Babies Breathe Research Articles

Translating continuing professional development education to nursing practice in Rwanda: Enhancing maternal and newborn health

IntroductionApproximately 99% of the three million neonatal deaths that occur annually are in developing countries. In Rwanda, neonatal asphyxia is the leading cause of neonatal mortality accounting for 38% of all neonatal deaths. The Helping Babies Breathe (HBB©) course was initiated by the American Academy of Pediatrics (AAP) in 2010 to reduce neonatal mortality in resource limited areas. Despite the provision of HBB© courses to practicing nurses in Rwanda, little is known about nurses’ experiences of applying the knowledge and skills acquired from those courses to practice. This study was conducted in 2014 in five district hospitals (Nyamata, Rwamagana, Gahini, Kiziguro, and Kibungo) located in the Eastern Province of Rwanda. PurposeExplore nurses’ experiences of translating continuing professional development (CPD) education utilizing the HBB© course to nursing practice in Rwanda. MethodsQualitative descriptive design. A purposive sample of 10 nurses participated in individual interviews. NVIVO computer software was used to manage qualitative data. Content analysis was used for generating categories from the data. FindingsThree categories emerged from the analysis: 1) application of competencies acquired from education sessions to practice, 2) benefits of CPD, and 3) facilitators and barriers to the application of competencies into practice. Qualitative interviews revealed that Nurses’ perceived confidence in performing newborn resuscitation improved after taking part in HBB© courses. Nonetheless, nurses voiced the existence of conditions in their work environment that hindered their ability to apply the acquired knowledge and skills including insufficient materials, shortages of nurses, and potential inadequate human resource allocation. Recommendations and conclusionRegular offerings of newborn resuscitation CPD courses to health professionals in developing countries could increase their knowledge and skills, which could potentially reduce neonatal mortality. The findings from this study underscore a need to attend to the shortages of nurses and lack of neonatal resuscitation materials and equipment in Rwanda. Collaborative efforts can continue to enable nurses to effectively utilize competencies acquired from CPD courses in developing countries.

Ordinary Trauma: A Memoir by Jennifer Sinor

Reviewed by: Ordinary Trauma: A Memoir by Jennifer Sinor Gaynell Gavin Jennifer Sinor, Ordinary Trauma: A Memoir. Salt Lake City: U of Utah P, 2017. 279 pp. Paper, $19.95. In a Texas hospital, a young Vietnam veteran was told to choose between the lives of his wife and baby. One would have to be sacrificed to save the other. He chose to save his wife. The baby’s body was disposed of in a bucket after being extracted from the mother, a procedure expected to kill the infant. However, a doctor noticed the baby breathing, and Jennifer Sinor was saved. Hawaii was the place where Sinor’s conscious memory appears to have formed. Sinor’s father, after graduating from law school at the University of Nebraska, was stationed at Pearl Harbor as a naval attorney. Although there were no visible physical scars from her near-death experience at birth, even as a three-year-old she was at least “dimly aware that the oily black water . . . concealed an unknown number of bodies and sunken ships” from the bombing of Pearl Harbor, a historic national trauma (8). There was Hawaii’s vibrant beauty, while the family’s backyard offered both a tire swing and a bomb shelter, a juxtaposition paradoxically emblematic of the Cold War, unremarkably normalizing the threat of actual war. Children born into the Cold War absorbed its collective national anxiety, and those years were almost certainly harsher for military families, acutely aware of the threat and of “risks those in the military took” (188). But as a child and “daughter of the military,” Sinor “believes order and regulation will defeat evil and disarray” (64). Ordinary Trauma is a layered, complex, elegantly written memoir of individual and collective trauma. Despite its title, for me part of the conundrum of Sinor’s gripping book became untangling extraordinary from ordinary trauma, while wondering if this endeavor served any purpose. Sinor’s seems a memoir not only of ordinary but extraordinary trauma as well. Most American children born into the Cold War were not almost killed at birth to save their mothers, and repeated instances of extraordinary trauma punctuated Sinor’s life: a serious injury while in the care of a negligent babysitter, a baby brother scalded by a nurse at birth, another who nearly drowned. Surely the landscape of most family life, if probed, would reveal [End Page 134] reservoirs of sorrow beneath the surface, which seems particularly true for Sinor’s Nebraskan paternal lineage. Her father’s father, a farmer, sadistically mistreated his animals and his children, including sexually abusing a daughter and at least one granddaughter. These events raise the vexed question of ordinary versus extraordinary trauma again, although sexual abuse and other family violence remain far too widespread. Perhaps trauma is normalized into ordinariness for most people who experience it. As major forces in her life, Sinor’s parents are important characters in her memoir. Whatever his weaknesses as a parent, her father offered considerable strengths and gave incomparably better fathering than he received. Sinor notes that the same hands that were forced to drown farm kittens when her father was a child, “rocked me to sleep as a baby, held me when I skinned my knee” (37). It is impossible to imagine her abusive paternal grandfather comforting a child with a skinned knee or rocking a baby to sleep. Her own father advised Sinor to shut bad memories in a dresser drawer and not reopen it. In addition to experiencing frequent military transfers, instilling a lack of a sense of home, Sinor presents the military child as riding “the backs of deactivated missiles” and ingesting “mutually assured destruction with her breakfast cereal.” Such ordinary moments may have passed “unnoticed” but “undid you nonetheless,” leading to the eventual realization that “the peace we experience in the United States is one achieved by force” (69–70, 195). At fourteen she wrote in her Holly Hobbie diary, “I think there may be a nuclear war which we will deserve because the world is falling apart” (197). Such moments seem slightly offset by the Star Wars trilogy, paralleling Ronald Reagan’s Star Wars program in Sinor’s teen years and...

Volume ventilation in neonates

Preterm babies are born with immature airways and deficiency of surfactant and a compliant chest wall. This increases the work of breathing with a large proportion of extreme preterm babies requiring invasive ventilation through the endotracheal tube. The improvements in the uptake of antenatal steroids and better perinatal care allow a proportion of these preterm babies to be successfully managed non-invasively. Those ventilated are at risk of iatrogenic lung injury including ventilation induced lung injury. Synchronising the ventilation to the baby's breathing pattern and minimizing lung injury are crucial in reducing complications such as bronchopulmonary dysplasia and long term respiratory morbidity. Volume targeted ventilation in preterm babies has been evaluated in last two decades and is now standard of care. Meta-analysis of trials reports that it improves short-term outcomes to discharge and some complications of prematurity.

Programed Switching Between Parallel Oscipap Flows -- a Practical Method of Sustained Ventilation after "Helping Babies Breath"

Programed Switching Between Parallel Oscipap Flows -- a Practical Method of Sustained Ventilation after "Helping Babies Breath"

Using quality improvement to decrease birth asphyxia rates after 'Helping Babies Breathe' training in Kenya.

The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB. Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic-ischaemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time, and chi-square analysis was used. Ninety-six providers received HBB from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p = 0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits. Focused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training.

Making every baby count: Reflection on the Helping Babies Breathe Program to reduce birth asphyxia in sub-Saharan Africa

Making every baby count: Reflection on the Helping Babies Breathe Program to reduce birth asphyxia in sub-Saharan Africa

Implementing Education to Reduce Neonatal Mortality in Low-Resource Environments.

* Abbreviations: CQI — : continuous quality improvement HBB — : Helping Babies Breathe Mortality among children under 5 years of age in developing countries has fallen dramatically in recent decades. Unfortunately, declines in neonatal mortality during this period have been less impressive. Neonatal mortality now accounts for >40% of under-5 mortality.1 About one-quarter of neonatal deaths result from intrapartum-related conditions and their consequences (eg, birth asphyxia),2 with an estimated 10 million newborns requiring some level of intervention to establish breathing and circulation at the time of birth.3 One strategy for reducing neonatal mortality is to improve the care of babies at the time of birth by improving the knowledge and skills of providers. Helping Babies Breathe (HBB), a low-cost and low-tech simulation-based educational program on newborn resuscitation, was developed to support this strategy. In this issue of Pediatrics , Arlington et al4 report the evaluation of large-scale implementation of HBB in Tanzania as a strategy to reduce neonatal mortality. This report is important for several reasons. Previous evaluations of HBB have been on a smaller scale and focused primarily on providers in hospital settings. … Address correspondence to Carl Bose, MD, Department of Pediatrics, CB 7596, University of North Carolina Hospitals, Chapel Hill, NC 27599-7596. E-mail: cbose{at}med.unc.edu

Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal

BackgroundEach year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal.MethodsA time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis.ResultsOne hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill retention were daily bag-and-mask skill checks (RR-5.1, 95% CI 1.9–13.5) and use of self-evaluation checklists after every delivery (RR-3.8, 95% CI 1.4–9.7).ConclusionsHealth workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills. Further studies are required to evaluate HBB-QIC in primary care settings, where the number of deliveries is gradually increasing.Trial registrationISRCTN97846009. Date of Registration- 15 August 2012.

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi’s Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers.

Actions to Help Babies Breath at Birth: Training Interventions to Improve Health Workers Knowledge, Practices and Competency

Background: Whether training of health workers on Helping Babies breathe (HBB) improves knowledge; practical skill in tertiary health facility of republic of South Sudan has not been studied. Therefore the study examined the effectiveness of training on the prospective outcome of knowledge practical skill and subsequent newborn mortality in the hospital setting. Methods: Our quasi experimental study compared the outcome of the training in two tertiary hospital of Wau and Juba pre and post intervention using heaping Babies Breathe training for health workers. Our hypothesis was that HBB training would result in 20% increase in knowledge, skill and subsequent reduction of early new-born mortality among new-born born with asphyxia. Result: We enrolled seventy health workers in the two sites of the studies. Health worker within each site were tested on their knowledge and practical skill pre intervention. In the post intervention, health workers knowledge, practical skill and competency in intervention site increased tremendously. There was no significant increase among the health workers in Wau Hospital. Mortality due to asphyxia reduced in Juba teaching Hospital where intervention occurred and remained at the pre intervention in Wau teaching Hospital. Conclusion: Training of Health worker on HBB in South Sudan was associated with improvement in knowledge, practical skills competency and reduction in early new-born mortality within 24 hours. The improvement in knowledge, skill and competency suggest there is need for rapid scale up of HBB training for health workers in south Sudan.

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

ABSTRACT Background: The Helping Babies Breathe (HBB) program teaches basic newborn resuscitation techniques to birth attendants in low-resource settings. Previous studies have demonstrated a decrease in mortality following training, mostly in large hospitals. However, low-volume clinics in rural regions with no physician immediately available likely experience a greater relative burden of newborn mortality. This study aimed to determine the impact of HBB trainings provided to rural Ghanaian midwives on their skills retention and on first 24 hour mortality of the newborns they serve. Methods: American Acadamy of Paediatrics (AAP)-trained Master Trainers conducted two 2-day HBB trainings and 2-day refresher courses one year later for 48 midwives from Ghanaian rural health clinics. Trainee skills were evaluated by Objective Structured Clinical Examination (OSCE) at three time points: immediately after training, four months after training, and four months after the refresher. Midwives recorded the single highest level of resuscitation performed on each newborn delivered for one year. Results: 48 midwives attended the two trainings, 32 recorded data from 2,383 deliveries, and 13 completed OSCE simulations at all three time points. The midwives’ OSCE scores decreased from immediately after training (94.9%) to four months later (81.2%, p < 0.00001). However, four months following the refresher course, scores improved to the same high level attained initially (92.7%, p = 0.0013). 5.0% of neonates required bag-mask ventilation and 0.71% did not survive, compared with a nationwide first 24 hour mortality estimate of 1.7%. Conclusions: The midwives’ performance on the simulation exercise indicates that an in-depth refresher course provided one year after the initial training likely slows the decay in skills that occurs after initial training. Our finding that 5.0% of newborns required bag-mask ventilation is consistent with global estimates. Our observed first 24 hour mortality rate of 0.71% is lower than nationwide estimates, indicating the training likely prevented deaths due to birth asphyxia.

Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?

BackgroundThe first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities.MethodsWe conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training.ResultsOne hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training).ConclusionsHBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.Trial registrationClinicalTrials.gov Identifier: NCT01681017; 04 September 2012, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1141-3) contains supplementary material, which is available to authorized users.

A pilot program of knowledge translation and implementation for newborn resuscitation using US Peace Corps Volunteers in rural Madagascar.

BackgroundPrevention of adverse perinatal outcome using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm can reduce perinatal mortality in low income settings. Mercy Ships is a non-governmental organisation providing free healthcare education in sub-Saharan Africa and in an attempt to reach more rural areas of Madagascar with our neonatal resuscitation training we designed a novel approach in collaboration with US Peace Corps Volunteers (PCV). PCVs work in rural areas and contribute to locally determined public health initiatives.MethodWe used a model of knowledge translation and implementation to train non-medical PCVs in HBB who would then train rural healthcare workers. Bulb suction and a self-inflating bag were donated to each health centre. We evaluated knowledge translation and behaviour change at 4 months using the Kirkpatrick model of evaluation.ResultsTen PCVs received training and then trained 42 healthcare workers in 10 rural health centres serving a combined population of over 1 million. Both PCVs and rural healthcare workers showed significant increases in knowledge and skills (p < 0.001). The commonest behaviour changes persisting at 4 months were adequate preparation before delivery; use of rubbing and drying as a means of stimulation instead of foot tapping or back slapping; and use of the self-inflating bag to give respirations. Anecdotal evidence of changes in neonatal outcome were reported in several health care centres.ConclusionOur study demonstrates that non-medically trained PCVs can be used to successfully train rural healthcare workers in newborn resuscitation using the HBB algorithm and this results in improvements in personal and organizational practice at 4 months, including anecdotal evidence of improved patient outcome. Our novel method of training, including the provision of essential equipment, may be another tool in the armamentarium of those seeking to disseminate good practice to the most rural areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-016-0207-3) contains supplementary material, which is available to authorized users.

A tailored video intervention to reduce smoking and environmental tobacco exposure during and after pregnancy: Rationale, design and methods of Baby's Breath

Low-cost interventions to decrease environmental tobacco smoke (ETS) exposure of pregnant women and their newborns are needed to lower health risks of exposed fetuses and infants. Baby's Breath is a tailored video intervention developed and tested in a randomized controlled trial. The study aimed to test the efficacy of tailored video versus usual care approaches to reduce the ETS exposure of fetuses of low-income women during and after pregnancy; and to assess this intervention separately among non-smoking and smoking women. Participating women, recruited early in pregnancy, who spoke English, were at least 18years old, smoke exposed (current smokers, quit smoking on their own, or were exposed to smoke of others), pregnant with only one baby, and had access to a telephone and video player, were randomized to experimental or control conditions. Intervention participants received newsletters containing content aimed at smoking cessation and avoidance (5 during and 3 after pregnancy), in addition to videos (3 during and 2 after pregnancy) individually tailored on behavioral theory-based survey questions. Comparison participants received newsletters and videos on healthy pregnancy topics. Outcomes included salivary cotinine of both mother and baby (32weeks gestation and 6months postpartum) as well as self-reported ETS exposure and avoidance behaviors. This study may demonstrate the efficacy of a low-cost intervention to decrease ETS exposure, and will fill an important gap in describing the utility of this innovative intervention technology, as well as demonstration of potential benefits to this type of intervention.

Provider experiences with the large-scale ‘Helping Babies Breathe’ training programme in Tanzania

Objectives: Worldwide, there has been renewed emphasis on reducing neonatal mortality in low-resource countries. The Helping Babies Breathe (HBB) programme has been shown to reduce newborn deaths. The aim of this study is to present provider-level perceptions and experiences of the HBB programme implemented at-scale in Tanzania and identify key lessons learned for scalability in similar and other settings.Methods: Focus group discussions with HBB-trained providers were conducted using a prospective longitudinal study design between October 2013 and May 2015. A semi-structured discussion guide was used to facilitate the focus groups which were held 4–6 weeks and 4–6 months post-HBB training. Data were managed using NVivo software and analysed thematically.Results: A total of 222 focus group discussions were conducted in 252 trained facilities and involved 599 providers across 15 regions of Tanzania. Birth attendants reported that the training programme helped increase knowledge, skills and confidence, and that the provided equipment simplified resuscitation. Supportive supervision and regular follow-up visits were considered critical for skills retention. On the other hand, the brief 1-day training in Tanzania, small financal incentives, intra-facility rotations of trained attendants, staff shortages, limited rescucitation spaces and mastery of the bag-and-mask were considered challenges to the HBB programme in Tanzania.Discussion: The HBB programme was largely very well received during its first at-scale implementation in Tanzania. Addressing the main challenges cited by participants, particularly the training duration, may increase provider satisfaction with the HBB training programme.

International Perspectives: Reducing Birth Asphyxia in China by Implementing the Neonatal Resuscitation Program and Helping Babies Breathe Initiative

Although China has advanced as a leading economic world power since World War II, its perinatal health outcomes, including neonatal mortality, have lagged behind those of other rapidly developing countries. Some factors behind the relatively high neonatal mortality rate include geographic challenges to providing health care in rural regions and disparities in care across different levels of hospitals. To tackle the problem of neonatal mortality, specifically to reduce birth asphyxia, key stakeholders have worked to implement the Neonatal Resuscitation Program and Helping Babies Breathe initiatives across China in the past decade. These efforts have already borne fruit in improving clinical care and are likely to provide further benefit in improving long-term outcomes.

Designing and Implementing the Helping Babies Breathe Program in Tanzania.

The first day and especially the first hour are critical to newborn survival with the highest risk of intrapartum-related neonatal deaths, from 60 to 70%, occurring within 24 hours of birth. Birth asphyxia (BA) or failure to initiate or sustain spontaneous breathing at birth contributes to approximately 27 to 30% of neonatal deaths. In 2009, Helping Babies Breathe (HBB), an evidence-based educational program developed to teach neonatal resuscitation techniques in limited-resource setting, was introduced and piloted in Tanzania. HBB resulted in a significant 47% reduction in early neonatal mortality from 13.4 to 7.1 per 1,000 live-born deliveries ( p < 0.0001) and a significant reduction (24%) in fresh stillbirths from 19.0 per 1,000 preimplementation to 14.4 per 1,000 births postimplementation ( p = 0.001). The use of stimulation and suctioning increased, whereas the need for bag mask ventilation decreased significantly post-HBB. This success was attributed to several key strategies including elevating BA as a national priority in health care, identification of a primary person (a pediatrician) at the ministerial level who assumed ownership of the program, local site ownership by a midwife, a commitment to train all birth attendants in the current health workforce in HBB, a commitment to provide required resuscitation equipment at all levels, and periodic review of the data (biannually) at a centralized meeting, under the direction of the Ministry of Health, involving all stakeholders to instill a sense of accountability. A national rollout of provider training is almost complete with almost 15,000 already trained.

Normal Range of Head-to-body Delivery Interval by Two-step Delivery.

Background:The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interval by waiting for at least one contraction (two-step) after head delivered in normal birth.Methods:From March 1 to March 30 in 2015 at Haikou Maternal and Child Hospital in China, normal vaginal birth with normal baby condition were recorded by video. Videotapes were transferred to computer then replayed and observed.Results:Ninety-two cases were enrolled in this study. The average head-to-body delivery interval by two-step delivery was 71.04 ± 61.02 s, (mean + 2 standard deviation = 193.07 s, 95% confidence interval [15.65–229.15] s). Fifty-one patients (51/92, 55.43%) were <60 s, 41 patients (41/92, 44.57%) were over 60 s. Shoulders delivered at the first contraction were 96.74% (89/92), 3.26% (3/92) had delivered by the second contraction. Shoulders emerged from perineum were 71.73% (66/92), 15.21% (14/92) transversely, and 13.04% (12/92) emerged from under pubic arch. Babies cried before the shoulder were 31.52% (29/92), cried after birth 52.17% (48/92), and 16.30% (15/92) did not cry after birth. Baby activities included as making faces, sucking, and bubbled from mouth and noses, and the lighter blue color of skin with good perfusion.Conclusions:The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby's breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.

Skills retention in Sudanese village midwives 1 year following Helping Babies Breathe training

BackgroundOver 80% of deliveries in Sudan occur in isolated villages, attended by village midwives (VMWs). Upgrading newborn resuscitation skills with the Helping Babies Breathe (HBB) programme could improve newborn survival...

Abstract: Implementing Sustainable International Accepted Trainings at Muhima Hospital, Kigali, Rwanda

Abstract Background This is a description of a pilot project that was implemented at the Muhima Hospital, the largest maternity hospital in Rwanda. The goal of the program was to facilitate the teaching of staff the best practice of maternal child health. The program was established through monthly staff trainings using three evidenced-based global maternal and neonatal health programs: Helping Babies Breath, Helping Mothers Survive, and Basic Life Support. Methods The “Train the Trainer Model” was used and monthly staff trainings were developed and implemented. The students were experienced nursing staff trained by advanced midwifery students during their clinical rotation at Muhima Hospital. Human Resources for Health (HRH) educational mentors supported the students and staff during the trainings. Following the first training, Muhima staff nurses were selected based on expertise and enthusiasm to be future trainers. These nurses received advanced instruction as trainers. The long-term program goal is that all hospital staff and students complete each of these three training programs once every two years. Results Initially the staff expressed resistance to the process, but this barrier was overcome as the staff became comfortable and effective as providers and trainers. Trainings done in the local language elicited more participation compared to trainings in English. Staff and students enjoyed the simulations and developed a comfort level and camaraderie between staff, students and HRH educators. Conclusions Challenges of sustainability in relation to motivation and organizational issues is being discussed with the hospital director and the staff trainers. Planning and organizing are ongoing, with the goal to expand the program to include health centers. This professional staff development project and the desire for community outreach programs are impressive. Community outreach would be beneficial for the professional development of the nurse midwife trainers and staff in the rural district facilities throughout Rwanda. Key words : helping babies breath, helping mothers survive, basic life support, teaching, training, Rwanda