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New coaching effort enhances maternal care in Indonesia & Mexico

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Ariadne Labs clinical implementation specialist Emily George, second from left, and Dr. Rose Molina of Partners in Health, second from right, led a three-day training with clinicians In Chiapas, Mexico.

By Emily George, RN, BSN, MPH

Clinical Implementation Specialist, Nurse Liaison

A baby died the night I arrived in Chiapas, Mexico to provide implementation training on the Safe Childbirth Checklist. The mother almost lost her life, too. She was laboring at home with a midwife when suddenly, her labor stopped progressing and the baby started showing signs of distress. The mother began losing a lot of blood. The midwife was unable to provide emergency care, so the mother was taken by ambulance to the small healthcare facility where she was saved, but her baby was not. I was standing outside the facility when she was brought in and I could see her family waiting powerlessly in the courtyard.

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Newly trained coach and nurse midwife Tunis, left, explains the rationale behind the WHO Safe Childbirth Checklist to a facility head at a community health clinic in Indonesia.

All of the nurses who had been working the night before showed up the next morning for our scheduled training. We began with a long debriefing session on what had gone wrong, what went well, and what they wished they could have done differently. Chiapas is one of the many places where communities are suffering from high rates of maternal and infant mortality. Ariadne Labs is trying to reduce these rates by introducing a simple tool and implementation approach: A checklist with all the essential birth practices recommended by the World Health Organization, and ongoing support and monitoring in a way that will ensure that birth attendants provide the necessary care at the appropriate times to every expectant mother, everywhere, every time.

We know that simply providing the Safe Childbirth Checklist to birth attendants without proper implementation guidance is useless. Proper training and ongoing implementation support is vital to ensure that the checklist is used in a meaningful way. Ariadne Labs is increasingly devoting more time and resources to collaborating with partners around the world as they implement the WHO Safe Childbirth Checklist. Recently, Ariadne Labs, along with Dr. Tapan Kalita of Population Services International and Dr. Rose Molina, of Partners in Health – Mexico, partnered with teams in Sumatra, Indonesia, and Chiapas, Mexico to provide checklist implementation coaching and support.  

Both Indonesia and Mexico have extremely different risk factors, capacity, and needs. It was imperative that we build a training package that would take into consideration the barriers and accelerators to change. To do this, our team held conference calls prior to our arrival and then in-person conversations on the ground with our partners, to better understand the local context and determine where to start. Then, together with our partners, we customized a training package which provided a roadmap for their implementation journey, as well as concrete steps to accomplish their overall goals for enhancing the quality of maternal and newborn care.

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Ariadne Labs clinical implementation specialist Emily George, center in red, and Dr. Tapan Kalita, center kneeling, led a three-day training with clinicians in Sumatra, Indonesia.

Indonesia

In Indonesia, the recipients of our implementation coaching and training package were a group of physicians, nurses, and/or midwives seeking to implement the Safe Childbirth Checklist among 20 community health clinics. Tapan and I spent time visiting these facilities, engaging the leaders, and learning about their existing efforts to provide excellent care.

During our three-day training, we provided several tips and tricks for how to introduce the checklist, how to find clinical champions, and how to provide ongoing support through observation and feedback as the checklist is being used among providers. Following the training, the clinicians reported that they felt empowered to conduct facility level introductions of the checklist, as well as provide strong rationale for its use.

Mexico

In Mexico, Ariadne Labs was asked to provide implementation training and support as part of a research study to improve the quality of maternal care and increase the amount of facility-based births in one region of Chiapas. Rose and I worked with the obstetric nurses responsible for the majority of maternal care for the only facility in the region. Our training began the morning after an infant had died in the facility where the checklist was to be implemented. This devastating event further highlighted the urgency to implement tools like the checklist to help provide even better care during childbirth.  

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Nurses in Chiapas, Mexico engage in a role-playing exercise during the coach training workshop.

Since all the trainees were nurses, we focused on how to engage physician leaders, how to get “buy-in” for the checklist, and how the checklist can be used as a tool for improving communication, teamwork and a culture a safety. Additionally, we spent time in the facility learning about their supply chain and determining the best ways to proceed with checklist implementation even when there are stock outs, emergencies, and other infrastructure challenges.

Both Indonesia and Mexico shared similar goals – to implement the Safe Childbirth Checklist in a meaningful way and to enhance maternal and infant quality of care.  However, both of these countries had vastly different needs. Our role at Ariadne Labs is to collaborate closely with our partners and their frontline staff to develop customized implementation training packages. We also provide ongoing coaching and support as checklist champions continue on their implementation journey.

When I learned of the mother who had lost her baby and considered the impact it would have on her family and community, I was filled with sorrow. It brought to light the personal suffering that communities everywhere face with global rates of maternal and newborn death. We are making tremendous strides in reducing these numbers, but more work remains. The Safe Childbirth Checklist is not the panacea for reducing maternal and infant mortality, but it’s an intervention we believe can make a significant impact when implemented in a meaningful way.

If you are interested in implementing the Safe Childbirth Checklist in your region, please contact Ariadne Labs at scc@ariadnelabs.org. Click here to learn more and to download our safe childbirth tools.