For many years, HAS has provided continuing education for the traditional birth attendants in the HAS primary service area. Most births occur at home, with the support of these matrones, using materials which are provided by the hospital.
The matrone training program was started in the early 1960’s as part of the HAS strategy to reduce the incidence of neonatal tetanus, which was usually associated with unsanitary birth practices. That training, along with immunizations of women of childbearing age, resulted in the eradication of neonatal tetanus, which was one of HAS’ first public health successes.
The general strategy for supporting childbirth in the HAS service area has been under review during the past year, and is shaped by several recent trends. Many of the matrones are elderly, and are not able to continue to provide the same level of service. Their daughters and nieces are not as interested in this career, so as the older ones age out, most will not be replaced. At the same time the formal Ministry of Health policy is to encourage births in institutional settings, such as hospitals or health centers.
HAS’ birthing center has been reserved for high-risk pregnancies only; it is an active service, and could not be expanded to meet the demand for uncomplicated deliveries. Throughout the rest of Haiti, many organizations are preparing to provide normal deliveries in health centers and dispensaries. When HAS expanded the four health centers several years ago, they were designed to include rooms for lying-in and deliveries. For a short time, HAS provided normal deliveries at its dispensary in Deslandes, but at that time were not able to support it with 24-hour staff coverage. However, that provided adequate experience to be able to plan for such a service.
As HAS continued to plan for a new approach to labor and delivery services, it began a search for a nurse-midwife to assist in the high-risk obstetrics unit, and to help to evaluate options for a future service model. Regrettably, the destruction of the government school for nurse-midwives, and many students, were lost in the January earthquake, so recruitment of a trained midwife has been delayed. Recently, HAS made contact with Midwives for Haiti, and organization which trains nurses to be midwives in a one-year course in Cap Haitien.
HAS submitted the name of a candidate, Guerline Romelus, for the 2011 course; she was accepted , and will start the program in January. She graduated from the national school for nursing, and is from Petite Riviere. After completing the course, Guerline will return late in 2011 to work in the HAS L&D suite and also to provide continuing education to the community matrones.
At the same time, Mme Jeanne Bright, a labor and delivery nurse, has been recruited to conduct a one-year training and assessment program for the current matrones, to enhance their skills, and to determine their current clinical capabilities. During 2011, HAS will assess a number of options for further development of community-based surgeries, and we hope to be able to establish as labor and delivery suite in one of the four health centers.