Air, Air, Air: a champion midwife programme in Tanzania using HOT neonatal resuscitation—lessons learned

Abstract

Background Tanzania has approximately 40 000 newborn deaths per year, with >25% of these linked to intrapartum-related hypoxia. The Helping Babies Breathe© and Golden minute© (HBB©) programme was developed to teach skilled intervention for non-breathing neonates at birth. While Helping Babies Breathe© and Golden minute©, providing training in simulated bag and mask ventilation, is theoretically successful in the classroom, it often fails to transfer to clinical practice without further support. Furthermore, the proclivity of midwives to suction excessively as a first-line intervention is an ingrained behaviour that delays ventilation, contributing to very early neonatal deaths. Methods The ‘champion’ programme provided guided instruction during a real-life resuscitation. The site was Amana Hospital, Tanzania. The labour ward conducts 13 500 deliveries annually, most of which are managed by midwives. Brief mannikin simulation practice was held two to three times a week followed by bedside hands-on training (HOT) of bag and mask skills and problem solving while reinforcing the mantra of ‘air, air, air’ as the first-line intervention during a real-life emergency. Results Champion midwives (trainers) guided instructions given during a real emergency at the bedside caused learners beliefs to change. Trainees observed changes in baby skin colour and the onset of spontaneous breathing after effective ventilation. Conclusions Visible success during an actual real-life emergency created confidence, mastery and collective self-efficacy.

Silent Tears of Midwives: ‘I Want Every Mother Who Gives Birth to Have Her Baby Alive’—A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania

“…Many participants remained optimistic despite systemic difficulties; they learned lessons and built the self-confidence necessary to believe that babies can be saved in the future. Some examples of the midwives’ diverse positive adaptative behaviours and strategies were focused maternal education, concise clinical skills training, purposeful foetal heart monitoring, and the initiation of resuscitation at the bedside through the Champion program that advocates mentored hands-on-training during real live neonatal resuscitation [ 71 ]. Furthermore, midwives found ways of utilizing expired/single use equipment by resterilizing kiwi cups as many as 25 times, thereby saving babies’ lives.…”