Mangala Devi is a demonstration birth center at the Tribhuvan University Teaching Hospital in Kathmandu, Nepal.  The unit was established as a combined effort by the department of obstetrics and gynecology, volunteers from the Royal College of Midwives in the United Kingdom, and the Midwifery Society of Nepal (MIDSON). https://www.rcm.org.uk/news-views-and-analysis/views/the-mangala-devi-birth-centre-tribhuvan-teaching-hospital-nepal

The aim of this center is to provide respectful, women-centered care for women with uncomplicated pregnancies.  The unit is led by nurse midwives and provides a home environment including food and drink, music, and ‘walk about’ space for mothers, families, and other support persons during child birth. Women are encouraged to use a variety of birth positions, including the use of birthing balls.

The Mangala Devi Birth Centre opened in June 2014.  Services are not yet 24×7 because of staff shortages.  But a total of 243 women received care through mid-April 2016.  75% of mothers were able to give birth at the center and no serious medical complications have been encountered among mothers delivering at the center.  The C-Section rate among mothers transferred to hospital care was 33%.  Patient satisfaction surveys have revealed high approval rates for midwifery care, delivery options, the facility, and safety.   The Mangala Devi experience is proving to be helpful to demonstrate birth home safety and financial advantages to the medical community, policy makers, and funders.

On a national level, Nepal has a remarkable story of health progress.  Despite poverty, insurgency, persistent political upheaval, and some of the world’s most challenging terrain for the delivery of healthcare, Nepal has reduced its maternal mortality ratio by almost 50%.  It is one of the few countries on track to achieve MDG 5.  Nepal’s success is attributed to widespread improvements in access to medical services, particularly in remote areas. Further improvements have been facilitated by economic and behavioral changes at the household level, driven by increased empowerment and education of women and greater awareness of how to mitigate pregnancy-related risks.

Most of Nepal’s births, and most of Nepal’s continuing maternal deaths, take place in rural areas isolated by severe mountains and limited transportation.  Professor Kiran Bajracharya, who is also the President of Midwifery Society of Nepal, respects the success of training skilled birth attendants to work at 200 of Nepal’s primary health posts, yet she also feels that this isn’t enough. “Women continue to die because of geography.”  Professor Bajrachary has a vision to enhance primary health stations with full trained midwives practicing midwifery models of care.  For her, Mangala Devi is the demonstration of that vision’s hope.

Stan Shaffer, 2016

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