Are you interested in becoming an HMS trainer?

Supporting Safe Birth, Inc. is sponsoring a training opportunity on Helping Mothers Survive Bleeding After Birth Complete (BABC) day 1 ONLY and Essential Care for Labor & Birth (ECL&B) modules. This opportunity is scheduled for April 4 – 5, 2020 in Madison, Wisconsin. Secure your spot today!

To apply, please visit the Supporting Safe Birth website: https://supportingsafebirth.org/trainings/

Helping Mothers Survive is pleased to announce that the inaugural global training of our newest module, Essential Care for Labor & Birth (ECL&B), was held at the International Confederation of Midwives (ICM) Africa Regional Conference in Windhoek, Namibia on September 11, 2019.  Intensive preparations for the workshop included preparing all master trainers in advance and having materials shipped to Namibia and cleared through customs. Many documents were printed locally and in-country logistics were supported by the Independent Midwives Association of Namibia (IMANA). Partners from Laerdal Global Health traveled with needed materials as well.

ECL&B began its development with the American College of Nurse-Midwives (ACNM) and Jhpiego in 2016.  ICM provided expert feedback during module development, with this collaboration resulting in a 1-day learning module designed to improve the quality and experience of care for women and newborns during labor, birth, and immediately after. ECL&B is the foundation of the Helping Mothers Survive suite, forming the basis of quality, respectful care for women at birth.

Jhpiego master trainer (MT) Gaudiosa Tibaijuka traveled from Tanzania to support ICM 50,000 Happy Birthdays midwifery Project Managers (PM) from Ethiopia, Rwanda and Tanzania, and ICM midwives Martha Bokosi and Florence West along with Laerdal Global Health MTs  to implement the training, in which 37 participants were certified as ECL&B champions. Most of the participants were midwives and nurse/midwives, along with two midwifery students and one doctor, coming from 22 different countries and representing the education sector, Ministries of Health, iNGOs and UN agencies. Congratulations to ICM for this well-received event! Stay connected with HMS by joining our member portal on the website.

The ECL&B module is a 1-day learning module designed to improve the quality and experience of care for women and newborns during labor, birth, and immediate postpartum. Embedded in the module are a series of short video clips from Global Health Media Project to enrich the learning experience. In Baltimore, we prepared six Master Trainers from our partners at Project Cure who assisted us in the training on September 12^th at the Admiral Fell Inn with a group of 33 participants from 17 organizations.

After preparing seven Master Trainers from our Latter-day Saint Charities partner, we held the ECL&B training for 42 participants from 18 organizations in Salt Lake City held at the Relief Society Building on Temple Square on September 18th.

In total, 21 countries and 31 organizations were represented, and below are some testimonials of how participants plan to implement ECL&B in the future.

“I have been teaching HBB [Helping Babies Breathe] in Guatemala and desire to expand to mother care in multiple regions.”

“I work with a group of midwives and physicians at a busy mission hospital in rural northern Ghana. I plan to share the training with them. I will also share the training with global health students at my home institution.”

“Share with my fellow nursing students what is learned and apply it to our clinical settings at various Maternal/Infant units in local hospitals.”

“Preparing for a medical humanitarian mission to Morocco in the spring of 2020.”

Coming soon in 2020:  French translation of ELC&B and two companion modules in the HMS suite: Complications of Labor & Birth and Vacuum Assisted Birth!

including two from the Ministry of Health, were first trained as master trainers at a workshop in Abuja.

The HMS PE&E module is delivered over two days with Day 1 dedicated for any provider who may care for pregnant, laboring, or postpartum women and must be able to rapidly diagnose and treat pre-eclampsia at any level of the health system. Day 2 is designed specifically to build capacity of skilled birth attendants who work in referral facilities with the capacity to provide care for ongoing management of women with severe pre-eclampsia and eclampsia.

Project C.U.R.E. is providing a training of Master Trainers in March 2019 for HMS-Pre-Eclampsia & Eclampsia module and will take place in Denver, CO (currently sold out). Please visit the Project C.U.R.E. website for more information: https://projectcure.org/programs/helping-mothers-survive.

At the hospital, the Karawa maternity ward nurses, who had been trained in HMS BAB in December 2017, received the woman. They discovered that the bleeding was due to a retained placenta. Dr. Deambi performed manual removal of the placenta to stop the bleeding. Today Madame Fanzawe and her twins are doing well. Her husband, Mr. Nako, is very happy, too! He expressed his gratitude to everyone for taking care of his family.

Because of the “train the trainer” approach used by Paul Carlson Partnership, those trained in 2017 used the knowledge and skills received in the training to train 37 more Congolese nurses in HMS BAB and HMS PE&E spreading life-saving skills even further. For more information about this story and the Paul Carlson Partnership please visit: https://www.paulcarlson.org/2018/05/11290/

Onsite trainings that feature shortened, simulation-based lessons with support for practice led to a 17% decrease in postpartum hemorrhage, a 47% decrease in retained placenta, a 34% decrease in stillbirth and a 62% decrease in newborn death across 125 public facilities in Uganda.

“Traditional training approaches have not worked,” lead author Cherrie Evans says, referring to in-service workshops taught by outside experts to large groups gathered for a week or more in hotel conference rooms across sub-Saharan Africa. “Skills are taught and competencies are ‘learned,’ in so far as the attendees pass tests at the end of these events. But the literature shows that this strategy has not meaningfully changed how health care providers care for people day in and day out and, as a result, haven’t impacted survival when mothers hemorrhage or babies fail to breathe at birth.”

The study authors worked with the Ugandan Ministry of Health to move lessons onsite, shorten training sessions, and put midwives’ own peers (in this case, local Ugandan staff) in charge of leading short, simulation-based practice after training. Using the Bleeding after Birth and Helping Babies Breathe training modules, they tested the approach in Western and Eastern Uganda that lasted from January 2014 to October 2015.

A total of 755 midwives, nurses and doctors were trained in 125 facilities covering more than 70,000  births. “The evidence shows that if providers learn with the team they work with, in the setting where they work, they are more likely to change their practices and maintain skills and competencies well after the training is over,” says Evans, DrPH, a senior maternal and newborn health advisor at Jhpiego where she directs Helping Mothers Survive.

“This important study advances our understanding around the most critical question confronting global health today—understanding how provider performance can be sustainably improved,” says Thomas F. Burke, MD, Chief of Global Health and Human Rights, Massachusetts General Hospital, Harvard Medical School. “Dr. Evans and team teach us that critical elements of state-of-the art implementation efforts should include: “light touch, rapid cycling, and team training.”

Reducing maternal and newborn death rates in developing countries depends on marshalling a skilled, competent health workforce and, as critical, a strong health system. The latter, however, requires a series of fixes across a variety of categories—supply chains, data collection, and infrastructure—that take time.

“While we wait for enough funding to strengthen entire health systems, we can significantly increase newborn survival and prevent maternal complications with just this very simple, inexpensive training intervention that builds caregiver confidence and competence, and ultimately improves performance,” Evans says.

Peer-assisted learning after onsite, low-dose, high-frequency training and practice on simulators to prevent and treat postpartum hemorrhage and neonatal asphyxia: A pragmatic trial in 12 districts in Uganda was written by Cherrie Lynn Evans, Eva Bazant, Innocent Atukunda, Emma Williams, Susan Niermeyer, Cyndi Hiner, Ryan Zahn, Rose Namugerwa, Anthony Mbonye, Diwakar Mohan.

Funding was provided by Saving Lives at Birth partners: United States Agency for International Development (USAID); Government of Norway; Bill & Melinda Gates Foundation; Grand Challenges Canada, and the UK Government.

Helping Mothers Survive had a strong presence at FIGO this year with oral and panel presentations, booth activities and partner meeings each day of the conference. The HMS team was invited by Dr. Andre Lalonde to support his preconference Postpartum Hemorrhage Simulation Training. In partnership with Alemnesh Reta of Laerdal Global Health, and Dr. Gregg Alleyne of Drexel University, Dr. Cherrie Evans, the HMS Secretariat Director, provided demonstrations of the competency based training approach through Bleeding

after Birth Complete. Additional demonstration sessions occurred during the conference.  Dr. Evans was also invited by FIGO to represent Jhpiego and the HMS team on the invited HMS Impact Panel presenting evidence from the Saving Lives at Birth study.  This project resulted in a substantial decline of fresh stillbirth and newborn death before discharge, and a reduction in PPH and retained placenta.  HMS also hosted a lunch for our global partners to provide a venue for sharing and collaboration.  New modules were presented, current and upcoming events and activities were shared, and partners had the opportunity to discuss their own HMS projects.

The Helping Mothers Survive team traveled to Rwanda, Ethiopia, and Tanzania this summer to support the International Confederation of Midwives (ICM) to launch their 50, 000 Happy Birthdays project.  Working with country midwifery associations, educators and other partners, Jhpiego conducted Training of Trainers for Bleeding after Birth Complete (BABC) and Pre-Eclampsia & Eclampsia (PE&E) using the low-dose, high-frequency (LDHF) approach to learning. Below is a short summary of what we accomplished in each country.

KIGALI, RWANDA (August 2018)

The HMS team worked with Jhpiego country staff in partnership with the Rwanda Association of Midwives (RAM). And 50K HBD project manager, Fidele Nkurunziza. We trained a total of 61 midwives, nurses, doctors, and clinical officers in both HMS BABC and HMS PE&E.  Of those trained in the first round, 10 were selected to be mentored while training their first group of participants.

ADDIS ABABA, ETHIOPIA (September 2018)        

In Ethiopia, we built the capacity of a smaller group of trainers working with the Ethiopia Midwives Association (EMwA) and the project manager for 50K HBD, Tachawt Salilih.  Six were EMwA trainers for the 50K HBD project, one was a Dutch physician who was working in Northern Ethiopia, and one was a physician from Cameroonian M.D who will be implementing HMS in West Africa through UNFPA.

Six participants were mentored during their first training of 18 additional candidate trainers in HMS PE&E to start the scale-up of the 50K HBD project.

MWANZA & GEITA, TANZANIA (September/October 2018)

The HMS team worked with Jhpiego staff from the Boresha Afya (BA) project to train midwives from the Tanzania Midwives Association (TAMA) including Lucy Mabada, project manager of 50K HBD. For this event, 14 Master trainers were trained from the Geita, Tanga, and Katavi regions. Of the 14, five candidate trainers were mentored during their first training of 24 providers in Geita. In week 3, the newly mentored trainers offered training to begin rolling out HMS BABC and PE&E to all 132 Facilities in Geita and selected facilities in Tanga and Katavi regions.