Cherrie Evans | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: To prevent PPH, uterotonic must be given immediately after birth. This is the same period where attention to newborn breathing is essential. Helping Babies Breathe (HBB) training has been widely used but connection with third stage care for the mother is limited. In Uganda we purposely paired HBB with Helping Mothers Survive (HMS) to address this gap.

Methods: In June 2014, facility-based HMS simulation training for PPH management was implemented in all public facilities in 12 districts (126 facilities) followed by ongoing practice. In September 2014 the same methods were used to deliver HBB including twinned practice for PPH. Baseline and midline facility readiness and observation of births occurred before and two months after the HBB intervention in 2014 and 2015. Identical end-line assessments will occur in six months to assess maintenance of skills after dormancy. We describe 435 baseline and 619 midline observations of birth.

Results: Advanced preparation of uterotonic occurred in 78% of baseline observations and 89% at midline. Preparation of self-inflating ventilation bag in advance of birth rose from 35% at baseline to 54% at midline. Providers administered correct dose of uterotonic within 1 minute of birth in 11% of baseline observations and 33% at midline. Covering baby including head with dry towel was 86% at baseline and 94% at midline. Dramatic increases were seen in breastfeeding attempts from 25% at baseline to 66% at midline. In facility assessment, oxytocin refrigeration improved from 24% to 52%.

Conclusions: Facility based, twinned training for PPH and HBB resulted in improvements in observed births for preparation of both uterotonic and resuscitation equipment, delivery of uterotonic within 1 minute, dry coverings for the newborn and breastfeeding within one hour. Twinning HMS and HBB through local trainers can improve quality of care.