Evidence-Based Practices Save Mothers’ Lives
Maria Kovalenko was very concerned about how she would deliver her second baby, after nearly dying five years ago as a result of postpartum bleeding when her first son was born. Doctors had fought hard to save her and succeeded after an hour of various medical interventions.
This time, however, her worries were unfounded. While delivering her second baby at the Lutsk Maternity Hospital – this time with her husband Vladimir present – Maria couldn’t help smiling: “This time it was completely different. First of all, I delivered on a chair with my husband helping me. I was scared that I would bleed like I did during my previous delivery, but doctors gave me oxytocin, and I delivered smoothly. I can’t stop wondering why they couldn't do the same five years ago.”
Postpartum bleeding remains a central cause of maternal mortality in developing countries, including Ukraine, where maternal deaths are three times higher than in EU countries.
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| Ukrainian Maternity Hospitals Successfully Implement Active Management of Third Stage of Labor |
Thanks to new evidence-based approaches implemented by USAID’s Maternal and Infant Health Project (MIHP), which many Ukrainian maternity hospitals are beginning to use, postpartum bleeding at the Lutsk Maternity Hospital has decreased from 2.2% in 2002 to 0.6% in 2006. The MIHP project, which is implemented by the JSI Research and Training Institute, has been working in Ukraine for over four years to improve perinatal practices, change attitudes and outdated practices of health care providers towards evidence-based medicine, and facilitate the adoption of internationally-recognized obstetric guidelines and protocols.
Among the most important guidelines for controlling postpartum bleeding is the implementation of Active Management of Third Stage of Labor (AMTSL). AMTSL speeds delivery of the placenta by increasing uterine contractions, which helps to prevent postpartum hemorrhaging. AMTSL includes three major steps: administration of oxytocin, a drug to help the uterus to contract, within a minute after birth; delivery of the placenta by a special procedure, which involves gently pulling on the umbilical cord; and, a special massage after delivery of the placenta. It can even be done at home if a trained health care provider linked to essential supplies is present.
Initially, Ukrainian health care providers in the pilot MIHP cites couldn’t understand the importance of AMTSL and didn’t properly manage the third stage of labor, particularly with women who were predisposed to bleeding. Back then, trainings and follow-up visits to MIHP maternities showed that the implementation of AMTSL helped to decrease dramatically the level of postpartum hemorrhaging and saved many lives. In Donetsk Maternity N.3, postpartum bleeding dropped from 3.4% in 2002 to 0.1% in 2006; in Simferopol, it dropped from 1.6% to 0.6%.
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