In the African nation of Malawi, pregnant women have had to make a difficult choice: have an at-home delivery where cultural traditions can be more easily incorporated, or deliver in the hospital where there is less risk but also less control. For a nation with one of the highest maternal mortality rates in the world, this can be a life-or-death decision.
During at-home births, babies are traditionally received by the child’s grandmothers, who attend the laboring mother along with a traditional birth attendant. But most health care facilities do not allow a companion to accompany a woman through labor and delivery.
Working in a quality improvement collaborative with IHI and three other health organizations comprising The Health Foundation Consortium, Likuni Mission Hospital set a goal of decreasing inpatient maternal and neonatal mortality by at least 50 percent in one year. To reduce the barriers to hospital births and improve safety, the hospital now allows women to have a female companion with them during labor and delivery.
“The team felt this would provide women the comfort of companionship and support, and create an extra layer of safety in an environment with severe human resource constraints,” says Karen Zeribi, MHS, IHI’s Quality Improvement Technical Assistant in Malawi. “They tested companionship first with the patients of one nurse. She reported that 100 percent of her patients took advantage of the opportunity and really appreciated it.” Eventually the change was spread to the entire ward.
What was not expected, says Zeribi, was the degree to which the nurses also valued the companions. “Patient companions alleviated some of the demands on the nurse midwives to provide comfort and support, allowing them to concentrate more on clinical duties.”
Between January 2006 and July 2007, the maternal death rate dropped from 0.31 percent to 0.16 percent.
02/01/2008
