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Competency Based Trainings For Community Midwives
On Prevention of Postpartum Complications
(Genital Tract Fistula)
Report Prepared by;
Dr. Sarwan Kumar
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
Background:
Skilled attendance at the time of birth is considered to be the single most critical component for ensuring safe motherhood. The role of skilled birth attendants, in particular midwives and others with midwifery competencies, is widely acknowledged as being crucial to addressing maternal and newborn mortality and morbidity, and to promoting women’s and children’s health. More than 65 percent of women in Pakistan deliver their babies at home, mostly assisted by an untrained traditional birth attendant or Dais with increased risk of birth complications, especially in rural areas of Pakistan. Such poor care seeking behavior around childbirth can result life threatening complications arising from hemorrhage, unsafe abortion, eclampsia, sepsis and obstructed labour. Due to unavailability of Basic EmOC services and mishandling of obstructed labour by TBAs, about 5000 – 6000 new cases of Genital Tract Fistula occur each year in Pakistan. Majority of these cases can be prevented by training of step down service providers and development of linkage between community and health service providers. Through these intervention women will have access to quality Basic EmONC services through skilled health care providers during pregnancy and childbirth and develop a referral system for comprehensive EmONC to secondary and tertiary care. Community Midwives already working in the communities are not well sensitized regarding the management of obstructed labour and preventive measures of its consequences before referring to the comprehensive care services. Considering an important role of Community midwives in prevention and management of obstructed labour, PNFWH with
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
support of UNFPA and in collaboration with MNCH Sindh planned to organize five days competency based trainings on prevention of postpartum complications including genital tract fistula for MNCH deputed community midwives (CMWs) in Sindh. CBT Course Design: This refresher training course is designed to train CMWs on the provision of basic EmOC services at community level to avert maternal death and disability. The course builds on each participant’s past knowledge and takes advantage of her high motivation to accomplish the learning tasks in the minimum time. Training emphasizes doing, not just knowing, and uses competency-based evaluation of performance.
Training Objectives: Broad Objective: By the end of the 5 days training CMWs will be able to:
Describe basic EmOC and the team approach to the provision of care in relation to reducing maternal mortality and morbidity.
Describe the ethical issues related to EmOC, including feeling a sense of urgency, accountability for one’s actions, respect for human life, and recognition and respect for the right of women to life, health, privacy and dignity.
Use interpersonal communication techniques that facilitate the development of a caring and trusting relationship with the woman when providing EmOC.
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
Use recommended infection prevention practices for all aspects of EmOC.
Describe the process of rapid initial assessment and management of a woman who presents with a problem.
Identify the presenting symptoms and signs of shock and describe immediate and specific management.
Perform ABC approach of adult resuscitation before referral
Identify the presenting symptoms and signs; determine the probable diagnosis and use simplified management protocols for vaginal bleeding in early and later pregnancy.
Identify MVA Kit its specification and have detail knowledge of its processing.(But cannot provide service provision through MVA Kit).
Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for pregnancy-induced hypertension.
Identify and manage cord prolapsed.
Provide care during labor, childbirth and the postpartum period.
Get knowledge about breech delivery
Perform a vacuum extraction
Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for vaginal bleeding after childbirth.
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
Specific Objectives:
Demonstrate use of the partograph to monitor progress in labor, recognize unsatisfactory progress in a timely manner and respond appropriately.
Demonstrate clean and safe childbirth, including active management of the third stage of labor and examination of the placenta and birth canal after the birth.
Perform and repair an episiotomy
Identify and repair cervical tears
Can early recognize and management (competently catheterize) of obstructed labour before referral.
Training Methodology:
Presentations, illustrated lectures and group discussions
Case studies
Simulated practice with anatomic models (Demonstration & Hands on Practice)
Simulations for clinical decision-making Training materials: A number of training materials were used in five-days training, as follows:
Reference manuals
Audiovisuals on managing complications in pregnancy and childbirth
Presentation Graphics
Instruments and equipment
Anatomic models (Simulation Models) Participant Selection Criteria: Referred by MNCH Sindh
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
1st
Competency Based Training
2nd
Competency Based Training
3rd
Competency Based Training
4th
Competency Based Training
Date: 25th - 29th July 2011 Date: 12th – 16th Sept 2011 Date: 12th – 16th Sept 2011 Date: 15th – 19th Nov 2011
Venue: Red carpet Hotel, Sukkur Venue:Hotel Inter Park Inn, Sukkur
Venue: Sapna Inn , Larkana Venue: Al-Harmain Hotel, Karachi
Master Trainers:
Dr. Shamim Akhter
Dr. Shazia Khokhar
Dr. Hasan Ala
Master Trainers:
Dr. Shazia Khokhar
Dr. Reshma Kumari
Dr. Anjum
Dr. Sara Memon
Master Trainers:
Dr. Shahida Shaikh
Dr. Heeranoad
Dr. Bisma Zia
Dr. Yasmeen
Master Trainers:
Dr. Shabana Kanwal
Dr. Alia Tabassum
Dr. Kaneez Fatima
Dr. Ayesha Haq
Participants: 44 community midwives from district Khairpur & Sukkur
S.no Full name Place
1 Samina Rind Gari Khairo
2 Nazia Lashari Jacobabad
3 Noureen Naz Jacobabad
4 Saqiba Domki Kandh Kot
5 Khalida Brohi Kandh Kot
6 Jamila Soomro Jacobabad 7 Soomri Soomro Kandh Kot
8 Sabira Soomro Jacobabad
9 Zubeeda Wadh
Participants: 17 community midwives from district Khairpur & Sukkur S. no
Full name Place
1 Samreen Bashir Kashmore 2 Naseem Mirjat KotDiji 3 Farzana Shikarpur
4 Sanam Naz Thari Mirwah
5 Azra Thari Mirwah
6 Kalsoom Kumb 7 Benazir Kumb 8 Sobia Javed Rohri 9 Amina Sukkur 10 Shaheena Sukkur 11 Naseem Akhter Sukkur
Participants: 17 community midwives from district Larkana
S. no
Full name Place
1 Shabana Abro Gerello
2 Zulekhan Shah Pathan
3 Shahida Junejo Kachiunar
4 Akeela Noor Kumber
5 Nazia Somtio Larkana
6 SumeraMeerani Akil
7 ShahidaParveen Toof chacol
8 Samreen Naz Larkana
9 Khalida Surjani Sobdar
Participants: 49 community midwives from district Jamshoro, Dadu & Thatta
S. no
Full name Place
1 Sakina Chana Jamshoro
2 Sajida Memon Jamshoro
3 Kuhra Brohi Jamshoro
4 Sheena Brohi Jamshoro
5 SajidaKhatoon Jamshoro
6 Abida Parvin Jamshoro
7 Nazia Khaskho Jamshoro
8 Anjum Baloch Dadu
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
10 Naghma Chandio Wadh
11 Farzana Shaikh Gambat
12 Zabu-nisa Gambat
13 Salma Gambat
14 Shakeela Gambat
15 Amiran Gambat
16 Shabana Khairpur
17 Seemab Khairpur
18 Shahnaz Khairpur
19 Ghulam Fatima Khairpur
20 Shabana Afzal Khairpur
21 Fahmida Khairpur
22 Uzma Phulpoto Shikarpur
23 Farhana Shikarpur
24 Hurmat Mahar Shikarpur
25 Naseem Akhtar Shikarpur
26 Nasreen Asghar Shikarpur
27 Kiran Chana Sukkur
28 Irfana Qureshi Sukkur
29 Sumera Channa Pano Akil
30 Zubaida Khanum Ghotki
12 Shibzadi Kashmore 13 Tahira Zenab KotDiji 14 Heer Hisbari Sukkur
15 GhulamYaseen Khatoon Sukkur
16 Kalsoom Sukkur 17 Elizebath Rohri
10 Zarish Larkana
11 Ifat Shaheen Dokri
12 Koonj Larkana
13 Rubena Balleshah
14 Naseem Larkana
15 Fozia Solangi Larkana
16 Fozia Abro Larkana
17 Moona Baloch Larkana
9 Rukhsana Baloch
Dadu
10 Mehrunissa Baloch
Dadu
11 Khalida Dadu
12 Shabana Lashi Jamshoro
13 SaimaKhaskheli Jamshoro
14 Zaibunisa Jamshoro
15 Rukhsana Jamshoro
16 Hakeema 17 Mehwish 18 Nazia Jamshoro
19 Nasara
20 Kausar Shah Jamshoro
21 Saeeda Saho
22 Samina Ghari
23 Rabail Gul Dadu
24 Amber Atta Dadu
25 Sadaf Dadu
26 Saba Shereen Dadu
27 Hina Soomro
28 Rehana Dadu
29 Noorjahan Dadu
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
31 Zebul Nissa Ghotki
32 Asiya Sukkur
33 Hazooran Ghotki
34 Zainab Noor Ghotki
35 Aasia Pitafi Ghotki
36 Shabana Bano Khairpur
37 Ruqia Begum Khairpur
38 Sehrish Sukkur
39 Shabana Larir Sukkur
40 Rehana Marvi Rohri
41 Shumaila Rohri
42 Nusrat Thari Mirwah
30 Sanam Lakhiar
Dadu
31 Salma Dadu
32 Arbeli Pehwar Dadu
33 Gulshan Paree
Dadu
34 Moomal Dadu
35 Rabia Dadu
36 Shahnila Dadu
37 Afroze Dadu
38 Rabia Yousuf Dadu
39 TasleemuNissa
Dadu
40 KanwaloKandhro
Dadu
41 Shamila Dadu
42 Zahida Dadu
43 Hanifa Dadu
44 Bukhtermin Dadu
45 Safia Dadu
46 Soniya Dadu
47 Aneela Khaskheli
Thana Bla Khan
48 Sajida Parveen Jamshoro
49 ShaziaSoomro Jamshoro
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
Training Evaluation: Before starting the training session a written pretest with interview were conducted with individual participants in each workshop to understand the knowledge and concept of participants about basic maternal health care services, fistula and Basic EmONC. At the end of each presentation trainer ask question (Quiz) about the previous session in order to assess the understanding of the participants. Trainers also conducted periodic assessments through pre and post test in order to evaluate training. Recommendations and Conclusions:
All participants advised to go through the whole training material in detail and use it for your ready reference.
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)
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