Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India

The Care Around Birth approach provides an integrated implementation framework to improve the quality, equity, and dignity of care during the intrapartum and immediate postpartum periods, thereby addressing key drivers of maternal and newborn mortality.


Case study: To fill in the Partograph
Rani (wife of Rambhajan), 18 years of age, was admitted to your hospital today at 10:00 am with complaints of 39 weeks pregnancy and labour pains since 7:00 am. This is her first pregnancy. You are attending to Rani at the facility. Plot the following findings on the partograph: At 10:00 am: • The cervix is dilated 5 cm.
• She had 2 contractions in 10 minutes, each lasting less than 20 seconds.
• The membranes are intact.
• Her temperature is 37° C. In the postpartum period the mother needs to be counselled on a) Exclusive breastfeeding, including colostrum feeding, b) To take adequate rest, sleep c) Maintain hygiene including perineal hygiene, and washing her hands before handling the baby. d) All of the above 6.
The birth companion should be asked to stay with the mother and newborn and call for help in the following condition a) Mother feeds baby b) Mother complains of severe headache c) Every time mother passes urine d) Only when it is time for discharge 8. 0.5% Chlorine solution for decontamination of used (infectious) items is prepared by: a) Addition of 3 table spoon bleaching powder paste to 1 litre water b) Addition of 1 teaspoon bleaching powder to 1 litre water and same ratio for larger volumes c) Addition of 3 teaspoon Bleaching powder to 10 litre water d) Addition of 3 teaspoon bleaching powder paste to 1 litre water and same ratio for larger volumes 9.
After conducting a delivery, if you have to dispose placenta, oxytocin syringe and needle respectively-which color bins will you use? i. Introduce yourself and explain to the labor room staff that the purpose of this exercise is to assess her/his competency on essential care to the newborns. This will eventually help us understand the areas where the support needs to be provided. ii. Select a place which is well lit and place neonatalie at a hard and elevated surface for conducting the assessment, preferably a newborn care corner. iii. Make her/him aware of the mannequin and the tools available to assess her competency. iv. 'S' against each item means that the provider has to explain it by just speaking and 'D' means she/he has to demonstrate that function. 'SD' means the response should be a mix of both but mainly the demonstration. v. Describe the below mentioned case scenarios to the person being assessed. If she/he has difficulty in understanding the scenario, explain it to her/him again. vi. Discuss that during demonstration s/he has to demonstrate for both essential newborn care and resuscitation exactly the way she/he deals with a real newborn at her/his facility. iii. Ensured delivery room temperature is >25 0 C (S) ii. Delivered the baby over mother's abdomen (S) The provider spoke about starting the examination around one hour of birth Handwashing before examination (S) ii. Demonstrate, how chest rise and cord pulsations can be checked on a mannequin. iii. If the assessor uses bag and mask to ventilate, then observe till the first one minute and then ask to stop and let her complete rest of the steps.

Scenario 1. A mother is
Scenario: A baby has just been delivered in your labor room. The baby is not crying and is meconium stained. What steps would you take to resuscitate the baby? Demonstrate the steps on this mannequin, using the available aids. Number of low birth weight babies (<2.5 kg) registered out of total live births 5.3 Low birth weight babies (<2.0 kg) registered Number of low birth weight babies (<2.0 kg) registered out of total live births 5.4 Newborns in whom temperature was recorded at birth Number of newborns in whom body temperature was recorded at birth out of total live births 5.5 Newborns who were dried as per ENC 2 guidelines after birth Number of newborns who were dried after birth out of total live births 5.6 Newborns in whom delayed cord clamping (in 1-3 minutes) was practiced following birth Number of newborns in whom delayed cord clamping was practiced out of total live births 5.7 Newborns who were administered Vit K1 following birth Number of newborns who were administered Vit K1 after birth out of total live births 5.8 Newborns where breast feeding was initiated within one hour of birth Number of newborns in whom breast feeding was initiated within an hour of birth out of total live births Case 10 Number of times mother monitored for Blood Pressure and Pulse, 6 hours post delivery Number of times newborn monitored for temperature, breathing within one hour of birth Number of times newborn monitored for temperature, breathing, breast feeding and passage of urine and stool within 1-6 hours of birth (For each individual monitoring if all the components are monitored only then it is counted) 5 Fetal Heart Rate, Amniotic Fluid, Cervical dilatation, Uterine contractions, Mother's vitals (Pulse and BP) filled as per desired frequency 10 Stock outs* 10.1 Stock out of oxytocin Stock out of oxytocin reported in the facility even for a single day during the month