Helping Mothers Survive: Implementing the Bleeding After Birth Program at the John F. Kennedy Medical Center in Monrovia, Liberia

Abstract

While significant throughout Sub-Saharan Africa, the West African country of Liberia suffers from one of the highest maternal mortality rates in the world. Here, the lifetime risk of a woman dying as a result of pregnancy or childbirth complications is 1 in 24. Although pregnancy-related hypertension conditions, anemia, infection, and unsafe abortion all attribute significantly to maternal death, postpartum hemorrhage – heavy, life-threatening bleeding after childbirth – is the leading cause of maternal mortality globally. Research suggests that active management of the third stage of labor (AMTSL), a practice that shortens the length of time from the delivery of the baby to the delivery of the placenta through the use of medications and manual interventions on the part of the provider, can significantly reduce the incidence of postpartum hemorrhage where necessary resources are available and where health workers receive training in using AMTSL. The Helping Mothers Survive – Bleeding after Birth (HMS-BAB) program is a didactic and simulator-based training package for frontline maternity providers to equip them with the knowledge and skills needed to prevent mothers from dying on the day of birth. The program is centered on the evidence-based practice of AMTSL for hemorrhage prevention, as well as the necessary steps to engage should a postpartum hemorrhage occur. Recent research suggests the HMS-BAB program significantly improves a provider’s knowledge, skill, and confidence in managing postpartum hemorrhage, both initially as well as over time. The following describes the implementation process to bring the HMS-BAB Program to the John F Kennedy Medical Center in Monrovia, Liberia’s. This tertiary-care medical campus includes a 139-bed women and infant hospital and neonatal intensive care unit where Certified Midwives attend the vast majority of vaginal deliveries. The HMS-BAB program was introduced there in January, 2016, and successfully trained over 92% of the midwives working in the maternity hospital. While knowledge and skill gaps related to AMTSL practice were identified, midwives who completed the program reported improved self-efficacy and intent to incorporate AMTSL techniques into their practice. A clinical guideline was created and given to the administrators, nurses, and physicians of the maternity hospital to reinforce and sustain this change in practice.