Increasing Skilled Birth Attendance

The largest threat of maternal mortality occurs during labor, birth and the 24 hours following birth. Many of the interventions known to save the lives of women and their newborns depend upon the presence of a skilled birth attendant (SBA). This health professional must be accredited—such as a midwife, doctor or nurse—and have been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth, and the immediate postnatal period, as well as the identification, management and referral of complications in women and newborns.

Key Activities
MCHIP worked to improve quality of care through competency-based training, supportive supervision, quality of care surveys, an ongoing goal-oriented performance improvement approach, and development of user-friendly resources, including the Pre-service Education Toolkit. Support to field programs provided by MCHIP technical staff included training courses for SBAs as well as programmatic development. MCHIP technical staff provided input to the World Health Organization’s Making Pregnancy Safer Division regarding the revision of guidelines for provision of Postpartum and Postnatal Care (PPC/PNC).

Respectful Maternity Care (RMC) and prevention of abuse and disrespect is another key focus in SBA activities. MCHIP worked to strengthen the provision of RMC as a central aspect of quality improvement in gender equity and service delivery. Program efforts addressed the multiple contributing and enabling factors that influence respectful and dignified care, including: working conditions for providers; community engagement; social accountability; rights based approaches; and values clarification.

MCHIP technical staff were members of the White Ribbon Alliance Advisory Council and involved in developing the RMC Charter, a human rights based document that delineates international declarations and conventions which affirm women’s rights to RMC as well as other advocacy materials. And as part of its Latin America and Caribbean activities, MCHIP provided technical leadership for the development of the Caribbean Regional Midwifery Association (CMRA) in order for the small Caribbean island nations to have a regional voice for midwifery and to participate in the International Confederation of Midwives. Specifically, MCHIP worked with CRMA to promote and use distance-access continuing education modules for both pre-service and in-service instruction.

The Pre-service Education Toolkit, launched in 2011, provides health care professionals information to develop policies, design programs, and make decisions related to pre-service education based on evidence. The Roadmap provides guidance for implementation, and resources and tools are packaged for easier use at country programming level in one online location. The multi-organizational technical advisory group identified important materials that are updated using a continuous publishing process. As other toolkits with high relevance to pre-service education are developed (such as for postpartum hemorrhage and pre-eclampsia/eclampsia), they were linked to the toolkit, contributing to knowledge management efforts.

MCHIP also launched an RMC toolkit in the same model. It provides evidence-based content for use by clinicians, trainers, educators and supervisors as well as by policy makers interested in promoting RMC. In addition to the toolkit, technical staff specifically and purposefully included RMC content in trainings, courses and when providing field support to pre-service and in-service programs.

In the area of SBA, a key result of support to field programs occurred in Ghana, where MCHIP partnered with the Ministry of Health to develop two operations manuals—one for midwifery preceptorship, and one for simulation labs. Trainings on Basic Emergency Obstetric and Newborn Care and effective teaching skills were conducted across all midwifery schools and a follow-up training using a low dose/high frequency mobile mentoring was piloted. Technical staff also conducted trainings in Helping Babies Breathe (neonatal resuscitation) and Helping Mothers Survive (PPH), two courses designed to bring critical skills to frontline SBAs.