most of these deaths are preventable. To change the statistics globally and to end preventable neonatal deaths, partnerships must be formed to train more personnel in maternal and newborn health. Parent groups along with professional organizations, task forces, nongovernmental and governmental agencies must develop a clear integrated plan to address the causes of these maternal and neonatal deaths.
Global strategies in maternal and newborn health
The WHO’s 2015 report “Strategies Toward Ending Preventable Maternal Mortality (EPMM)” calls for maternal and child health programming and interventions to be population-based with a focus on prevention and wellness promotion. This report acknowledges the link between maternal health and newborn outcomes by recognizing that these outcomes are related to the availability, accessibility, acceptability and quality of services (AAAQ). To examine outcomes, as the report states, there must be metrics to measure successful outcomes and data collected on both the mother and newborn. This report links to the Every Newborn Action Plan (ENAP), which calls for the saving of 3 million lives annually and the development of metrics to measure outcomes beyond just neonatal mortality rates.
ENAP, launched in June, 2014, was created with the input of more than 60 organizations and adopted by all 194 UN member states at the World Health Assembly in 2014. This action was the first time that newborn health made it on the World Health Assembly agenda. It also brought to light the work that had admirably been done to decrease preventable maternal deaths, such as the training of skilled birth attendants. The Partnership for Maternal, Newborn & Child Health (PMNCH) recently released the zero draft for consultation of The Global Strategy for Women’s, Children’s and Adolescents’ Health, a report outlining the need for reproductive, maternal, newborn, child and adolescent health (RMNCAH) programs that are leveraged at country-level to address both maternal and child mortality. But this is not enough.
Amplifying nurses’ voices
Nurses, a large segment of the health workforce, have for the most part been silent, or at least not active participants, in the construction of these plans. In the last few years, neonatal nurses have been asked to contribute only after much of the work has been done. Why is this so?
- Neonatal nursing is a small, very specialized segment of nursing and health care
- Neonatal nursing’s role in neonatal health outcomes is often not recognized, or measurable
- Neonatal nurses in countries that bear the highest burden of poor neonatal outcomes have little to no power or voice as physicians generally play the pivotal role in not only health care decisions, but patient care
The time has come to change this situation. Neonatal nurses must be well-trained and well-educated. They must actively participate in advocacy for their patients and families. They must work with other disciplines, parents, NGOs, governmental agencies and policy makers to shape an integrated maternal, newborn and child health strategy. Neonatal nurses must and can serve on boards that are guiding this global work in order to bring a necessary perspective to the table.
It is time to move from theoretical papers to country- and local-level actions. Nurses must act. Neonatal nurses must unite with one strong voice to raise awareness of our contribution to improving health outcomes. All it takes is for us to use our neonatal nursing expertise and tell our stories. Visit the website of the Council of International Neonatal Nurses (COINN) to read about the three 2013 recipients of the International Neonatal Nursing Excellence Award: nurses who are truly making a difference.
Emily looked down to greet her child, a baby boy, and saw a limp, lifeless body. What should have been a moment of great joy turned into a terrifying struggle to breathe life into her newborn son. Nurse Mary Wekesa dried Baby Job vigorously, cut the umbilical cord, transferred the limp newborn to a dry blanket, and wrapped the motionless baby in the blanket, leaving his chest exposed. She placed a circular rubber mask over his bluish mouth and nose and squeezed a bulb-like attachment that made his chest rise and fall as air inflated his lungs. Suddenly, the loud cries of baby Job rang through the maternity ward.
Childbirth is natural – yet so much can go wrong. Before 2009, almost 1 million babies died because they were unable to breathe at birth. Five years later, that has gone down to 660,000 deaths (despite an increase in the number of live births), in large part thanks to innovative partnerships such as Helping Babies Breathe and other factors such as a global reduction in maternal mortality. And the potential is huge. In Malawi, the HBB program has trained 60 percent of skilled birth attendants to resuscitate newborns and equipped 88 percent of health facilities thus bringing Malawi closer to the goal of having at least one person who is skilled in neonatal resuscitation at the birth of every baby. Each of us can play a part in taking Helping Babies Breathe to the furthest corners of the earth – so that all babies have a chance to take their first breath of life.
We are proud to launch the five year report of HBB in Norway, hosted by one of our founding HBB partners, Laerdal Global Health. The report [see here] highlights how a public-private partnership is saving babies like Emily’s in over 70 countries around the world.
Since its introduction in 2010, more than 300,000 health providers in over 70 countries have adopted this simplified approach to resuscitating newborns who are not able to breathe at birth.
My colleague Lily Kak, USAID’s Senior Advisor for Global Partnerships and Newborn Health and an author of the report, writes eloquently: “HBB brings two people together – the newborn and the clinician – in a dramatic moment of life and death when much depends on the clinician’s ability to perform as s/he was trained.”
The HBB progress report highlights the importance of strengthening health systems as a key to long-term success and impact. We started with resuscitation to help babies breathe – using the best of public and private sectors to develop a practical, replicable program. Now we seek to build on those efforts to add additional modules and help babies survive and thrive.
HBB has implemented USAID’s premier model for public-private partnerships, or global development alliances (GDAs), to improve social and economic conditions in developing countries. GDAs provide a means of working effectively with professional associations, NGOs, faith-based organizations, and the corporate sector. HBB clearly illustrates the power of partnership in harnessing the resources, strength, influence and networks of partners towards the achievement of a common goal.
See FULL REPORT HERE
USAID would like to congratulate Laerdal on their 75th anniversary and recognize all of the partners of the Helping Babies Breathe Global Development Alliance on the first five years of astounding success. We look forward to many more!
Panelists give remarks at the Sharing Strategies for Integrating Maternal and Newborn Care: Strengthening the continuum side event in Geneva. Photo: PMNCH
The global health community gathered on Tuesday evening, May 19 to recognize the importance of integrating maternal and newborn care and to celebrate the release of the Every Newborn Action Plan (ENAP) Progress Report May 2015 and Strategies Toward Ending Preventable Maternal Mortality (EPMM). The side session at the 68th World Health Assembly Integrating maternal and newborn care: Strengthening the continuum was standing room only as a panel of champions for integration of maternal and newborn health took the stage. Co-sponsored by the Governments of Malawi and Cameroon, this event was planned with the support of a wide range of partners.*
Opening the event, Rajiv Bahl, Acting Director MCA, WHO, noted the how the unacceptable levels of maternal and newborn mortality and stillbirths impede the realization of healthy and sustainable societies. Yet 15 of the 18 countries, with the greatest burden of deaths and mortality rates, have taken concrete action. As moderator, Robin Gorna, Executive Director of the Partnership for Maternal Newborn & Child Health, underlined the importance of hearing from countries on success factors particularly through improving the quality and coverage of care through integrated strategies and programmes. She reflected on the synergies between these two strategies advancing efforts: ENAP discussed and endorsed at the World Health Assembly in 2014; and the EPMM launched this year at World Health Assembly.
The Minister of Health of Cameroon, Mr. André Mama Fouda, the Minister of Health of Malawi Ms. Jean Kalilani and the Minister of Health of Peru Mr. Anibal Velásquez Valdivia spoke at the side event. Photo: PMNCH
Three Ministers of Health shared perspectives on how implementation of the Every Newborn Action Plan together with maternal health interventions had improved health outcomes for mothers and babies in their countries. Cameroon’s Minister of Health, André Mama Fouda, noted that improving newborn health and preventing stillbirth is integrally linked to improving women’s health throughout the lifecourse. The Minister raised one of the key themes of the evening-the role of midwives in providing these essential, quality and integrated maternal and newborn health services. He noted he was happy and proud that new midwives were being trained in his country. Malawi’s Minister of Health, Jean Kalilani, highlighted efforts to increase access to family planning, reduce the age of marriage, and address cervical cancer as key strategies to reduce maternal mortality. These strategies will be linked to Malawi’s soon to be launched national Every Newborn Action Plan, developed in response to the government’s realization that Malawi was leading the world in pre-term births. Peru’s Minister of Health, Aníbal Velásquez Valdivia, discussed his country’s Comprehensive Health Insurance Scheme, which includes free access to basic health care for children younger than 5 years and for pregnant women, while giving priority to vulnerable populations living in extreme poverty.
UNFPA, UNICEF and WHO representatives then shared how they are working across the continuum of care to strengthen care for women, newborns and children. Her Royal Highness Princess Sarah Zeid noted that over half of all maternal, newborn and child deaths occur in fragile and humanitarian settings, and the need for urgent action to provide quality care to women and babies in those settings. Calling for every birth to be counted, she also made a plea for greater attention to stillbirths and the enormous impact on women and communities. While panelists and audience members shared the specific perspectives from across governments, donors, healthcare professionals, advocates and youth, the core message was strikingly the same: health outcomes for mothers, their newborns and children are inextricably linked but strategies and programs to improve RMNCH are often planned, managed and delivered separately, and this must change. Kate Gilmore, Deputy Executive Director of UNFPA, called for an end to fragmented programs that separate the mother and child and challenged all in attendance to finally put women and children at the center of all development programs. Nina Schwalbe, Principal Adviser, Health, UNICEF, reminded us that we can’t take care of the child if we don’t take care of the mother.
Kate Gilmore, Deputy Executive Director of UNFPA makes remarks during the side event. At right is Her Royal Highness Princess Sarah Zeid of Jordan. Photo: PMNCH
Concluding the session, Marleen Temmerman, Director RHR, WHO, used photos of the reality on the ground as a sobering reminder that ending preventable maternal and newborn deaths and stillbirths requires action now by everyone, everywhere.
As we prepare for the launch of the new Global Strategy for Women’s, Children’s and Adolescents Health and the Sustainable Development Goals, there is an increased focus on reaching every woman, newborn, child and adolescent everywhere. The event, and the ENAP and EPMM strategies, demonstrate the importance of an integrated approach to improving quality services, a growing commitment to work and investment across the continuum of care, and propose complimentary targets to get us there. As a global health community success will rely on supporting an integrated approach in research, policies, health services, and advocacy for maternal and newborn survival — one that helps to finally put an end to the preventable deaths of women and their babies.
*Supporting partners included:
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