Category: Women's Program Blog Created on Wednesday, 06 June 2012 03:41
The term “traditional birth attendant” was created to distinguish midwives with formal education from those who were trained empirically. In Haiti, the traditional birth attendants are known as matrones and the midwives with formal education are called femme sage or midwives. The matrones can be further broken down into several groups based on age, access to education, training programs, ongoing professional support, proximity to other medical services and additional roles assumed within their respective communities.
The training in Bas Limbe was designed for 15 matrones. 18 matrones enthusiastically registered. The majority had minimal to no formal education, were illiterate in both words and numbers, had minimal access to medicines or diagnostic tools, and had very minimal knowledge of anatomy and physiology. They were responsible for most of the births in their villages and had been serving in this role for many years. They were enthusiastic, arrived early and appeared to be supportive of one another. There were two male matrones. All but three were mostly elderly, and most viewed their matrone work as a religious calling.
In an informal pre-assessment they stated that most maternal deaths were caused by eclampsia. They wanted tools and equipment to prevent and treat problems. Most were well informed about the need for cleanliness, clean razor blades and clean cord string. They were not always aware of the services provided in prenatal care at local clinics but did see them as places to go in an emergency. They had very little to basic knowledge of anatomy or fetal development, and how it related to safe births. They depended on movement, massage and prayer to help a baby to be born. Some assisted at several births a week and others were very rarely called to a birth.
The group met for more than 10 training days - including several sessions that were devoted to “Helping Babies Breathe”, a neonatal resuscitation program. The sessions were 5 hours long with 30 minutes for hand washing and lunch. The following goals of the training were addressed and met throughout:
1. To encourage matrones to actively help all women in their villages to get prenatal care. To understand the services provided in prenatal care and how they impact safe delivery (screenings, HIV and syphilis testing, vitamins and safe delivery kits
2. To know where prenatal care can be found nearest to their village including mobile clinics
3. To gain a basic understanding of reproductive anatomy and fetal development
4. To know when to transport and to develop a transport plan
5. To help matrones to see themselves as leaders for public health and adequate sanitation in their communities
6. To help know how to assess a woman in labor for possible complications including signs of pre-eclampsia, bleeding, infection and a difficult presentation
7. To know how to prevent complications in childbirth (adequate intake and output of fluids, encouragement, monitoring the length of labor, waiting for an urge to push in second stage, careful delivery of the placenta, support with breastfeeding, hygiene)
8. To know how to set up for a clean birth and to be prepared for an emergency
9. To demonstrate clean practices, set up and best practices in a normal birth
10. To demonstrate emergency techniques in childbirth (suction of the baby, resuscitation, external bi-manual compression of the uterus, recognition and approach to shock and seizures)
11. To be able to help women with problems in breastfeeding to keep breastfeeding
12. To refer women for postpartum care and family planning
13. To dispel myths in their villages that may cause harm to mother and baby.
Teaching was hosted at the HVH guesthouse, and conducted primarily by American Midwife Sarah and HVH nurse Youselène. The following teaching techniques were used and proved to be quite fruitful:
- Sitting in a circle
- Starting with a prayer and a song
- Sharing birth stories
- Bringing in medicinal plants and sharing their uses and effects
- Large charts and pictures of anatomy and fetal development
- Role plays and playing back the skills demonstrated in small groups
- Repeating demonstrations and playback demonstrations
- Oral quizzes – each take a card and answer a question
- Singing and dancing breaks
- Storytelling cards
- Limited lectures
- Graphic picture book
- The use of demonstration birth pants, doll with placenta
- A trip to the clinic
- Demonstration on a real-life pregnant model from the village (position of the baby)
- Demonstrations using the safe birth kit given out by Haiti Village Health
Upon completion of the course, the participants and we felt that attending Traditional Birth Attendants were better equipped to meet the aforementioned goals. HVH is currently planning to continue professional development with the matrones with periodic review of the material taught during this curriculum.
We look forward to updating you further on their community involvement and on the community impact of the program.
CPM (Certified Professional Midwife)
MAT in Education
Public Administration License
In collaboration with
Emmanuelle Britton MD CM, CCFP
Women’s Health Director
Haiti Village Health