The 2017 Birth Home Symposium

April 6, 2017, Petionville, Haiti – Sixty birth center representatives and supporters gathered on April 6, 2017 at the Hotel Montana for the 2017 Birth Home Symposium.  Participants were from Haiti, the United States, Canada, the Dominican Republic, Mexico, and Peru.

Updates were heard from several of Haiti’s Birth Homes, including:

  • MamaBaby (Cap Haitian)
  • Carrie Wortham Birth Center (Cabestor)
  • Heartline Ministries Birth Center (Port-au-Prince)
  • Olive Tree Birth Center (Jacmel)
  • Maison de Naissance (Torbeck)
  • UNFPA Smile Clinics (Port-au-Prince, Carrefour, and Jacmel)

The symposium discussion focused on Birth Center Development and Sustainability.  Presentations included:

  • Birth centers globally: clues to success – Jennifer Stevens, the GoodBirth Network
  • Birth center neighbors in Mexico: new opportunities – Cris Alonso, Luna Maya Birth Centers
  • Alignment of midwifery and government objectives in Haiti – Vavita LeBlanc, UNFPA
  • Respectful birth movement and birth centers – Kay Sandberg, the Force for Global Healing

In a work session, participants reviewed standards for maternal-newborn care, respectful care, midwifery practice, and birth center operation.  From these, the following priorities were identified:

Birth Center Checklist

(Special priorities in bold, Indicators in italics)

Personal Safety  (respectful care, cultural sensitivity, holistic health promotion)

  1. Every woman is treated with respect and dignity
    staff education and sensitivity education log, grievance process for patients,  standard end of care patient survey
  1. Every mother is informed about the benefits of continuous support and continuous support is provided
  1. An individual midwife is committed to accompanying a mother throughout her labor.
  1. Every mother is informed about the benefits of drug-free comfort and pain relief methods during labor, and every mother is provided access to drug-free comfort and pain relief methods.
  1. Each mother is asked about cultural traditions and spiritual expectations that may apply to her pregnancy and delivery 
  1. Any traditional birth assistants known to the mother are invited to participate in the mother’s care within the facility
  1. Every mother has access to her health information.
  1. The birth center provides programs to enhance wellness and prevent illness.
    education checklist for patients; Info for vitamins, vaccinations, etc
  1. Every mother is offered a tour and orientation to the model of care
  1. There is shared decision making for all services related to pregnancy, birth and newborn care
  1. There are posted signs and explanations of client rights
  1. All staff members identify themselves and wear identification badges indicating their role
  1. Home visits are performed
  1. Every mother is addressed by name
  1. The environment offers adequate privacy based on client preferences
  1. The staff dress in a professional manner
  1. The mother determines what support persons will accompany her during labor and delivery
  1. All women and their families receive information about their care
  1. All women and newborns have privacy around the time of labor and childbirth, and their confidentiality is respected.
  1. No woman or newborn is subjected to mistreatment, such as physical, sexual or verbal abuse, discrimination, neglect, detainment, extortion or denial of services.
  1. All women can make informed choices about the services they receive
  1. The reasons for interventions or outcomes are clearly explained
  1. Every woman receives support to strengthen her capability during childbirth.

Health Safety

  1. The birth center is committed to evidence-based practices proven to be beneficial
  1. The birth center does not perform potentially harmful procedures or practices
  1. Routines of care are periodically reviewed to identify practices that are outside of existing guidelines, may be unnecessary, or may be harmful.
  1. The staff possess and routinely apply midwifery knowledge and skills that optimize the normal physiology of birth
    chart audit or case review (and for following standards), review of transfers and death 
  1. Every woman and newborn receive routine, evidence-based care during childbirth and the early postpartum period, according to WHO guidelines.
  1. Women with complications (pre-eclampsia, eclampsia, obstructed labor, postpartum hemorrhage, etc.) promptly receive appropriate stabilizing interventions, according to WHO guidelines, and are transferred according to a pre-determined emergency plan. 
  1. Newborns with complications (premature or low birth weight, failure to breathe, risk or suspicion of infection, etc.) promptly receive appropriate stabilizing interventions, according to WHO guidelines, and are transferred according to a pre-determined emergency plan.
  1. Every woman and newborn is appropriately assessed on admission, during labor and in the early postnatal period to determine whether referral is required, and the decision to refer is made without delay.
  1. Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred.
  1. For every woman and newborn who requires referral, the referral follows a pre-established plan that can be implemented without delay at any time. 
  1. For every woman and newborn referred within or between health facilities, there is appropriate information exchange and feedback to relevant health care staff.
    standard transfer form for transfers and for receiving information back
  1. For every woman and newborn who requires referral:
  • the referral follows a pre-established plan that can be implemented without delay at any time.
  • There is appropriate information exchange with the referral hospital and feedback to relevant health care staff.
  • a qualified staff member accompanies the patient to the hospital.
  1. All women and newborns receive care according to standard precautions for preventing hospital-acquired infections. 
  1. Every woman and newborn has a complete, accurate, standardized medical record during labor, childbirth and the early postnatal period
  1. Every health facility has a mechanism for data collection, analysis and feedback as part of its activities for monitoring and improving performance around the time of childbirth.
  1. Written guidelines are available in at least these areas:
  • assessment of the mother on admission, during labor, and at delivery
  • routine newborn care
  • pre-eclampsia/eclampsia
  • postpartum hemorrhage
  • obstructed labor
  • preterm labor
  • infection or risk for infection
  1. At every birth, there are at least two staff currently trained in:
  2. a) The Helping Mothers Survive program or its equivalent
  3. b) Helping Babies Breathe program or its equivalent
  1. The birth center strives to achieve the Baby Friendly Health Initiative 10 Steps to Successful Breast feeding. 

Institutional safety (program organization, staff, and facility)

  1. The birth center provides a continuum of collaborative care with all relevant health care providers, institutions, and organizations (i.e. the birth center works as a part of a larger health care system).
  1. Skilled birth attendants and support staff have appropriate competence and skills mix to meet the requirements of labor, childbirth and the early postnatal period.
  1. At least one skilled birth attendant and support staff are immediately available at all times.
    clear schedule of who is working and back-up schedule
  1. The birth center has leadership and programs for continuous quality improvement.
  1. The facility has functioning, reliable, safe and sufficient systems for:
  • clean water
  • energy
  • sanitation
  • hand hygiene
  • general waste disposal
  • medical waste disposal
  1. Areas for labor, childbirth and postnatal care are designed, organized and maintained so that every woman and newborn can be cared for according to their needs for privacy and safety.
  1. Adequate stocks of medicines, supplies and equipment are available for routine care and management of complications.
  1. The general geographical area served is defined.
  1. The birth center is a legally constituted organization.
  1. There is an established mechanism for staff and clients to provide input to the birth center leadership.
  1. There is a plan for the operation of the center in the absence of the administrator and/or clinical director.
  1. There are protocols for maintenance of equipment, building and grounds, as well as control of the use of the facility.
  1. The birth center complies with applicable local and national regulations.
  1. There is a plan for informing the community of the services of the center.
  1. Plan to ensure fiscal sustainability.
  1. The birth center has an established system for hiring, training, and supporting its staff.
  1. Records are maintained for all employed staff, including their qualifications and current training.
  1. Written performance evaluations are performed for all staff.
  1. Written personnel policies are available to all staff, including:
  • Conditions of employment
  • respective obligations of employer and employee
  • benefits
  • grievance procedures
  • sexual harassment and workplace violence
  • non-discrimination
  1. The birth center conducts routine, periodic maternal and newborn medical emergency drills and continuing professional education programs
  1. The facility establishes and maintains a safe, home like environment for healthy women and newborns (space for furnishings, equipment and supplies appropriate for comfortable accommodation for the number of families served and the personnel providing services.)
  1. The birth center facility provides adequate security measures for staff and families and has appropriate disaster plans.
  1. There are systems in place to monitor equipment, medications, and supplies.
    inventory checklist
  1. Hazardous supplies, such as sharps and expired medications, are disposed of properly.
  1. Any research activities and protocols for conducting research are approved by the governing body of the birth home.

 

 

 

 

   

     

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