Local Midwives Research Articles

P0286 / #1094: EVALUATION OF RESUSCITATION SKILLS FOLLOWING IMPLEMENTATION OF HELPING BABIES BREATHE IN A RESOURCE-LIMITED SETTING

Aims & Objectives: Philippines has a persistently high neonatal mortality rate (14 per 1,000 live births). Helping Babies Breathe (HBB) simulation training has led to reductions in early neonatal mortality. However, data is lacking in application of skills taught in HBB such as bag valve mask (BMV) in clinical practice. In our study, HBB trainings were held for local nurses and midwives in the Philippines. Follow-up of HBB skills both at refresher training and at live deliveries in local hospitals was used to assess skill retention and application post-training. Methods: HBB trainings were held for local nurses and midwives in the Philippines over two days in August 2018. Follow-up of HBB skills was assessed in two settings: in refresher classes 12 months post-training (n=11) and at live deliveries in local hospitals 6 to 12 months post-training (n=14). Adherence to HBB skills was assesed using the validated HBB OSCE B. Results: At 12-month follow-up, passing rate for HBB OSCE B was 81%. Time to initiate BMV worsened from an average of 90.0 seconds to 135.9 seconds, with only 2 providers achieving successful BMV within the “Golden Minute” compared to 6 immediately post-training. In clinical practice, 93% of birth attendants followed HBB protocol for normal newborn care, though zero of 3 newborns received BMV when indicated. Conclusions: Some essential skills have been adopted by trainees that persist after HBB training. Future training sessions should focus on skill retention and initiation of adequate BMV within the “Golden Minute” after birth, as this skill was not observed in clinical practice.

A Local Midwife or a Doctor? Two Systems of Knowledge in Birthing Practices of Russian Old Believers

The article explores complex relationships between traditional midwifery and medical institutions as two legitimate knowledge systems in the communities of Russian Old Believers in the Republic of Moldova and in Romania. It is aimed at discussing beliefs and practices around giving birth with the help of a local midwife from the same community, their transformation caused by the access to maternity hospitals as well as distribution of roles between a traditional birth attendant and a doctor. The article is based on oral narratives of Old Believers who used to be local midwives or gave birth to children with the help of such a specialist. The narratives were recorded by the author in 2008–2018.

Working with a Rural Ethiopian Health Centre to Create a Framework for High-quality, Women-friendly Services

In the first of two articles, Brydon provides insights regarding the charitable work she has been involved in. Midwives@ethiopia works in partnership with local midwives and allied workers to improve maternal and neonatal outcomes. This article provides an overview of this work, and part 2 will offer reflective insights by Dawit Tilahun, a clinical nurse in Udo Health Centre.

Pencarian Informasi Kesehatan Ibu dan Anak Pada Masyarakat Miskin Penerima Manfaat Program Keluarga Harapan (PKH)

Background: Program Keluarga Harapan (PKH) is a priority program that is expected to improve the welfare of its beneficiaries. In the implementation, the PKH’s beneficiaries are required to attend family enhancement meeting activities (P2K2). Among all the information that must be given to P2K2, which one is needed and is in demand by the beneficiaries of PKH? Objectives: To know the needs of maternal and child health information in the PKH group of recipients. Method: We involved 76 PKH beneficiaries and asked them to fill our questionnaire. The questionnaire consists of 12 questions about what kind of health information they need and how to obtain it. Sampling techniques use is simple random sampling. Result: There are some KIA information needs sought by the KPM. But the greatest need is information about the KB. Information search is done by asking directly to the local midwife's conclusion: PKH escorts need to establish good cooperation with midwives and master the information about the KB because it is tasked to deliver it to the PKH beneficiaries through P2K2 activities.

A Nurse-Led Population-Based Health Education Project to Improve Infant Care Knowledge for an Old Order Mennonite Community

Population health is changing the focus of nursing practice as nurses are challenged to focus on health promotion and education for communities rather than limiting their practice to restorative care for individual acute care patients. This new focus is necessary to improve knowledge of maternal and infant health among vulnerable populations. One particularly vulnerable population is members of Old Order Mennonite communities, who frequently rely on self-trained local midwives in the community for home births and home remedies when caring for their infants. Providing evidence-based education to members of this isolated population can be a challenge because they do not typically access information outside of the community. The purpose of this article is to share the process of developing, publishing, and disseminating a culturally sensitive infant care manual for an Old Order Mennonite community using a community-based participatory model and to highlight the impact nursing outreach can have on improving health knowledge.

Episiotomy wound healing by Commiphora myrrha (Nees) Engl. and Boswellia carteri Birdw. in primiparous women: A randomized controlled trial

Ethnopharmacological relevanceTraditional Persian medicine manuscripts refer to plants such as Commiphora myrrha (Nees) Engl. (myrrh) and Boswellia carteri Birdw. (frankincense), which could be used to improve wound healing process. Since that time, local midwives in Iran continue to provide these herbs to precipitate episiotomy wound healing. Aim of the studyTo investigate the efficacy and safety of myrrh- and frankincense-based sitz-baths on episiotomy wound healing in primiparous women. Materials and MethodsThis randomized controlled trial was conducted on 90 primiparous women with singleton pregnancies after normal vaginal delivery at Hafez hospital affiliated to Shiraz University of Medical Sciences from July to October 2019. Study participants were randomly allocated in three groups (2 intervention groups and 1 control group). Women in intervention groups were assigned to receive either 10-min sitz-bath of myrrh extract or frankincense extract twice a day for 1 week. While the women in control group received the betadine sitz-bath for the same period of time. The main outcome was the episiotomy wound healing, which was measured using the REEDA scale before intervention, on 2nd and 7th postpartum days. ResultsAn improvement in the episiotomy wound healing was significantly greater in patients receiving myrrh than those receiving the frankincense or betadine on 2nd (p = 0.003 and p < 0.001) and 7th (p = 0.043 and p = 0.015) postpartum days. However, the total REEDA score was not statistically different between the frankincense and betadine groups on 2nd and 7th postpartum days (p > 0.05). ConclusionThe present results suggest that myrrh was more efficient than frankincense and betadine in healing of the episiotomy wound and could be recommended as a safe natural therapy.

Islam and Myths about Family Planing: The Impact of Greenstar Media Advertisement Campaign on the Mindset of the Rural Dwellers of Pakistan

Religious guidance in Islam is derived primarily from the Holy Qur’ān and Sunnah. For cases not discussed in the Holy Qur’ān, Muslims refer to ijtihad and ijma, that is, they strive to find solutions for the existing problems by reinterpreting Islamic decrees while utilizing the ultimate superintendent sources (Holy Qur’ān and Sunnah) and seek consensus. The study aims to investigate the effects of Greenstar media advertisement campaign on the mindset of the rural dwellers of Pakistan through selective exposure technique. Greenstar marketing tends to educate the rural populace about population control and guides them about different birth control methods, such as contraceptive pills. The researchers carried out a survey with a sample of 200 respondents, out of which 100 were male and 100 were female. Data was collected by providing two questionnaires to take sample from different age groups developed on a five point Likert scale. The results of the study highlighted that regardless of exposure to Greenstar media advertisement, rural men still showed a rigid attitude towards using these products (p value = 0.000). On the other hand, rural women considered local midwives more knowledgeable and expert about the matter at hand (p value = 0.002) and were reluctant towards using Greenstar products that were advertised on the mainstream media due to the pressure of their husbands (p value = 0.000).

No More ‘Hands off the Breech’

This article explores recent research about physiological breech birth and implications for midwifery practice, challenging whether some ‘common understandings’ for breech births are evidence based. For example, ‘hands off the breech’, has been the golden rule, but how long is it safe to remain hands off? If you have only been taught supine manoeuvres, should you ask the woman to give birth on her back for her baby’s safety? The article ends with a call for developing more local midwife breech specialists, working with one voice alongside their obstetric colleagues.

Population-Based Estimation of the Preterm Birth Rate in Lilongwe, Malawi: Making Every Birth Count.

Objective The objective of this study was to perform a population-based estimation of the preterm birth (PTB) rate in regions surrounding Lilongwe, Malawi. Study Design We partnered with obstetrician specialists, community health workers, local midwives, and clinicians in a 50 km region surrounding Lilongwe, Malawi, to perform a population-based estimation of the PTB rate during the study period from December 1, 2012 to May 19, 2015. Results Of the 14,792 births captured, 19.3% of births were preterm, including preterm early neonatal deaths. Additional PTB risk factors were similarly prevalent including domestic violence, HIV, malaria, anemia, and malnutrition. Conclusion When performing a population-based estimation of the rate of PTB, including women without antenatal care and women delivering at home, the 19.3% rate of PTB is among the highest recorded globally. This is accompanied by a high rate of risk factors and comorbid conditions.

Analisis Tingkat Konsumsi Zat Gizi terhadap Gizi Kurang Balita di Puskesmas Jelbuk Kabupaten Jember

Anak-anak memiliki masalah yang sangat bervariasi berkaitan dengan pertumbuhan, perkembangan dan nutrisi. Kekurangan makronutrien dapat memicu malnutrisi protein-kalori dan ketika dikombinasikan dengan defisiensi mikronutrien dapat menimbulkan masalah gizi pada balita. Penelitian ini bertujuan untuk menganalisa tingkat konsumsi dalam kejadian gizi kurang pada balita di Puskesmas Jelbuk, Kabupaten Jember. Penelitian ini merupakan penelitian analitik dengan desain observasional menggunakan pendekatan case control. Populasi dalam penelitian ini adalah seluruh balita usia 0-5 tahun. Tehnik pengambilan sampel dengan menggunakan Simple Random Sampling. Besar sampel ditentukan berdasarkan rumus besar sampel pada penelitian dengan pendekatan case control yaitu sebanyak 42 balita. Hasil penelitian menunjukkan bahwa ada pengaruh yang signifikan antara tingkat konsumsi kalori (α=5%,p=0,003), tingkat konsumsi protein (α=5%,p=0,003), tingkat konsumsi karbohidrat (α=5%,p=0,002) dan tingkat konsumsi lemak (α=5%,p=0,005) dengan kejadian gizi kurang pada balita. Hendaknya ada koordinasi serta upaya dari bidan wilayah, Puskesmas dan Dinas Kesehatan setempat untuk meningkatkan kegiatan-kegiatan berkaitan dengan promosi kesehatan tentang pola asuh berkaitan dengan pentingnya asupan nutrisi pada balita.

PERBEDAAN KOMITMEN IBU DALAM PEMBERIAN IMUNISASI DPT 2 PADA BAYI USIA DIBAWAH 3 BULAN SEBELUM DAN SESUDAH PEMBERIAN HEALTH PROMOTION MODEL NOLA J., PANDER

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Parent's commitment to immunizing hertoddler is one of the obstacles to achieving thesuccess of the immunization coverage target.Immunization itself is very important as an effort toprevent disease in children and has beenrecommended to the community. Based onpreliminary study results, researchers conductedinterviews with local midwives obtained data thereare some children who have not immunized DPT 2 itis strengthened by interviews with 10 mothers whodo not immunize DPT 2 on the baby for fear of sideeffects. The aim of this research is to know thedifference of mother's commitment before and aftergiving Health Promotion Model Nola J.Pander.&#x0D; This research used one group design pre post testdesign. With two variables, independent variablesare health education, dependent variable of mother'scommitment. The data collection used questionaire,data taken from respondent such as mother withpopulation of 44 responden with amount the sampelcounted 30 mother were taken with simple randomsampling technique, at Burneh community healthcenter. The results were analyzed descriptively andcorrelated using the Wilcoxon Match Pairs Test&#x0D; The results were analyzed descriptively andcorrelated using the Wilcoxon Match Pairs Test test.Analysis of Wilcoxon Match Pairs Test with p value =0.000 so H1 accepted means there are differencesbefore and after health education with Nola J.Panderapproach.&#x0D; There are still several other factors that influence thecommitment, among others, family and culturalfactors that are not examined in this study, so thatthe next researcher is expected to do research onthe influence of these factors on the mother'scommitment&#x0D; &#x0D;

Case Report: Thalassemia with Malnutrition

A 2 years old patient presented with a complaint of weight that had not increased in the past few months. The patient was identified by the Puskesmas Team in an integrated UKM activity on March 30, 2017, with a condition of complaining of fever and being taken to the local midwife, but there had been no improvement. Next, after the examination, the patient was advised to be referred to Sukadana Regional Hospital, East Lampung Regency, Lampung, where physical and laboratory examinations were conducted with results showing hemoglobin (Hb) 6.9 and a pediatrician established a diagnosis of thalassemia.

Мать и дитя в ранней советской политике: случай Дагестана

В статье анализируется советская социальная политика 1920–1930-х гг. в области охраны материнства и детства в Дагестане. На основе архивных материалов, опубликованных документов, литературы и периодики раскрываются ее основные тенденции. Анализ позволил выстроить целостную картину преобразований в области медицинской помощи горянкам, их эмансипации, включения в общественную жизнь. Документальные материалы отражают сложности проникновения советских преобразований в дагестанские селения. Советское здравоохранение столкнулось с традиционными медицинскими практиками, которые формировались на протяжении длительного времени. Население пользовалось услугами местных повитух, которые не имели какого бы то ни было профессионального образования, что связано с отсутствием в Дагестане специализированных учебных заведений. Однако уже в середине 1920-х гг. открыта акушерско-фельдшерская школа, которая занялась подготовкой квалифицированных медицинских работников. Постепенно с ростом числа медицинских работников количество родов, которые принимались в стационарах, начинает расти, увеличивается и число коек в лечебных заведениях, открываются колхозные родильные дома. Создаются комиссии по охране материнства и детства, в чьи обязанности входила организация чтения лекций по санитарному просвещению, методическая помощь медицинским работникам. Как показывают статистические данные, до введения запрета на производство абортов их число в Дагестане было значительным. Запрет абортов привел к росту рождаемости и открытию родильного дома в Махачкале. Создание Дагестанского медицинского института в 1932 г. и в его рамках кафедр детских болезней и акушерства и гинекологии положительно сказалось на оказании квалифицированной медицинской помощи матерям и детям. Включение горянок в общественную жизнь повлекло за собой открытие большого числа как стационарных, так и сезонных дошкольных детских учреждений. В статье показано, что несмотря на голод, нежелание местных жителей прибегать к квалифицированной медицинской помощи, а также иные трудности, связанные с проведением советской социальной политики, в 1920–1930-е гг. в Дагестане наблюдался естественный прирост населения.

Maternal Care among Madurese through the Form of Culture

To overcome the maternal’s health problem, preventive action based on the culture’s perspective was chosen compared to the medical’s perspective. Madurese still believe in the myth about food and action which affect their pregnancy. Based on the theory of A. L Kroeber, there is 3 form of culture to identify a community’s culture. This study aim is to identify maternal care among Madurese through the form of cultural: 1) ideas; 2) activities and 3) artefact. This study was a descriptive research with the qualitative approach. This study conducted in the area of Puskesmas Trageh (Bangkalan) and Puskesmas Omben (Sampang) in Madura. The total main informant was 18 persons that consist of 3 pregnant women for each area and the key informants consist of 1 midwife coordinator, 1 local midwife, 1 shaman and 1 family member of each pregnant women. The maternal care towards the form of cultural ideas: 1) They should have a good intention towards other people; 2) increase their worships through reading HolyQur’an; 3) avoid the distraction of the spirits by pray and use a talisman. The maternal care towards the form of cultural activities: 1) have a celebration to show the gratitude feeling towards God; 2) drink herbal medicine and do massage at stomach by the shaman; 3) avoid several foods based on myth. The maternal care towards the form of the cultural artefact uses the talisman to avoid misfortune. It showed phenomena that Madurese still do traditional maternal care which often contradictory to the modern medicine.

Dispatches from Haiti, 2010

Haiti is a country that appears fleetingly in the English-speaking media, when stricken by disaster or more recently by epithets. Perhaps few are aware that Haiti was the first independent nation in Latin America and the Caribbean, and the world’s first black republic—independence declared on January 1, 1804—in a revolution led by former slaves who defeated Napoleon’s 40,000-strong colonial forces. Or that, when others abandoned the independence wars against Spain, Simon Bolivar appealed to Haitian president Alexandre Petion and with Petion’s troops and material aid, went on to free slaves across Spanish-held colonies in Latin America. Over the centuries, the Haitian people have indeed been beset by disasters, both natural and man-made. But they have also stood against daunting odds and have received solidarity from their hemispheric neighbors, Cuba among the countries allied with Haiti’s attempts to provide for its people. In this Retrospective, MEDICC Review reprints excerpts from a blog by Senior Editor Conner Gorry, who, during February and March 2010, was embedded in the disaster-response medical team sent from Cuba after the January 12 earth-quake. The team reinforced nearly 500 Cuban health per-sonnel already on the ground long term in 120 communities. Some 700 of the 1300 new arrivals were students or graduates of Cuba’s Latin American School of Medicine from 27 countries. Haitian graduates now number 1044. The international contingent (named after Henry Reeve, a Brooklyn-born general in Cuba’s own independence struggle)—became the largest medical relief effort assembled after the quake. The vivid stories here take us back to the urgency and chaos of those first weeks and months after disaster struck. But Haitian, Cuban and other Cuban-trained doctors dedicated to Haiti’s recovery—its long-term health care needs and strengthened public health system—provide an example of commitment to social equity and human solidarity in the face of enormous challenges. And their work with those from other countries proves effective cross-border, cross-cultural collaboration can work. Today, there are 664 Cuban health professionals collabo-rating in Haiti, 175 of them doctors posted throughout the country. In 2017 alone, they carried out 2.64 million patient consults, performed 40,842 surgeries, and delivered 5788 babies (many times working with local midwives). They labor in 21 community reference hospitals built with funds from Venezuela; 31 rehabilitation centers, also built after the 2010 earthquake; 14 health centers; and 29 sentinel sites for epidemiological surveillance (mainly for cholera and vector-borne diseases). A national workshop for orthotics and prosthetics was also established to assist earthquake victims, with equipment and other resources provided by Cuba. The Editors

‘Impact’, educational influence and the practice of shared expertise

This paper argues that participants and locals should be seen as at the centre of all development, including international and health development work. Consequently, in contexts of health and wellbeing, patients should be seen as active participants, which also implies the need for the independence and freedom of all and the development of dialogical spaces in which all may negotiate what counts as a life worth living. ‘Impact’, on this view, should be seen from a lifeworld perspective of evaluating the effects of dynamic evolving practices where all are seen potentially as donors and beneficiaries within contexts of mutually negotiated reciprocal relationships. Data drawn from extensive fieldwork with local trauma surgeons, midwives and healthcare personnel in rural Cambodia provide the basis of new perceptions about processes of ‘passing on’ knowledge and expertise. The ideas presented have potential implications for normative understandings of the social organisation of healthcare in domestic and international settings.

Dispatches from Haiti, 2010.

In this Retrospective, MEDICC Review reprints excerpts from a blog by Senior Editor Conner Gorry, who, during February and March 2010, was embedded in the disaster-response medical team sent from Cuba after the January 12 earthquake. The team reinforced nearly 500 Cuban health personnel already on the ground long term in 120 communities. Some 700 of the 1300 new arrivals were students or graduates of Cuba's Latin American School of Medicine from 27 countries. Haitian graduates now number 1044. The international contingent (named after Henry Reeve, a Brooklyn-born general in Cuba's own independence struggle) became the largest medical relief effort assembled after the quake.

Midwife or doctor local opinion leader to implement a national guideline in babies on postnatal wards (DesIGN): protocol of a cluster-randomised, blinded, controlled trial

IntroductionNeonatal hypoglycaemia is a common condition that can cause developmental delay. Treatment of neonatal hypoglycaemia with oral dextrose gel has been shown to reverse hypoglycaemia and reduce admissions to neonatal...

Adaptation of a Screening Tool for Perinatal Depression and Anxiety in Community‐Based Maternal Health Services in Mali

PurposeThe aim of this research is to adapt and validate a perinatal depression and anxiety screening tool in Mali, West Africa for use in community‐based maternal mental health prevention interventions.Research QuestionsHow do standardized screening tools for depression and anxiety align with maternal depression and anxiety symptomatology in Mali? Is the adapted depression and anxiety screening tool valid and reliable?SignificanceMidwives in low‐resource settings such as Mali provide the majority of maternal health services with few resources. As with other threats to maternal and newborn well‐being, perinatal depression is a significant cause of morbidity and mortality including poor perinatal outcomes and infant development. However, mental health issues are rarely included in maternal health programming, and local midwives have few tools to address the issue. An important component of maternal care is screening for depression and anxiety with a tool based on local ethnomedical understandings of mental health. Western screening tools have been adapted and validated in other low‐income contexts but not in the Malian context. Such a tool has the potential to provide midwives with a way to identify women who need mental health support.MethodsWe are using a mixed‐methods study to adapt and validate a postpartum depression and anxiety screening tool using the DIME Program Research Model: Design, Implementation, Monitoring, and Evaluation. Focus groups and interviews conducted in Sélingué, Mali in 2016 provided local terms and symptomatology upon which to base the adaptation of screening tools. A pretest was conducted among local midwives in Sélingué in June 2016, and additional pretests with community women are ongoing; additional interviews to establish reliability and validity with childbearing women took place in September of 2016.ResultsTo date, multiple elements of the Edinburgh Postnatal Depression Scale and Hopkins Symptom Checklist were expressed locally. Some elements from established screeners were not locally relevant, and new elements were added to the adapted tool.DiscussionPerinatal depression in low‐resource settings requires locally relevant screening tools. Such tools are necessary for community‐based efforts to integrate perinatal depression screening, prevention, and intervention into routine care in Mali.

Prevalence of Perinatal Asphyxia with Evaluation of Associated Risk Factors in a Rural Tertiary Level Hospital

Background: Perinatal asphyxia (PNA) is one of the most important causes of perinatal mortality and morbidity which can be preventable and managable.Objectives: The purpose of the study was to determine the prevalence of perinatal asphyxia and to explore the factors influencing or related to the development of the PNA.Materials and Methods: It is a cross-sectional study conducted in the neonatal unit of department of pediatrics, KYAMC hospital from January 2015 to December 2016. Two hundred eleven neonates admitted in neonatal unit including SCABU were enrolled in the study considering inclusion criteria. Necessary information about sociodemography, peri-natal history (including antepartum, intrapartum and fetal risk factors) were collected by detailed history taking on a pre-designed questionnaire. Clinical examinations and outcomes were also recorded. We used Student's t-test and ?2-test to determine the association of PNA with various risk factors.Results: The male to female ratio was 1.6:1. The mean age of the neonates during admission time was 3.66 (±5.506) days (in PNA 1.8±2.803 days and in normal group 6.11±7.047 days). The overall prevalence of PNA was 56.9% (120); male 60.8% (73) and female 39.2% (47). Identified significant materno-fetal risk factors were maternal young age (p= .038), low socioeconomic condition (p = .000,) primiparity (p = .003), muconium stained amniotic fluid (p = .004), obstructed labour (p = .019), low birth weight (p = .009) and home vaginal delivery by local dai and midwives (p = .017). Serious neonatal complications noted among the asphyxiated babies were hypoxic ischemic encephalopathy with convulsion, neonatal jaundice, septicemia, transient tachypnoea of neonate, hypoglycemia, respiratory distress syndrome, caput succedaneum and feeding problem.Conclusions: Findings of this study highlight the need for the better obstetrical care and awareness of the possible presence of the risk factors of PNA among mothers and fetus, so that the occurrence and worsening of PNA could be prevented or at least appropriately managed. It can reduce the high incidence of morbidity and mortality due to birth asphyxia.KYAMC Journal Vol. 8, No.-1, Jul 2017, Page 43-48