In Colombia, Training Program Saves Mothers' Lives

An obstetric training program supported by the Pan American Health Organization (PAHO) and the U.S.Agency for International Development (USAID) helped cut in half the number of maternal deaths due to hemorrhage in Antioquia, Colombia, according to data from Antioquia's health department.

Obstetric hemorrhage, or severe bleeding, is the most common cause of maternal death, claiming millions of lives each year in both developing and developed countries. Urban centers usually see fewer such deaths because most births take place in hospitals. However, in Medellín (capital city of Antioquia), obstetric hemorrhage was the leading cause of maternal deaths from 2003 to 2006 (16 of 49 deaths). It was also the leading cause of maternal death in the department of Antioquia as a whole, causing 62 of 181 maternal deaths in 2004–2006.

In a baseline study, the NACER Center (associated with PAHO's Latin American Center for Perinatology, CLAP) at the University of Antioquia determined that quality of care during childbirth was the major culprit. It identified the key problemareas as underestimating mothers' blood loss and insufficient or delayed transfusions of blood and intravenous fluids to women with hemorrhaging.

To address these issues, NACER, with help from PAHO, USAID, and the health departments ofAntioquia and Medellín, developed a training program in managed childbirth for health workers in public and private hospitals. In a series of "Code Red" workshops, trainers used childbirth simulations to teach health workers how to prevent and respond to hemorrhage in birthing mothers.

The program appeared to be highly effective. In contrast to an average of four deaths annually in Medellín due to obstetric hemorrhage in 2003–2006, there was only one such death in 2007, and the key factor appeared to be a delay in transporting the patient to the hospital. In Antioquia as a whole, there were 10 maternal deaths in 2007 due to obstetric hemorrhage, down from 23 in 2004, 18 in 2005, and 21 in 2006. Seven of the 10 deaths in 2007 occurred before the training workshops, while three occurred afterward.

"This methodology is very practical," one participant said in a workshop evaluation. "It makes it easy to grasp what are good and bad behaviors and to learn from them in a positive way."

"The central elements behind this project's success were the educational approach to updating clinical knowledge and competencies, and a vision of teamwork in which each member of the team has an in-depth understanding of his or her specific role in managing emergencies such as hemorrhagic shock," said Joaquín Gómez, director of NACER.

"Carrying out surveillance was also important, because the statistics showed where and how serious the problem of obstetric hemorrhage was," says Vicky Camacho, former manager of the PAHO-USAID maternal mortality initiative and now medical officer at theWorld Health Organization in Geneva. Colombia's Ministry of Health plans to provide similar training workshops in rural areas throughout the country.