MCHTC: Day 3 New Beginnings
New Champions!
The goal of the conference is to provide both mother and baby the best chance of survival during and after labor.
On day 3 of the Conference, we welcomed a brand new class of Champions who rotated from our conference partners’ Essential Newborn Care: Helping Babies Breathe portion into our Helping Mothers Survive module.
What Are They Learning?
Repairing Vaginal Tears
During the course of any delivery, the possibility of vaginal tears remains a difficult reality even with the proper training and equipment. Here the Tenki team is teaching the Champions and Rising Trainers how to repair 1st and 2nd degree vaginal tears that can lead to excessive bleeding.
Manual Delivery of Retained Placenta
After the baby is born, sometimes the placenta is not delivered in one piece or at all. To remove any remaining products, the students learn to don elbow length sterile gloves and manually remove any retained placenta pieces from the uterus.
Non-Pneumatic Anti-Shock Garment (NASG)
This compression garment allows for increased venous blood return to vital organs. This helps buy time to stop or decrease uterine bleeding and transport the mother to a higher level of care.
Bi-Manual Uterine Compression
Bi-manual uterine compression is a procedure that can be used to stop post-partum hemorrhage. Manual compression of the uterus is applied from within the mother and from the abdomen to help stop the bleed.
Aortic Compression
If the bi-manual uterine compression fails to stop the hemorrhage, then they will compress the abdominal aorta to try and stop the bleed. They do this by applying pressure to the aorta with a fist until blood flow is cut off to the uterus. When they can no longer feel a femoral pulse the students know they have performed it correctly. This a procedure of last resort and can help buy time to insert a uterine balloon tamponade (UBT) if hemorrhage persists.
Uterine Balloon Tamponade (UBT)
In the case that there is continued post-partum hemorrhage (PPH) that is unresponsive to uterine massage or medications like Oxytocin and TXA, the students learn to insert a condom that acts like a balloon and inflate it with clean water to apply pressure uniformly within the uterus to stop the bleed. This can also help buy time for transfer to higher level of care if the hemorrhage continues.
In low-resource environments, improvisation is often needed. Above you can see the students are using a condom as the balloon with a water bottle standing in as the uterus. The condom is folded around the mouth of the bottle as though it were the cervix and the catheter is inserted before filling the condom with fluid through the catheter.
What Are They Teaching?
See One, Do One, Teach One.
The new round Champions gave the Tenki team an opportunity to once again provide realistic and sometimes stressful scenarios to test the students on what they’ve learned in lectures and demonstrations.
Mariama is seen here using the Birthing Simulator while the new Champions practice some of the skills we describe above with their peers.
Realism Matters
This second class of Champions was larger than the first, so Amanda stepped up to help Mariama and provide initial instruction of Bleeding After Birth.
Amanda is seen here with one of the NMTs providing a realistic demonstration. These give the Champions their first look at how to apply some of the interventions they learned in lecture and why they help to manage life threatening complications.
Practice Makes Perfect
Maria remained with the Rising Trainers on Day 3 to take on the challenge of “Teaching How To Teach”. Now that they have a firm grasp of the skills and equipment, the Rising Trainers spent Day 3 giving lectures to each other within the supportive environment of their peers to become masters of the material.
Becoming better communicators, facilitators, and self-sufficient educators is a tall task, but Maria and the Rising Trainers are doing their best to spread this high quality care across Sierra Leone. We look forward to seeing how they perform on Day 4 when they will be lecturing, demonstrating, and taking full ownership over their future role as Trainers.