MCHIP Introduces Cutting Edge Tool in Madagascar to Reduce Postpartum Hemorrhage

31 January 2012

Voahangy had just given birth to her second child, but the bleeding would not stop. Luckily she had chosen to have her baby girl at the busy private health facility run by nuns in Mahajanga, in North Western Madagascar, where an average of 4–5 babies are born per day. Even more fortunate, the nun who assisted her during the birth, Sister Lydie, was a seasoned midwife who had just attended an MCHIP training covering how to help women who experience complications during childbirth.

In this training, MCHIP trainers introduced a cutting edge tool for fighting postpartum hemorrhage (excessive bleeding) known as the condom tamponade. The tamponade is very effective at controlling bleeding and utilizes accessible, inexpensive materials, ideal for resource challenged settings like Madagascar, where state of the art drugs, equipment, and trained medical staff are scarce. MCHIP is introducing this and other innovative techniques to combat the high maternal death rate in Madagascar, now at 498 per 100,000 women.

When Sister Lydie noticed that Voahangy was losing excessive amounts of blood, she did not hesitate to insert the tamponade, which quickly stopped the bleeding. Having stabilized Voahangy, she knew from her MCHIP training to organize an immediate transfer to a hospital where Voahangy could receive care from doctors trained to deal with obstetrical complications.

Not everyone is as lucky as Voahangy. Even when they give birth in a facility, too many women or their newborn babies die when complications arise. Since the two leading causes of maternal death in Madagascar include hemorrhage and eclampsia (high blood pressure and convulsions), MCHIP targets these two areas in their trainings.

Georgette, another experienced midwife, attended a similar MCHIP training, this time in the capital, Antananarivo. There she learned another vital procedure to treat excessive bleeding after childbirth known as aortic compression, in which the provider presses firmly on the woman’s abdomen, over the aorta, to control bleeding. Though a simple technique, many health care providers in Madagascar are not familiar with this life-saving procedure.

Georgette’s training was led by Myrta Rahaga, a retired midwife and one of MCHIP’s pool of 18 trainers who have trained 437 doctors and midwives throughout Madagascar since June on vital maternal and newborn interventions. Myrta had taught Georgette and about 20 other doctors and midwives this technique through supervised practice on mannequins. That same evening, Georgette helped a woman give birth who started to hemorrhage. She applied firm pressure to the woman’s aorta and was able to stop the bleeding. Myrta described how Georgette returned to the training the next day and excitedly related her success, very pleased to have participated in such a practical, hands-on training.

Doctors and midwives expressed similar sentiments at an MCHIP training conducted by Myrta in Fenerive Est, in North-East Madagascar. Dr. Andriantsiory and two other participants -- a doctor and a midwife -- had already attended trainings on how to provide emergency care for women and newborns with complications, which briefly covered the use of magnesium sulfate, the first line drug to treat eclampsia. However, they said that it was not until their training with MCHIP that they felt capable of actually using the drug. All three confirmed that their health facilities had magnesium sulfate, but Dr. Andriantsiory explained “I didn’t use it because I was nervous to get the dosage wrong. I feared I might not be able to revive someone if I gave them too much.”

Not surprisingly, on pre-tests evaluating training participants’ ability to treat eclampsia, they scored poorly, averaging 20%. During the training, Myrta and her co-trainers required each participant to simulate magnesium sulfate injections, in four skills stations where participants practiced their new skill under the supervision of the trainer. Myrta proudly explained that at the end of the session, participants scored on average of 80-90%. And when she asked them “Are you going to use magnesium sulfate now?” they
responded with a resounding “Yes!”