Training birth attendants in developing countries increases babies' survival

In developing countries, where millions of babies die in the womb or soon after birth, research has shown that providing training in newborn care and resuscitation to birth attendants significantly increases the likelihood of a baby's survival.

The study was conducted in six countries. Researchers from the University of North Carolina at Chapel Hill School of Medicine took part in the study in the Democratic Republic of Congo, in partnership with the Kinshasa School of Public Health.

"The successful application of this intervention has the potential to prevent the deaths of hundreds of thousands of babies worldwide each year," said Carl Bose, M.D., a professor in UNC's Department of Pediatrics and a co-author of the study, which is published in the Feb. 18, 2010 issue of the New England Journal of Medicine. Waldemar A. Carlo, M.D., of the University of Alabama at Birmingham, is lead author.

"This is a simple intervention and this study demonstrates that it can be effectively taught to traditional birth attendants, who deliver most of the babies born in developing countries such as the DRC," Bose said. "Worldwide each year, approximately seven million babies die in the womb or soon after birth, and 98 percent of these perinatal deaths occur in developing countries."

Four categories of birth attendant were included in the study: physician, nurse/midwife, traditional birth attendant and a category that included family members and unattended deliveries. Traditional birth attendants, typically non-professional, lay midwives, were by far the most common, attending 40 percent of deliveries in the entire study and nearly 75 percent of deliveries in the DRC. Nurse/midwife was the next largest group at 30 percent, followed by family/unattended/other (17 percent) and physician (13 percent).

In the study, birth attendants from rural communities in Argentina, the DRC, Guatemala, India, Pakistan and Zambia were trained using the Essential Newborn Care program of the World Health Organization (WHO) and the Neonatal Resuscitation Program of the American Academy of Pediatrics.

The Essential Newborn Care course includes training in routine newborn care, resuscitation of babies who have stopped breathing, breastfeeding, keeping the baby warm, "kangaroo care" (skin-to-skin contact between mother and baby), care of the small baby, and common illnesses. The Neonatal Resuscitation Program provides more advanced resuscitation training than the basic training that is part of the Essential Newborn Care course.

UNC's Cyril Engmann, M.D., assistant professor of pediatrics and adjunct professor of maternal and child health in the UNC Gillings School of Global Public Health, led training sessions for the study in the Democratic Republic of Congo.

The results of the study show a statistically significant reduction in stillbirths of about 30 percent, from 23 stillbirths per 1,000 births before the intervention to 16 after the intervention.

Although there was not a reduction in deaths among newborns during the first seven days of life, Bose said, there was a reduction in the total number of stillbirths and newborn deaths, often referred to as perinatal mortality. The reduction in perinatal mortality was about 15 percent, Bose said.

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