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The Colorado School of Public Health’s Center for Global Health announced the opening of its birth center at the Trifinio Center for Human Development in Guatemala. The new center pairs traditional birth attendants with nurses trained as skilled birth attendants so deliveries can be shifted from the home to the birth center, and if needed the local hospital. Further, the center provides a strong setting for multidisciplinary teams to evaluate maternal and child health interventions.
Midwives, OB/GYNs and pediatricians from Children’s Colorado and the University of Colorado School of Medicine have been training traditional birth attendants and community nurses in midwifery both in person and via tele-health using the World Health Organization’s safe delivery checklist, as well as the American Academy of Pediatrics’ Helping Babies Breathe® program and Laerdal’s MamaNatalie® birthing simulator to simulate both normal births and births with complications.
“Prior to opening the center, in 2012, more than 50% of women reported giving birth at home with the help of a traditional birth attendant. As a result, these communities had extremely high rates of maternal morbidity and neonatal mortality,” said Gretchen Heinrichs, MD, DTMH, director of Maternal Health Programs at the Center for Global Health. “With the opening of the birth center in Trifinio, we hope to quickly improve the training of traditional birth attendants who were mostly self-taught and had little outside evaluation of their skills.” An additional innovation of the center pairs nurses, who this year have received additional training in birth from a nurse midwives, with the traditional birth attendants, allowing for a safer family-centered experience.
In consultation with both local community leaders and traditional birth attendants, the birth center was designed as a safe space for deliveries where family members and traditional birth attendants are welcome. Contrary to deliveries in the local hospital where women often stay alone and remain in bed, women at the new birth center are encouraged to have family members present to support them and are free to walk and deliver in the position that is most comfortable to them. In addition, the center uses evidence-based practice to avoid potentially harmful and unnecessary interventions such as routine episiotomy.
The birth center has two delivery rooms with private baths where the baby stays in the room with the mother throughout her stay. The model of nurses partnered with the traditional birth attendants, all supervised by a back-up physician is already working. Thus far, they have successfully delivered five babies. Offering birth services is a cornerstone of the “Creciendo Sanos: Madres y Ninos” program (Growing up Healthy for Mothers and Children), which enrolls mothers early in pregnancy, provides group prenatal care visits, newborn home visits, and monthly group sessions that integrate health, development, nutrition and hygiene education, as well as track child height and weight through 3 years of age.
“By offering women in this region of Guatemala a basic level of care that we have come to take for granted in the United States, we are able to make immediate impacts on the lives of women and children in this community,” said Dr. Heinrichs. “And our long-term commitment to both the people and health professionals in these communities will allow us to make significant and enduring improvements to the health of the population.”
Leading up to the birth center opening, Dr. Heinrichs also established a pregnancy registry. “We felt like we couldn’t make progress without measuring the outcomes, and we had no idea what percentage of women were delivering at home versus in the hospital. We needed this information to understand the motivations for birthing at home, and whether a birth center would be accepted by the women in the community,” she said.
Registering pregnant women in a database and collecting information about their pregnancies through prenatal visits allowed a dialogue to unfold between Dr. Heinrichs, her midwifery colleagues and women from communities across the Trifinio region. Information captured in the registry included things like whether the pregnant woman had previous children, and what her birth plan was for the present pregnancy, as well as clinical data such as fetal growth, weight gain, and blood pressure.
The Trifinio Center for Human Development is the result of a public-private partnership between the Jose Fernando Bolaños Foundation, the family that owns the banana and palm oil plantations in Trifinio, the University of Colorado and Children’s Colorado. The clinic and birth center are the first permanent medical facilities in a developing country for both Children’s Colorado and the University of Colorado. The goal of this partnership is to improve the lives of the children and families of the plantation employees and people living in the surrounding communities, which suffer from high rates of maternal illiteracy, food insecurity, maternal pregnancy complications and depression, child malnutrition and child developmental delay.