"Statistics have never been so good!" exclaims Linda Rampersad, who has worked as a midwife in the Maternity Department of the Port of Spain General Hospital (POSGH) over the last 13 years. In fact, during the last six months, no woman has died during pregnancy or while giving birth at this institution, nor at any other institution in Trinidad and Tobago. This news has been celebrated by all the staff at the POSGH, which receives approximately 350 pregnant women per month in antenatal care. (Photo: POSGH Midwife Linda Rampersad).
PAHO support to prevent maternal deaths
Rampersad, a gentle and friendly person with extensive midwifery experience, tells PAHO of some of the measures that were implemented with PAHO support to improve the health of women attending the maternity clinic. "Vaccination against the influenza virus was a major measure implemented to reduce the risks to this population, and staff members are also trained to use the non-pneumatic antishock garments, which prevents mothers from entering shock during postpartum hemorrhage."
This technique was introduced in 2016 by PAHO's Latin American Center for Perinatology and Women's Reproductive Health (PAHO/CLAP). In fact, the POSGH was the first hospital to report implementation of the condom tamponade technique learned during the 2016 PAHO/CLAP training, which resulted in saving a young mother's life shortly after the training was conducted.
Women are also supported with patient-centered care throughout their pregnancy and during and after delivery, with continued education that addresses the cultural nuances affecting antenatal and postpartum care. This is important given that Trinidad and Tobago is a multicultural society.
"We are thrilled with Trinidad and Tobago´s achievements in preventing maternal deaths," says Suzanne Serruya, director of CLAP. "Their continued efforts are an excellent example of how countries can keep their women and children safe and healthy."
An integrated approach using the Perinatal Information System (SIP)
Best practices in maternal health, including generating quality data to take better care of mothers and their babies, continue to be the focus at the POSGH. This institution is one of the five main hospitals in Trinidad and Tobago that is participating in the pilot project collecting both retrospective and prospective data via the Perinatal Information System (SIP), a medical history form created by PAHO/CLAP to guide the clinical care and management of every pregnant woman and her baby. Eight thousand records have been converted to SIP and approximately 30 basic indicators, including for high-risk pregnancies and HIV, have been produced as well as an analysis of Perinatal Mortality of Very Low Birth Weight Infants in Trinidad and Tobago for 2016-2017.
Dr. Sally Ishmael, Head of Department and Medical Chief of Staff, considers that the implementation of SIP "is an opportunity to obtain statistics in an easy way, with just the touch of your finger. It is a useful tool, especially for midwifes, that reemphasizes how important it is to collect accurate information and how this in turn impacts the quality of care of mothers and their babies. Besides, it allows you to validate local protocols without dependence of international protocols."
Rampersad agrees, adding that they are learning while SIP is being implemented. Both health care professionals recognize that the SIP form collects more relevant information about the patients to assist with their care and management. For example, SIP also registers whether a woman has been a victim of domestic violence, an increasing trend in Trinidad and Tobago. With this information, therefore, it is possible to call other professionals for an intervention. (Photo: Ishmael and Rampersad)
Minister of Health expresses support for SIP
Following the announcement by the Honourable Terrence Deyalsingh, Minister of Health of Trinidad and Tobago, that during the first six months of 2018, Trinidad and Tobago has had no direct maternal deaths, he recognized the commitment of the health care providers in the institutions and the important support of PAHO to achieve this goal. In this context, Deyalsingh affirmed that Trinidad and Tobago will fully implement SIP Plus given the successful piloting of the system since January 2017.
"We will mandate the Perinatal Information System to be implemented, not only in the public sector, but also in the private sector. With this evidence-based tool we will have a clear map on the way forward to reach our SDG goals for maternal and child health and maintain it," said Deyalsingh.
Below photos show how medical records were previously done (left) and how they will now look with SIP (right).