Tuesday, February 20, 2018

Midwife training gives mothers and babies in remote villages a better chance of life

By Ponlok Leng

© UNICEF Cambodia/2018/Ponlok Leng
Savadi, a midwife in Ratanakiri province 
who has recently undergone a practical hands-on training programme, 
is busy at work at the Samaki Health Centre in O Chum district.

Ratanakiri Province, Cambodia, 20 February 2018 –  Savadi Yon, 26 years old, is employed as a secondary midwife at the Samaki Health Centre in O Chum district, in Cambodia’s remote north-eastern province of Ratanakiri.

Savadi belongs to the Kreung indigenous group and works to help children and mothers in rural communities that are primarily home to ethnic groups.

Her career path is representative of how one can make a difference to the lives of others in remote, rural locations, despite her initial reservations about her ability to perform such a demanding role.

Savadi studied at the Stung Treng Regional Training Centre for Nursing and Midwifery located in Stung Treng Province between 2013-2015 and completed her training as a secondary midwife in 2015.

Immediately after her graduation she was deployed as a secondary midwife at the Samaki Health Centre. Her main responsibilities include antenatal care, delivery, post-natal care, birth spacing and immunization.

Between 2000 and 2014, Cambodia achieved a 46 per cent reduction in neonatal mortality (Cambodia Demographic and Health Survey- CDHS). The rate of women going for four or more antenatal care visits increased from 60 per cent in 2010 to 76 per cent in 2014 (CDHS).

The increase in the number of midwives providing antenatal care and deliveries within an expanding primary health care network in Cambodia is one factor that has contributed to improving newborn and maternal health by helping more women to give birth in health facilities or with the presence of skilled personnel during delivery.

However, out of every 1,000 babies born alive, about 18 babies still die before their first month of life (CDHS2014), accounting for 50 per cent of all under-five mortality. Children born to poor families, and in rural areas, are more at risk. 

More efforts are underway in the country to improve maternal and newborn care in remote under-served areas through a number of health interventions, including the provision of more skilled medical personnel and progress in emergency obstetric care. One such intervention is the training for midwives to help more women have a skilled attendant at their delivery, with the birth conducted in a hygienic, appropriately equipped clinic.

In her first years of practice, Savadi encountered tough challenges in her work due to a lack of both experience and confidence.

“I was afraid when I assisted another midwife to deliver a baby for the first time and I understood that I was not confident at all to assist the delivery alone due to my limited practical experience.’ says Savadi. 

To upgrade the skills and boost the confidence of newly recruited midwives such as Savadi, UNICEF is supporting the ‘Delivery Practical Training’ at provincial referral hospitals and encouraging experienced midwives to serve as ‘preceptors’ to provide intensive coaching and on-hands practice to the trainees. The training aims to provide trainees with the skills necessary to assist mothers giving births at health centres and is being supported and coordinated by the Provincial Maternal and Child Health Programme.

The initiative incorporates additional technical support and on-site coaching from the Maternal and Child Health (MCH) team of the provincial health department.

Mrs. Keo Sunty, who works with Ratanakiri Provincial Health Department’s Maternal and Child Health Programme, said: “From my observation, Savadi demonstrated good progress in learning and working. She is very committed, not only during her practical training in hospital but also when returning to her daily duty.”

Savadi received supervision from skilled and experienced mentors and was coached by ‘preceptors’ for a period of 10 days.

“After participating in the 10-day delivery practical training and coaching at the provincial hospital, I am now confident to deliver a baby on my own”, said Savadi.

Because of the very demanding nature of community midwifery, this is a highly intensive training programme that involves regular quarterly supervision and coaching sessions, quarterly Midwife Coordination Alliance Team (MCAT) meetings and other training activities related to maternal new-born and child health, when necessary.

After her coaching period ended at the hospital, Savadi returned to the Samaki Health Centre and over a 12-month period she performed 32 more successful deliveries without supervision.

She is now a fully competent midwife and this can be seen from the confidence in her approach to her work and her smiling expression of satisfaction. This ability was evident when Savadi recently took care of a delivery out in the forest when a pregnant woman went into labour before she could reach the health centre.

With this increased knowledge, greater confidence and ever an expanding experience base, Savadi and other newly trained midwives are helping to realize safer birth deliveries for mothers and their babies in remote, marginalized areas across Cambodia.

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