Bill & Melinda Gates Foundation

Saving lives in childbirth: do we have a game changer?

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September 19, 2014

Imagine this. You’re a staff nurse at a rural hospital in Uttar Pradesh, one of India’s poorest states, and you’re responsible for deliveries at the busy facility. The other staff nurse didn’t show up, and you have no doctor onsite for backup, a common occurrence. You have six women in recovery, one woman with the baby crowning, and multiple other responsibilities tugging at you. You had a training course in safe birth practices, but the list of things you were expected to do was more than you could memorize. And no one ever explained how you were supposed to pull all of it off in the chaos of a real birth center anyway.


Then the baby is born, and she’s blue. She’s not breathing. Your heart starts racing. It comes back to you that you were supposed to have a bag mask ready for resuscitation of the newborn. But now what are you supposed to do?


Scenarios like this play out every day in India, and across the developing world. Every year, almost 300,000 women die giving birth and one million newborns don’t survive their first day, because quality maternity and newborn care is in such short supply in low-income settings. Most of these deaths are preventable – but how?


A multi-year research program is underway to address that challenge in 120 public hospitals across Uttar Pradesh. The BetterBirth trial aims to rigorously test whether practical changes in health workers’ behavior – applying WHO’s Safe Childbirth checklist - can actually reduce major harm and save lives when they are most in danger.


The checklist idea was originally developed by the aviation world to help pilots ensure basics weren’t forgotten, to reduce complexity, and foster teamwork. The Safe Childbirth Checklist we’re testing in Uttar Pradesh aims to achieve the same goal. It’s a user-friendly distillation of best practices such as handwashing, taking the woman’s blood pressure, and having all your critical life-saving materials available at the bedside including key medications, a sterile blade, a suction bulb—and a bag mask for resuscitation.

If our major stress test in real time of an innovative childbirth safety program is effective, it could provide us with a model which could be replicated globally a game changer for maternal and newborn survival, in other words. Our partners include the government of India, WHO and Population Services International, as well as the Community Empowerment Lab in Uttar Pradesh, the state government.


What happens in India matters greatly worldwide. It’s the world’s largest democracy. It also has  the largest number of maternal and newborn deaths. The Indian government is addressing that challenge head on, with the recent launch of the India Newborn Action Plan (INAP), the country’s first nationwide commitment to save newborn lives.


“The vision of the India Newborn Action Plan is a world with no preventable deaths of newborns or stillbirths,” said Dr Rakesh Kumar, Joint Secretary, RMNCH-A, Ministry of Health and Family Welfare, Government of India.  


It’s our job with the BetterBirth trial to translate these high-level policy goals into measurable reductions in maternal and newborn deaths on the ground.  We know it isn’t enough to get women to deliver their babies in health care institutions rather than at home. To save the lives of mothers and babies, you have to improve the quality of care. And that's really hard to do.


“Addressing gaps in newborn health is the single most important thing we can do to reduce child mortality in India and worldwide. It is also one of the most important things India can do to ensure health equity – in particular for women and children,” Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, said recently in Delhi at the India Newborn Action Plan launch.  “We’re committed to supporting Indian leadership in advancing appropriate new technologies to achieve the greatest impact. The WHO Safe Childbirth Checklist in Uttar Pradesh is an astonishingly simple and powerful idea for improving the quality of care.”


To achieve this, our trial is heavily focused on coaching nurses who are the backbone of staff delivering babies in Uttar Pradesh health facilities. We’ve found that nurses mentoring other nurses is most effective. 


What will motivate these staff nurses to change practices on the job under working conditions requiring daily heroism? Can strengthening nurses’ abilities actually reinforce the system itself? What are we learning through this process?


Watch this space. We’ll be exploring these questions in upcoming blog posts on the BetterBirth trial. We invite you to comment and share on Twitter with a message such as this one:


The safe childbirth #checklist: a game changer for #EveryNewborn #INAP


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