Training rural health care providers for prevention of PPH

Abstract

Maternal mortality in India is an unresolved issue with more than 130,000 deaths every year. Home births remain a strong preference and often the only option for many women in rural locations [1]. Post partum hemorrhage (PPH) accounts for approximately 25---30% of maternal deaths in India [2]. Intervention with an effective drug at the time of delivery by a skilled attendant would be a crucial factor in averting death due to PPH. However, such individuals are not routinely present and many women deliver only in the company of concerned family members who, although they have assisted many times, are not skilled or trained birth attendants. This study tested whether use of 600 mcg of oral misoprostol, administered during the third stage of labor by auxiliary nurse midwives (skilled birth attendants) reduced the incidence of postpartum hemorrhage. Nineteen auxiliary nurse midwives (ANMs) from four primary health centers (PHC), Karnataka, India administered the intervention to 1620 women. The ANMs were responsible for screening and recruiting the study participants, obtaining informed consent, randomization, delivery of the intervention, measuring the blood loss and following the participants during the 6 weeks postpartum. The training of the ANMS included screening for