Our day started with a song. Ten matrones, many quite elderly, had traveled a distance to join us at Haiti Village Health for a training seminar called Helping Babies Breathe. The song they sang was joyous, a chorus celebrating life, for these women have collectively delivered life to generations of villagers in the Bas Limbe region. After the traditional song was sung, one by the one, the matrones stood up and recited their stories in Creole.
Our day started with a song. Ten matrones, many quite elderly, had traveled a distance to join us at Haiti Village Health for a training seminar called Helping Babies Breathe. The song they sang was joyous, a chorus celebrating life, for these women have collectively delivered life to generations of villagers in the Bas Limbe region.
After the traditional song was sung, one by the one, the matrones stood up and recited their stories in Creole. Most of these Traditional Birth Attendants (TBAs) had no formal training. Many had been trained by family members or had been called in a dream to bring babies into the world. For 30 or 40 years they had been caring for mothers and delivering babies in village homes with no electricity, no running water, and very little in supplies.
Dr. Mary Ann Lofrumento with trainee Bernadette
As a pediatrician who works in a hospital with a high level maternity floor and neonatal intensive care unit, I was amazed by their stories and their skill. Although the truth of the matrones’ collective experience will be difficult to determine, the women spoke of only a few disastrous outcomes. They have learned by experience to recognize problems early and get the mothers to a birthing center or hospital. They use a combination of various traditional methods and approach childbirth as a natural occurrence. Sometimes, however, complications arise that can be very dangerous for both mother and baby.
Today the matrones would participate in a workshop called Helping Babies Breathe, a program developed by the American Academy of Pediatrics in collaboration with World Health Organization (WHO), USAID, and other global health organizations. The objective of this program is to train traditional birth attendants in resource poor countries in the skills of newborn resuscitation and in the hopes of decreasing neonatal mortality.
The WHO estimates that worldwide, one million babies die each year from birth asphyxia (e.g. inability to breathe immediately after delivery). In Haiti, the statistics are that 50 babies will die for every 1000 births in the first month of life, 4 will die right after birth. The HBB program addresses this challenge as well as helping to move forward Millennium Development Goal #4 (MDG4) the reduction of child mortality by two thirds from 1990 to 2015.
A key concept of HBB is The Golden MinuteSM: Within one minute of birth, a baby should be breathing well or should be ventilated with a bag and mask. The Golden Minute identifies the steps that a birth attendant must take immediately after birth to evaluate the baby and stimulate breathing. Surprisingly, very few of these babies actually require intensive medical treatment or even oxygen. The Golden Minute is the first minute of life, and many babies need only to be kept warm, cleaned, and be stimulated to breathe.
Our team of doctors, nurses and nursing students was organized by Hands up for Haiti; a U.S. based non-profit organization that facilitates medical missions to Haiti. For the past two years, HUFH has worked with Haiti Village Health, bringing teams of doctors and nurses to work in the HVH clinics and to do educational programs for the local staff and villagers. On this trip, our mission was to hold two Helping Babies Breathe workshops.
Dr. Jill Ratner and myself, both pediatricians, and Judy McAvoy RN have received certification to teach the Helping Babies Breathe course. Our goal was to help train not only the TBAs, but also the Nurses and Agent Sante's of Sante Pou Yo . We believe that no program can survive without working with our Haitian colleagues to provide sustainability. Therefore we also planned to certify Dr. Brinvert as a master trainer so that he could continue the training of the local matrones.
Dr. Brinvert teaches hand washing techniques
The first step was a review of keeping the delivery area clean, proper hand washing, and sterilization of tools such as knives or scissors to cut the baby’s umbilical cord; next we emphasized the need to ensure that the baby was breathing in that most important Golden Minute. Using special baby mannequins, filled with water, the women could practice using an ambu bag and mask to inflate the baby’s lungs. For some, their hands stiff from age, this part was a great challenge. “Respire de, twa; Respire de, twa” Suddenly a smile appears on the matrone’s face as the baby’s lungs inflate with the proper rhythm. Most babies will not require this advanced level of care, but all the babies these women deliver will benefit from today’s classes on proper control of infection, rapid drying and stimulation of the newborn.
At the concluding ceremony, after each workshop, 18 women received their certificates proudly bearing their names. Most of the matrones could not read or write but this piece of paper was precious to them. The posed for pictures, hugged us and then sang and danced, their voices joining together in harmonies, a joyous chorus celebrating life.
Mary Ann LoFrumento MD