Maternal and Child Health

Birth Attendants in Haiti Provide Life-Saving Services to Young Mothers

Birth Attendants in Haiti Provide Life-Saving Services to Young Mothers
Matrone Celanie Bontemps (center) with women from her community whose babies she helped deliver.

The young woman is 21 years old and pregnant. She lives in Dupuy, a mountainous community several hours by foot from the nearest clinic and five hours from the closest hospital in the district of Petit-Goave, Haiti. This is her first pregnancy, and while the head nurse at the clinic has been kind, patient and instructive at each antenatal visit, at this hour the young expectant mother is at home, lying on the floor, in pain. Her home is a one-room hut with mud walls, a dirt floor and a metal roof. It is shared with a partner, his mother, two teenage sisters and an elderly aunt who moved in after the earthquake.
Today, the aunt holds the young woman’s hands, mops her forehead and whispers inanities in an attempt to calm her. This is a home, not a hospital; the metal roof does little to keep the midday heat at bay. There is no doctor, no nurse, no fancy hospital gown or bed. Just the young woman and her family. And Madame Bontemps.
Madame Celanie Bontemps is a little over five feet tall. Today, she has on a pearly white T-shirt over a knee-length green skirt; a white bandanna covers her head. She wears prescriptions glasses too, a new addition to her otherwise spartan getup. Celanie is ready for the baby and so is the woman. Celanie pulls her green and white plastic toolbox closer; her hands have been washed and are now sporting yellow plastic gloves. She carefully extracts plastic sheets from the box and places them beneath the woman, so that the baby is protected from the dirt floor. Celanie is a matrone, or a matron. She is a birth attendant and has delivered many babies in the village.
The baby arrives. It’s a girl. Celanie quickly wipes the baby down with a clean cloth and ties up the umbilical cord with two clean strings a few inches apart. She washes her hands again with soap and water and then proceeds to carefully cut the umbilical cord between the two knots with a new razor blade. She swaddles the baby girl with a sky blue blanket and lets the new mother hold her baby so she can feed her. The aunt steps out to gather up some dirt from outside. She goads Celanie to sprinkle some of it on the baby’s umbilical stump. The dirt will keep the cord clean, the aunt says. Celanie gently but firmly refuses. She says that the best thing to do, for now, is to let the cord dry. Soon, Madame Celanie says, the head nurse at the clinic in Olivier will be training her and other matrones on using a “medicament” that can be safely applied to the stump. But for now, Celanie says, just let it be. She gathers up the sheets and used razor blade and cleans up. “I will come back tomorrow” she tells the new mother, “and then again the day after. Everything will be all right now,” she whispers, and leaves.
This 21-year-old new mother will not be one of the 800 women around the world who die every day from childbirth or pregnancy related issues. Her pregnancy was uncomplicated, and the delivery of her baby girl, though not at a hospital or clinic, was conducted by a community health worker who is trained in safe birthing practices and uses a clean delivery kit for every delivery.
Global Health Action (GHA) works with over 60 matrones or Traditional Birth Attendants (TBA) like Madame Celanie Bontemps in over 30 communities in eight communal sections of the district of Petit-Goave in Haiti. Through Global Health Action’s support, Bontemps participates in monthly refresher education sessions where a clinic nurse and a community health nurse provide feedback, technical support, guidance and instructions on safe delivery. While at the meeting, Bontemps and her fellow TBAs pick up their regular supply of clean delivery kits and report back on the number of deliveries they have assisted. And every year she participates in a week-long training course to update her skills in safe birthing. Community health providers like Bontemps provide the only support for thousands of women and infants in rural settings where poor families are unable to access health facilities or where such facilities simply do not exist.

GHA is able to offer these services to the women and children of Haiti through support from funders like United Methodist Women and the United Methodist Committee on Relief. With this support, in 2013 GHA’s Traditional Birth Attendants helped deliver 848 babies, referred mothers to the hospital 212 times and conducted 2,251 post-natal visits after home delivery.
In 2014, GHA is pilot-testing a World Health Organization-approved protocol of chlorhexidine application to the umbilical cord stump of a newborn baby during the first week of life. This antiseptic application has been proven to prevent infection and contribute to reduced neonatal mortality rates in South Asia. Soon Bontemps will be able to add chlorhexidine application to her routine. And soon, another new or expectant mother will benefit from the Bontemps’ safe birthing practices, clean hands and razors, calming touch, and gentle words and wisdom.

Girija Sankar is the director of Haiti Programs, Global Health Action.

Posted or updated: 9/11/2014 11:00:00 PM
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