Young mothers like this one in southern Ethiopia are involved in role-playing proper responses to birthing emergencies.


Picture Safe Motherhood:
Nurses lend an ancient practice new life

The majority of births in developing countries still take place at home with family members, unskilled attendants, or no one to help the mother.

When a serious problem develops—uncontrolled bleeding, high fever—it often proves fatal. Each year, nearly 600,000 women die from complications related to childbearing, many in the first few days after giving birth.

“The approach of waiting until there’s a problem, then referring a mother or baby to a hospital wasn’t working,” says Associate Professor Lynn Sibley, academic program director of the Lillian Carter Center for International Nursing at Emory’s Nell Hodgson Woodruff School of Nursing. “It can take six days in Ethiopia to walk to a hospital carrying a stretcher, and a woman can bleed out from hemorrhaging in two hours.”

Sibley, with colleagues from the American College of Nurse Midwives, has designed an emergency-care plan for assisting with home births—the Home Based Life-Saving Skills program.

A nurse-midwife and anthropologist by training, Sibley became familiar with traditional birthing methods in Belize. While completing her doctoral research, she lived and worked with a seventy-two-year-old midwife.

Previous approaches to training, Sibley said, have tended to ignore what birth attendants already know and do. “We needed to open a dialogue, to say, ‘Women are dying. What can we do together to stop it?’”

At the core of the new program are pictograms covering topics such as “bleeding too much after baby is born,” “pregnancy swelling and fits,” “birth delay,” and “baby has trouble breathing at birth.” The cards depict a problem on the front and emergency solutions on the back.

As a birth attendant at a recent training session told the instructor, “What we see is better than what we hear. Wherever we teach, when we show these pictures to people they say, ‘Aha! Aha!’ ”

Role-playing demonstrations are sometimes held outside under shade trees, attracting crowds of eager viewers.

This training doesn’t necessarily supplant traditional treatments, says Sibley, such as those encouraging a new mother who is bleeding heavily to drink goat’s blood with other liquids as a fluid replacement, or to press a leaf poultice on her abdomen to slow bleeding.

So far, the Life-Saving Skills program—which has received funding from the Bill and Melinda Gates Foundation and the U.S. Agency for International Development—has been used in villages in Ethiopia, India, Haiti and, most recently, Afghanistan and Liberia. It is also being promoted in a new joint statement by the International Confederation of Midwives and the International Federation of Gynecologists and Obstetricians.

“The people are amazing. They are making do with what they have, such as using plastic bags as gloves. And they have turned the emergency steps to take into songs,” Sibley says. “Beyond the skills they develop is the empowerment they gain.”—M.J.L.

Midwifery and Nursing at Emory — Ranked in the top ten midwifery programs in the nation by U.S. News & World Report, the Nurse-Midwifery and Family Nurse Midwife specialties in the School of Nursing are designed to prepare nurses with skills in pre-natal care, birthing, family planning, and well-women’s care. Emory’s nurse-midwifery program started in 1977, graduating its first class of eight students the following year. “I was in that graduating class—the best decision I ever made,” says Clinical Associate Professor Jane Mashburn 78N, director of the master’s program. “We have since graduated more than 250 students.”



 © 2007 Emory University