Training Workshop for Birth Attendants: Hygiene, Cord Care, Referrals

This is an informative article about a training held in Nigeria for traditional birth attendants.  The training focused on: hygience, cord care and referral to a health facility.  This training outline seems like it would be applicable to many countries in the developing world.

HYGIENE: Wherever labour and delivery are managed, cleanliness is the first and foremost requirement. Nails must be short as well as clean and hands must be carefully washed with soap and water. Attention should be paid to the personal hygiene of labouring women and TBAs. As well as to the cleanliness of the environment and all materials used during birth. Positive effect of three cleans – hands, perineal area, and umbilical area. The TBAs must make sure that there is clean water at hand. There is need for careful hand washing – clean hands, clean delivery surface, clean cord cutting and care prevents puerperal sepsis (infection after delivery). Some measures should be taken during all deliveries to prevent possible infection of the woman and / or the TBAs. These measures include the avoidance of direct blood /direct contact with blood and other body fluids by the use of gloves during vaginal examination, during delivery of the infant and handling the placenta. Surgical gloves are latex gloves there are sizes to fit the hand. Sterile surgical gloves should be worn for each vagina examination.

UMBILICAL CORD CARE: Minimal handling of the umbilical cord should be done. The cord if not handled properly, can be the portal of entry of bacteria and other infective organisms. Therefore, ensure good cord care: Cut with clean new freshly opened razor blade, tie tightly to avoid bleeding. Ensure that the tie is sterile and keep clean and dry until it falls off.

REFERRAL TO A HEALTH FACILITY: TBAs should refer a woman to a higher level of care if complications arise which requires interventions, which are beyond the competence of the TBAs… Some cases requiring referral to a health facility are prolonged labour, prolonged second stage of labour, retained placenta, cord presentation, cord prolapse, antepartum, and postpartum haemorrhage, scarred uterus such as a woman with previous caesarean section or previous myomectomy, eclampsia and obstructed labour^{16, 18}.