When Astou Ndèye's labor began, her husband, in-laws and family worried. Astou had bled so much when she gave birth previously that she had to be transferred to the regional hospital.

In Senegal, postpartum hemorrhage (PPH)—rapid, excessive blood loss after delivery that can cause a severe drop in the mother's blood pressure—is a major cause of women’s transfers to hospitals after childbirth and can lead to shock and death. In fact, it is the leading cause of maternal mortality in Senegal and accounts for a quarter of maternal deaths worldwide. Women who die from postpartum hemorrhage generally die within two hours of giving birth. The presence of a birth attendant skilled in preventing PPH might be a woman’s only hope of beginning her life as a new mother.

Fortunately for Astou, her attending nurse—Khaiba Fall—had been trained in one of the best techniques to decrease the incidence of bleeding, the active management of the third stage of labor (AMTSL), and she was going to do everything she could to try and make this birth a safe one.

Nurse Khaiba Fall received her training in the AMTSL technique through the USAID-funded Maternal, Neonatal and Child Health/Family Planning/Malaria (MNCH/FP/Malaria) Project in Senegal. Led by IntraHealth International, the project is supporting the Ministry of Health and Medical Prevention to initiate a provider training program in AMTSL and in the essential care of newborns immediately after childbirth.

AMTSL consists of three components: a) administration of a uterotonic drug within one minute of birth of the baby, b) controlled cord traction to assist with prompt delivery of the placenta, and c) massaging the uterus after delivery of the placenta.*

Through a USAID-funded regional initiative in Benin, Mali and Ethiopia, IntraHealth previously demonstrated that AMTSL could be successfully introduced in public health facilities in low-resource settings. Dr. Hamadoun Garba Cissé, a provider at a Bamako, Mali clinic that was part of the initiative, said, “AMTSL is good for morale, good psychologically for the clients because they feel like they should be done once the baby is out and for the providers because they don’t have to be afraid of hemorrhage anymore. It’s also more economic, with less dirty materials and clothing. Plus the time gained lets providers take care of other patients.”

AMTSL has since been added to national protocols in Benin and Mali, and IntraHealth is involved in developing protocols and training curricula geared toward global expansion of this life-saving practice. IntraHealth introduced the intervention in Senegal to enhance the Ministry of Health’s capacity to train providers in emergency obstetrics, thus giving nurses, midwives and community health workers an expanded role in the effort to reduce maternal mortality.

For Astou Ndèye’s recent birth, she was sent to the Lamarane health post in Senegal’s Ndoffane district. Astou did not have excessive bleeding and was able to hold her baby just minutes after the birth. Four hours later, Astou’s mother-in-law approached Nurse Fall to ask why Astou had not bled after childbirth. Nurse Fall explained that she had been able to use a new technique to prevent bleeding.

“[It] has really reduced the [number] of women being transferred to the regional hospital and should have been introduced earlier," remarked Nurse Fall.

To expand access to AMTSL training and skills, the project conducted workshops to train new instructors in AMSTL technique in five regions in Senegal: Thiès, Kaolack, Louga, Kolda and Ziguinchor. Fifty-five trainers from regional hospitals then built the AMTSL skills of 267 health care workers through on-site trainings at health centers.

The Senegal MNCH/FP/Malaria project also aims to:

• Increase use of family planning (FP) methods by improving providers’ FP knowledge and counseling skills as well as ensuring that health districts are stocked with contraceptive products
• Decentralize access to quality health care services
• Encourage a spirit of leadership among health care management and providers to ensure high-quality services
• Encourage male involvement in the use of family planning services
• Empower women and girls to actively participate in decisions about their health
• Increase providers’ and clients’ knowledge about prevention of malaria and the need for treatment services in order to save lives.

In the Kaolack region, where Nurse Fall works, the project’s AMTSL training has already resulted in fewer obstetric complications among women giving birth at health posts. For Astou Ndèye and many other women, this means a better chance of survival.

*Source: http://www.icddrb.org/: “Evidence for interventions included in the Minimum Package of Maternal and Newborn Interventions by Malay Kanti Mridha”

Photo: Hawa Talla l Photos should not be construed as indicating the health status of persons depicted.