Abstract
ProblemThe shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care.ApproachIn a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts.Local settingThe training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia.Relevant changesIn the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management.Lessons learntTo compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries.
Highlights
In February 2012, Maternal and Childhealth Advocacy International approached the Liberian Ministry of Health and the World Health Organization (WHO), proposing a collaborative partnership to reduce rates of maternal and neonatal mortality in Liberia
Apprenticeship-based training in advanced obstetric care was undertaken in CB Dunbar Maternity Hospital, which lies in Bong county – a rural area of almost 9000 km[2] with a population of about 330 000
Overall scores for the two trainees were 114/140 (81%) and 106/140 (76%). During their apprenticeship-based training, the two trainees were closely involved with hundreds of advanced obstetric procedures and the management of many serious complications of pregnancy or delivery (Table 1)
Summary
In February 2012, Maternal and Childhealth Advocacy International approached the Liberian Ministry of Health and the World Health Organization (WHO), proposing a collaborative partnership to reduce rates of maternal and neonatal mortality in Liberia. Apprenticeship-based training in advanced obstetric care was undertaken in CB Dunbar Maternity Hospital, which lies in Bong county – a rural area of almost 9000 km[2] with a population of about 330 000. They were allowed to perform caesarean sections either with someone who had not been trained to do the procedure or with someone who had been trained but played no active role in the surgery. At the end of two years, the trainees were given internships during which they are to continue their apprenticeship-based training for at least one year in Liberian hospitals, supervised by senior doctors.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
