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
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?
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
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
- can actually reduce major harm and save lives when they are most in danger.
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.
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.
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
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.
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.
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.
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
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
The safe childbirth
#checklist: a game changer for #EveryNewborn #INAP