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When a stillborn is not

Special Care Nursery - Sister Theresa Meae attending to a baby at the Port Moresby General Hospital Special Care Nursery
(Christine Pakakota/IRIN)

Saving a newborn’s life could be as simple as tapping the bottom of its foot, rubbing its back or helping pregnant women in rural communities get to a clinic. In this first part of a three-part series on initiatives to reduce maternal and newborn deaths, IRIN reports on a US-funded study that tracked 120,000 births in rural communities over two years to learn the impact of birth-attendant training on newborn survival.

An estimated 3.2 million foetuses die annually, according to World Health Organization (WHO); an additional 3.7 million babies die in their first month, mostly in rural communities with little or no health services.

But what is classified as a stillborn may actually not be, US-based University of North Carolina neonatologist Cyril Engmann, one of the researchers in the Democratic Republic of Congo (DRC), told IRIN.

“When some birth attendants see a newborn who is not breathing, they think the baby is dead. But that baby may be alive but did not take a breath yet,” Engmann said.

Traditional birth attendants with no formal training, nurses, midwives and doctors learned how to jumpstart breathing through hand-pumped ventilation, touching the child’s skin or tapping its foot. The training taught rural health workers in Argentina, DRC, Guatemala, India, Pakistan and Zambia WHO’s Essential Newborn Care course and for a smaller group, an American neonatal resuscitation programme.

Stillborns declined by 30 percent among babies delivered by birth attendants who participated in the three-day training, which took place between 2005 and 2007. 

Trainer Engmann estimated that up to one million babies’ lives could be saved annually with proper newborn care training, which includes regularizing the baby’s body temperature at birth and exclusive breastfeeding for the baby’s first months.

''Are we to stand by the sidelines, wring our hands and do nothing?''

Following the training more women in the six countries apparently turned to traditional birth attendants and relatives for giving birth; unskilled birth attendants and family members delivered almost 10,000 more babies in the year following the training than they had before, while doctors, midwives and nurses delivered 2,500 fewer, according to the study.

The percentage of babies born in birth attendants’ homes doubled, while those born in hospital decreased by 2.5 percent. Births in clinics increased by 3 percent.


The head of WHO’s Making Pregnancy Safer programme, Monir Islam, said investments in untrained birth attendants delay long-term improvements to maternal and infant care by drawing patients away from the services that sorely need improvement, reducing pressure on governments to fix them.

“People who do these training programmes have good hearts, but we push developing countries to remain in development by accepting a lower standard of care,” he told IRIN. “There is no incentive to move forward and improve health care services.”

Neonatologist Engmann told IRIN it is possible to push for skilled health workers and better facilities as well as better-trained traditional birthing attendants. “It is not an ideal situation, but are we to stand by the sidelines, wring our hands and do nothing? It would be unethical to not do something.”

Fifty-seven countries, most of them in Africa and Asia, face severe health worker shortages. It would take more than four million people to fill the gaps, according to WHO.

WHO’s Islam said temporary measures can weaken chances for long-term change. “We have been using stop-gap measures for the last 20 years and have fallen into the trap of transition. You and I will be having this conversation for the next 20 years.”


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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