Midwives in Action:
Improving Childbirth, Newborn and Young
Children’s Health with Continuing Education
Updates and Neonatal Resuscitation
Courses for Global Peers
Terri Clark, PhD, ARNP, CNM, FACNM
Associate Professor
Seattle University College of Nursing
Circle of Health International
Volunteer and Member, Board of
Directors
Healthy Mothers, Healthy Babies
More than 7 million infants die 0-12
months.
Almost two-thirds of infant deaths occur
in the first month of life.
Among those who die in the first month
of life, almost two-thirds die within the
first week.
Among those who die in first week
almost two-thirds die in the first 24 hours
of life.
Nurses and midwives are the
most needed health care
providers around the globe
today.
They provide three-quarters of
the world’s skilled health care.
Skilled nurses by day, midwives at
night
Highly experienced midwifery and
nursing educators and clinicians from
“capacity building countries” can
contribute improving nursing and
midwifery care in global settings which
have low educational resources.
Some countries have excess
educational capacity
Many countries around the world
have a chronic unmet health care
need.
Midwives want to be able to make a
contribution besides writing a check.
US Midwives are already contributing
• A substantial proportion of nurses and midwives
work in or volunteer in global sites
• Many CNMs/CMs would utilize their midwifery
skills if they had access to appropriate
opportunities and support– and important niche
for COHI.
• A significant number have been employed or live
overseas and can speak more than one language
So how can midwife and nurse
volunteers prepare for educational
opportunities?
1. Don’t reinvent the wheel!
Anticipate what you will want to have or teach: “Don’t skate to where
the puck is, skate to where it going to be.”
2. Get as much information as you can about the
situation your global partner before you travel.
3. Load up your laptop and take CDs with culturally
appropriate educational material for updates on
clinical practice.
Resources for your laptop
• http://www.midwife.org/global.cfm
• Source of information on Life Saving Skills, Home Based
Life Saving Skills: Publications and course opportunities
that adapt to many settings
• Opportunities for Africa’s Newborns. Practical data,
policy and programmatic support for newborn care in
Africa. The Partnership for Maternal and Child Health.
(2006 CD)
• http://www.hesperian.org/
• Hesperian works in close collaboration with health
workers, grassroots groups, and community
organizations around the world
More resources
• World Health Organization has a modular
Midwifery Curriculum adaptable to a variety
of settings and available in 6 languages.
• It can be printed off the web or ordered as
modular texts.
• http://www.who.int/making_pregnancy_safer
/documents/9241546662/en/index.html
• www.globalhealthlearning.org (USAID)
Sample Topics for “Midwifery Clinical
Updates” in Global Partner Settings
1.
2.
3.
4.
5.
6.
7.
Routine infection prevention practices
Hygienic clamping and cutting of the cord
Tetanus immunizations
Early and exclusive breastfeeding
Limited number of vaginal exams
No routine episiotomies
Providing eye care to prevent GC infection
where this is local policy
8. Partographs to monitor labor progress
For example:
Promoting family centered care
For example:
Promoting hand washing
For example:
Promoting Sanitation
Use Millennium Development Goals in
Curriculum Design
• Goal 3. Promote gender equality and
empower women
• Goal 4. Reduce child mortality
• Goal 5. Improve maternal health
Elements of Curriculum Design
• Identify Educational Goal or Skill
• Specify Objectives: (At the end of the session the
participants will be able to…)
• Steps for Educational Session
–
–
–
–
–
–
–
–
Identify the rational for training professional staff
List the steps in the normal process
Illustrate the pertinent physiology and anatomy
Discuss known risk factors and complications
Identify indications for intervention and nonintervention
Demonstrate the steps in assessment and in using the skill
Identify benefits of professional staff being trained in the skill
Link skill to overall local health and education strategic plan
Sample Curriculum
•
Newborn Resuscitation
•
•
•
•
•
•
•
•
At the end of the session the participants will be able to:
Identify the rational for training professional staff in every birth facility in Neonatal Resuscitation
List the steps in the normal process of transition to extrauterine life
Discuss the physiology and anatomy pertinent to immediate assessment of newborn well-being.
Identify indications for support of the newborn and for resuscitation
Demonstrate the steps in assessment and resuscitation
Why should all birth attendants know Neonatal Resuscitation?
It is never known for sure that any newborn will be in good condition at birth- even when there are
no known risk factors
Extending neonatal resuscitation skills to professional staff in every birth facility would contribute
to significant improvement in newborn survival and prevention of asphyxia at birth
Substantial improvements in child health outcomes cannot be made without improving newborn
survival rates on the day of birth…
•
•
Train-the-Trainers
Be prepared with educational equipment
and supplies to donate
When you are at your site
• Observe quietly and take in everything
• Note equivalent ways of meeting the same goals
• Acknowledge what they are teaching you, and
offer to reciprocate
• Everyone likes a Clinical Update!
• Assume everyone wants to do the best thing
• Be very sensitive of consuming resources, even
paper
• Consider that everyone’s behavior makes sense to
them-– What do you have to know to understand the context?
Remember:
• You have an accent and probably talk too fast or too
slow!
• If you are from the US your vernacular probably sounds
ungrammatical to other English speakers
• When people correct you it is a sign they care
• International visitors are a lot of work for the hosts
• Dress appropriately. To much of the world casual dress
is a sign of disrespect– it is assumed that you do have
nice clothing and are choosing not to wear it because
you don’t care and don’t take the hosts seriously.
Sample topics that travel well— all
supported by good evidence
1.
2.
3.
4.
5.
6.
Routine infection prevention practices
Hygienic clamping and cutting of the cord
Tetanus immunizations
Early and exclusive breastfeeding
Limited number of vaginal exams
Providing eye care to prevent GC infection
where this is local policy
7. Partographs to monitor labor progress
Potential limitations of working with
translators and cultural interpreters:
• Interpreters are in a difficult position– they feel no one
trusts them
• Everyone wants to put the best face on, including
interpreters
• If the interpreter thinks you are not making a good
impression or missing the mark they will “improve”
what you are saying
• They may asked to translate technical terms which they
don’t understand
– Make a glossary of terms with them before translation
begins
– Slides and glossaries can be translated and back translated
Elements that contribute to success
• Invitations from local professional leaders
• Work with leaders and opinion leaders in planning.
• Use local documents that have already been
approved.
• Seek local input on clinical issues, educational topics,
cultural and language sensitivities
• Be flexible, sensitive, and practical
• Advanced preparation helps
– Be prepared for things to move deliberatively
– Remember, Americans are known for working too hard!
Use local documents, where possible
Be alert to information that is
important to your hosts
Methods of overcoming language and
cultural barriers
• Enjoy social situations with your hosts
– Bonds of trust are developed
– People get to know each other
• Be cognizant of social norms
– Eat what everyone else eats
– For example, your eagerness contribute to your share of
doing the housework may be seen as putting someone out
of work
Returning to the same site is critical: It demonstrates
commitment
Bringing donated equipment may present problems: Ask
first!
IF you are planning to teach a
particular skill set
• Example: Neonatal Resuscitation Program
• Sustainability:
– Be sure the equipment is already in place or bring it to
donate
– Donors are easy to find! Mothers and newborns are
very inspiring to them, and depending on the type of
NRP equipment cost varies from $200- $1400.
– Resuscitation equipment is available from health
education supply companies and can be ordered on
line
Example:
Neonatal Resuscitation Program
– Use the existing country NRP courses– they are almost
always based on WHO standards and curricula
– The curricula are more elaborate with the degree of
development of the country, but principles are the same
– Plan a basic skills test and follow-on with a Train the
Trainer session
• Include principles of teaching
• Have a skills test-out (if not a paper and pencil
assessment)
• Plan opportunities to practice their teaching skills with
supervision
Local Leaders and Active Learning
Training the Trainers
“What did you learn that you liked
best?”
“Before I always put a baby with a low
APGAR to the side. I didn’t know
there was anything to do. Now I
know if I follow the steps we learned,
many babies can be saved!”