This article is a cross post from MCSP.
Sofala Province, Mozambique – It was midafternoon when 21-year-old Rosita Filipe arrived at Muxungué Rural Hospital. Pregnant for the first time, her obstructed labor had ceased to progress at Muligue Health Facility, nearly 30 miles away. She was transferred to the hospital to have access to its operating room and blood bank. Now in labor for more than a day, she was weak and in pain. The ambulance carrying Filipe, an escort nurse, and a relative was met by Nurse Deogrecia Chuquela and and Dr. Cristina Santana, who quickly examined her in the delivery room.
It was clear that the large size of the fetus prevented a normal delivery. And when Chuquela listened to the baby’s heart rate – holding the wide end of a pinard stethoscope against Filipe’s abdomen – she could hear that it wasn’t normal. Immediately, a team led by Dr. Santana did a cesarean delivery and the baby was born. But the danger for Filipe’s newborn wasn’t over yet: as soon as Chuquela held the baby boy, she knew he was not breathing. The Apgar score (for activity, pulse, grimace, activity and respiration) indicated an urgent need for the baby’s resuscitation. “We stimulated the newborn, but he did not cry or move. He seemed dead,” she said.
In fact, he was alive, but suffering from birth asphyxia, a leading cause of newborn death in Mozambique, and the cause of one-quarter of all neonatal deaths globally. And he had only moments to be saved.While Dr. Santana continued to care for Filipe in the delivery room, Chuquela worked diligently to resuscitate the newborn using the Helping Babies Breathe (HBB) approach. HBB focuses on the first minute of life — within this “golden minute,” a baby must be breathing well or should be ventilated with a bag and mask.
Chuquela followed the HBB steps to stimulate breathing. She thoroughly dried the newborn and rubbed his back. When he didn´t start breathing spontaneously, she placed him on a clean, warm, firm surface. Opening his airway and correctly positioning his head, she then used a suction device to clean his nostrils and mouth. She began positive-pressure ventilation with room air using a neonatal Ambu bag and mask to stimulate his breathing. Chuquela assessed the adequacy of ventilation by checking if the baby’s chest was rising at regular intervals and – after one minute of effective ventilation – monitored his heart rate.
Above: Filipe´s newborn after resuscitation
A short time later, the baby began breathing by himself and his vital signs were stabilized. She placed him under a heater with oxygen for two hours. Before being trained by MCSP to manage newborn asphyxia through HBB, this story may have had a very different ending. Chuquela admits she was scared after realizing the baby wasn’t breathing, but “I immediately had to put in practice what I learned to save the newborn’s life.”