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On a snowy afternoon a heavily pregnant Pooja reached CHC Sahoo in Chamba District with labour pains. She had just walked 6.5 kms on a snow covered road from Sara, a village in the higher Himalayan region of the district. At the facility the labour room nurse Meenakshi assessed Pooja’s condition and discovered that this was a breech delivery case. Meenkashi decided to refer Pooja to the district Hospital but Pooja refused to travel any further to another facility. Meenkashi was left with no choice but to conduct the delivery in her own facility Meenakshi is amongst the 1400 labour room staff members trained by Vriddhi project across six focus states on the care around birth approach. During the training she learnt about monitoring of labour using partograph she says “we learnt that partograph is useful in tracking the progress of labour and has also helped us refer cases in a timely manner and save lives.” She started monitoring Pooja’s condition and recorded the Fetal Heart Rate every 30 minutes as per the protocol. To everybody’s relief Pooja delivered a baby girl after two hours of admission but this was not the end of the story. The baby did not start breathing spontaneously, she was asphyxiated and needed to be resuscitated within the first ‘golden minute’. Meenkashi quickly transferred the baby to the radiant warmer leaving Pooja under the care of her co-worker, another labour room nurse. Using her recently acquired skills of resuscitation with bag and mask (also covered under the care around birth module) Meenakshi was able to revive the baby instantly. Pooja’s baby was named Meenakashi inspired by the nurse who delivered her safely. This is one of the many critical emergency conditions faced by labour room staff especially working in public health facilities in difficult terrains where ‘right decisions at the right time and prompt actions’ enable them to save lives. Vriddhi through its care around birth approach targets mothers and newborn at the critical time of birth. The approach not only aims at enhancing skills of health workers but also empowers them and builds their confidence to apply their learning to real life situations and make a difference.
Ensuring Kangaroo mother care for low birth weight and preterm babies
Tulsi a young mother looks relaxed and comfortable with her baby nestled close to her. She is very thankful to the labour room staff of District Hospital Dumka in rural Jharkhand where she delivered on May 11, 2017. After the initial anxiety of delivering before time a small baby she now looks relieved. She feels that Kangaroo Mother Care actually saved her baby’s life she says “Didi (nurse) explained me that a mother’s body is the best incubator for underweight and preterm babies to develop. Kangaroo Mother Care is an easy method which can be done at home as well, I am grateful that my baby survived and is doing well”. Tulsi is only 18 years old and belongs to the Tribal community of Santhal in Jharkhand, her village is located in a remote area with poor access to maternal and newborn health care services. Kangaroo Mother Care is a recommended practice for preterm and low birth weight infants in resource constraint settings. It is a simple yet effective method to promote the health and well-being of small and preterm newborns. Globally, prematurity is the leading cause of death in children under the age of 5, almost 1 million children die each year due to complications of preterm birth1. VRIDDHI through its Care around Birth approach is training labor room nurses on handling complications such as preterm and low birth weight newborns who’s lives are at risk. This model of Kangaroo Mother Care intervention under VRIDDHI is meant for implementation within the labor room and post-natal ward. The project has also developed a model for very low birth weight infants who require specialized care at Sick Newborn Care Units.
Jindi Devi lives in remote village in the Mandi district of Himachal Pradesh, she was due for her delivery on March 1, 2017. Radha, the village ASHA visited her in April gave her misoprostol tablet under the SURAKSHA initiative by the project VRIDDHI, and explained the benefits of delivering in a health facility. She also informed the family that the district had set up a birth waiting home to help expectant mothers like her who have to travel long distances to reach a health facility. She suggested that the family take Jindi to the birth waiting homes by the February 21-22 that is seven days prior to her expected due date and offered to accompany Jindi to Mandi. The family felt that with the ASHAs support they could try to try for an institutional delivery for Jindi Devi and ensured she reached Mandi birth waiting home well in time. Jindi was transported to District Hospital Mandi when she went into labour and delivered delivered a healthy baby girl on March 02, 2017. Jindi Devi’s family was pleased with the services at the birth waiting home and found it a very convenient linkage between the hospital and their village, they also mentioned that they would spread the message to in the village and encourage others to utilize these birth waiting homes as a transit facility. Government of Himachal Pradesh has set up Birth Waiting Home in districts with difficult hilly terrain and issues of access with and objective to improve access to health facilities by pregnant women living in remote and tribal areas. In Mandi district, this innovative concept was initiated in July 2016 and since then till February 2017, 108 pregnant women including Jindi Devi have availed this service. This initiative is being supported and facilitated in the high priority districts by project VRIDDHI team.
Sukhwinder Kaur, a nurse posted in CHC Dhanuala, has been in the profession for over 8 years. She knew about Active Management of Third stage of Labour and even practiced it, she however, had not given importance to administering Injection oxytocin within one minute of delivery. During the district level CaB training she learned not only how important the injection and its timing were but also discussed with her colleagues how to overcome day to day barriers to make this start happening. Now she is feeling very satisfied and says ‘since I have started practicing AMTSL as taught in the training, I have observed that there is a reduction in PPH cases in the facility as a result of administering injection oxytocin within one minute after birth’.
Sushila a Staff Nurse from Chain Rai District Women Hospital, Haridwar found respectful maternity care a novel concept. She says ‘while we underwent the care around birth training we heard about the seven rights of a mother’. This was an eye opener and we started making an extra efforts to listen to our patients and resolve their concerns especially about maintaining their privacy. We also set up screens in the labour room to provide privacy for our patients, and started allowing birth companions. We try our best to give mothers as much information as we can, we connect them with family planning counsellors to explain to them basket of choices and we have also displayed posters on key RMC messages across the facility.’ She feels that these efforts have led to many benefits such as mothers feeling comfortable about sharing their misgivings and women being more cooperative during labour.
Rupinder Kaur from CHC Dhanuala, Punjab shared her experience of improving essential newborn care practices in her facility after undergoing the care around birth trainings. She says ‘one very critical practice we learnt during the training is ensuring immediate skin to skin contact between the newborn and the mother and delayed cord cutting. This practice ensures immediate breastfeeding after birth, which helps us in curbing local practices of feeding the newborn water, honey and other non-recommended food items. The immediate skin to skin contact between mother and baby has helped us to take care of the dyad even as we continue procedures for the mother, earlier sometimes the newborn used to get neglected. We find that the mother is much more relaxed when her baby is close to her.’
Neha Kumari Kesari from CHC Palkot, Jharkhand is a champion health worker whose dedication and hard work has taken post-natal monitoring to another level. In Neha’s words "I got trained in the district on care around birth and I learnt many new things during the training. Earlier as a part of post-natal care we used to check mothers’ blood pressure and vaginal bleeding a few times, but all this changed after the training, we learned the different nuances of postnatal monitoring the timing, intervals, parameters and the need to record findings. We started on a trial basis as per our commitment during the training and gradually started a systematic postnatal monitoring and documentation. Support from VRIDDHI staff helped us to ground the intervention. This approach is very helpful and we have easily incorporated the practice in our routine."
55-year old Hira Devi, an ANM works in Jhanjheli Block in Mandi District of the Himalayan state of Himachal Pradesh, India. She travels upto 18 Kms each time she goes to assist an expecting mother for a safe delivery at home. Her zest to serve is what helps to break the barriers of age as she traverses the challenging terrains to reach the scattered households in the hills. But despite her unfailing efforts, mothers have lost lives due to excessive bleeding after delivery – a factor which was beyond her control.
The situation changed when the Government of Himachal Pradesh initiated the program ‘Community Based Advance Distribution of Misoprostol tablets to prevent Postpartum Haemorrhage’, and her block Jhanjheli of Mandi District was selected for the intervention ‘Suraksha: Protecting Mothers’. Hira Devi along with her 123 co-workers were trained by VRIDDHI to reach out to expecting mothers in the far flung hilly areas of Jhanjheli to distribute the lifesaving Misoprostol and counsel mothers. They also received a flipbook in their local language to help them explain ways to have a safe delivery and the use of Misoprostol tablets.
“I feel proud to be part of Suraksha because I feel that it helps me to save lives of mothers. This project does a great service by protecting mothers from dying. I think we are blessed that this project came to our block!”
“I was feeling weak and unwell in the 6th month of my pregnancy and after the checkup the doctor informed me that the HB level is 6.2 and prescribed four injections over a period of time. After taking the treatment I feel much better and healthy and better prepared for my delivery. ” - Santosh, Client, PHC Chattar Jind, Haryana
“The Newborn Care Corner in the labour room have helped us take care of resuscitate asphyxiated newborns, this is helping us save lives.” - Labour Room Nurse, District Hospital Simdega, Jharkhand