“I am not an expert like others, many things taught are new to me, and I don’t know how I will remember them all. I don’t know how I will conduct delivery during the clinical training sessions.”

Training Gives Confidence to Auxiliary Nurse Midwives
Sangeeta Kumari is an auxiliary nurse midwife (ANM)—a frontline health worker in the Beltu health subcenter in Hazaribagh District in India’s state of Jharkhand. Before participating in the hands-on skilled birth attendance training, Sangeeta was not confident that she could deliver a baby during the training’s clinical sessions, much less on her own post-training. The training gives ANMs the theoretical and practical skills they need to manage normal, uncomplicated pregnancies, delivery, and the immediate post-natal period. The training also qualifies ANMs as skilled birth attendants—able to identify, manage, and refer conditions that can cause complications for women and newborns.

Never having conducted a delivery before, Sangeeta was very nervous when she began her practical training in the labor room. For the first two days, she observed deliveries and sought advice from a senior ANM. On the third day, Sangeeta worked up her courage and successfully conducted a delivery on her own. By the end of her clinical training session, she had independently performed 12 deliveries.

“Never in my dreams did I imagine that I would ever be able to conduct a delivery independently,” admits Sangeeta, “but the training taught me how to do it.”

Reducing Maternal Deaths
The training Sangeeta received is part of the Government of India’s National Rural Health Mission, launched in 2005 to provide effective health care to rural populations, and to reduce the number of women and infants dying during or shortly after childbirth. The government of Jharkhand—a state of over 30 million people with one of the highest maternal mortality ratios in India: 312 per 100,000 live births[1]—asked the Vistaar Project to provide technical assistance in designing the state’s skilled birth attendance program. The program comprises skills-based training sessions, post-training supportive supervision, and availability of essential drugs and supplies at the health facilities where the skilled birth attendants conduct deliveries. The pilot program’s success in Deoghar District led to its scale-up in 14 other districts, including Hazaribagh, home to more than two million of the state’s residents.

A More Prepared Health Workforce
In Hazaribagh District, 2010 data (July-September) show that post-training, 100% of deliveries performed by the trained birth attendants received active management of the third stage of labor—a technique to prevent mothers from experiencing excessive and potentially fatal blood loss after delivery. Ninety-nine percent of the newborns delivered by skilled birth attendants were dried and wrapped and breastfed within an hour of birth—measures crucial to the survival of the infant. In Deoghar District, the mean total of deliveries conducted by skilled birth attendants has increased from 2.5 (at baseline)[2] to 4.2 per month (in June 2010)[3]. Initiation of breastfeeding within an hour of birth in all deliveries has also increased from 58% (at baseline) to over 98% (June 2010).

The training’s participatory approach—and the special attention given to less confident candidates like Sangeeta—allows ANMs to reach their potential and ultimately ensures that more women and infants survive.

The Vistaar Project is led by IntraHealth International and funded by the United States Agency for International Development. Please visit IntraHealth’s India country page to learn more.

[1] Registrar General of India, 2004-06

[2] The baseline survey was conducted in November-December 2008 (Nov-Dec 2008 N=69).

[3] Monitoring data collected from auxiliary nurse midwives by the Vistaar project staff from Deoghar District of Jharkhand (April –June 2010 N=140).