Making Birth Safer in Haiti
Haiti is the most dangerous country in the Western Hemisphere in which to give birth. Although large urban communities have improved their pregnancy outcomes by promoting skilled routine and emergency care by trained personnel, nearly half of the births in Haiti occur in rural villages which often lack these services. LaMontagne is one of the many Haitian villages that lack reliable access to healthcare, with the only local healthcare resource for the 30,000 residents being a limited pharmacy open only sporadically and staffed by two Haitian nurses. The nearest hospital is located in Jacmel, a city which is two hours away by car in optimal weather conditions. Most villagers do not have automobiles, and deliveries occur in individual homes attended by traditional birth attendants.
Since 2010, Stanford Maternal-Fetal Medicine Fellow Dr. Megan Foeller has traveled to LaMontagne every six months to provide and teach obstetric care. In collaboration with the non-governmental organization, Friends of the Children, Dr. Foeller established an educational program for 25 local traditional birthing attendants. Traditional birthing attendants in her program report high acceptance rates and have demonstrated excellent knowledge retention. Prior to the initiation of her program, 44% of traditional birthing attendants perceived colostrum as harmful to the newborn and recommended against immediate breastfeeding. Now, all of the traditional birthing attendants in her program report that they “strongly encourage mothers” to immediately and exclusively breastfeed after delivery.
Over the last six years, Dr. Foeller and Friends of the Children has conducted biannual educational sessions for traditional birthing attendants teaching obstetrical care and neonatal resuscitation through culturally sensitive methods and simulations.
On her most recent trip funded by the Global Outreach for Faculty and Residents (GoFar) program in the Department in Obstetrics and Gynecology at Stanford, Dr. Foeller focused on simulation training to teach vaginal breech maneuvers (most women do not have access to cesarean sections), recognition and treatment of postpartum hemorrhage and proper hygienic technique. In the future, she hopes to collaborate with community leaders to create an emergency transportation system for women who experience obstetrical complications and expand treatment options for postpartum hemorrhage.