MCHIP Paraguay Team Tailors Health Provider Training to Women’s Needs

Asunción, Paraguay—As often happens when public health specialist Maria Peña visits a local hospital, she comes upon a woman who is struggling to adjust to her new role as mother of the tiny baby now in her care. On this day at Hospital Regional de Ciudad del Este, a young mother is shifting from side to side in her narrow bed, trying to find the right position so that her newborn will breastfeed.

Peña is the Community Interventions Advisor in the Paraguay office of the U.S. Agency for International Development’s global flagship Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego.

“Two caring women were standing by her, giving her advice, but nothing seemed to help and the baby was getting fussy,” recalls Peña. “I couldn’t help my impulse and I reached out to her, talked to her for a while, asked her name and baby’s, and finally asked her if it was okay to touch her and help her with her baby.”

It takes just a few moves—Peña turns the mother and baby a few degrees to one side or another, wraps a blanket or two to use as pillows and positions them under the mother’s head and beside the infant—and a few encouraging words. Within minutes, both the mother and baby are nursing beautifully. “Baby latched to the breast, sucking vigorously, and mom resting in a comfortable position—a happy, loving couple,” says Peña, 46, the mother of five children. “One of the relatives who was trying so hard to help the mom said in her native language, ‘Heise ko la professional!’—Professional help does make the difference!”

Incidents like this provide Peña and her colleagues at MCHIP with valuable information as they assess maternal and child health services in facilities in two districts of Paraguay and work in partnership with the Ministry of Health to update the skills of health providers. MCHIP has been operating in Paraguay since September 2009, and is providing training courses and clinical skills updates for health providers from eight health centers and hospitals. Over time, these skills-building sessions will be rolled out to reach still more providers.

The goal is to reduce maternal and newborn deaths; MCHIP’s work focuses on ensuring a level of competency and evidence-based skills to build capacity among health providers, strengthen health systems, and improve the quality of care for women and newborns.

When Peña and her colleagues prepare health worker training courses, they take into consideration the discussions and interviews they have had with pregnant women and new mothers during facility assessments. The reason is: “Most women from these hospitals, in spite of their frequent hospital visits, had little knowledge of essential maternal and neonatal health, and although breastfeeding was the norm, newborn care and feeding practices required improvement,” says Peña. “Most pregnant women and new mothers could not identify danger signs related to pregnancy and the postpartum and newborn periods.”

In addition, she says community assessments showed that:

  • Although most women diligently attended prenatal visits, they ignored the importance of maintaining a healthy, nutritious diet during pregnancy and avoiding hazardous situations or habits;
  • Most didn’t recall having had a breast exam or receiving any breastfeeding information during their visits to the health facility;
  • Most women were unhappy about their birth outcomes and could not recall the labor process being mentioned during prenatal visits;
  • Most women did not have birth-preparedness plans or companions for any of their births;
  • Most pregnant women who were interviewed said they really wanted to nurse their babies, but were only able to nurse after the first hour postpartum; and
  • During the interviews—which, in most cases, took place immediately after birth—only about half of the babies were exclusively breastfeeding.

The conclusion drawn by Peña and the MCHIP team was: The knowledge gap identified through the assessments must be filled, and nurses and clinicians providing prenatal, delivery and postnatal care are in key positions to fill that gap and help ensure a safe and healthy pregnancy and birth experience for women.

“New moms and babies are essentially in a vulnerable situation during the maternal year,” says Peña. “Mother, family and community education is essential because more than 70% of all maternal and neonatal deaths occur during the week following birth.”

Based on these assessments, MCHIP’s Paraguay experts identified additional training information that should be included, while building the capacity of service providers, to meet the needs of women and families more effectively, enhance satisfaction, strengthen health systems, and contribute to the prevention of maternal and newborn deaths.

Results were also shared with the Paraguayan Ministry of Health and hospital quality assurance teams participating in a Jhpiego-supported quality assurance method, known as Standards-Based Management and Recognition, to help draft future educational publications. For example, the Libreta de la Embarazada (Pregnancy Notebook) will be revised this month, and leaflets that describe the importance of a labor plan and outline key messages for pregnancy and birth will soon be distributed at hospitals. In addition, the results will be used to provide guidance for updates to national norms and protocols. The revised norms and protocols are being incorporated into MCHIP training that is currently under way.

Community work is a valued and vital part of the MCHIP Program implementation, says Peña. “We are looking forward to building strategies to improve maternal and neonatal knowledge among mothers and families in hospitals where we will be working,” she says. “It is essential to empower women so that they feel confident with motherhood and communities can support the well-being of moms and babies.”

As one birth companion came to understand: “Professional help does make the difference.”