A 24 Country Flight for Every Mother: Maternova Research partners with Dr. Sophia Webster

Maternova — Tue, 18 Jun 2013 00:51:26 +0000

We are so excited to announce our partnership with Flight for Every Mother. Dr. Sophia Webster is a 21st century Amelia Earheart with a mission for mothers. She is a flying obstetrician/gynecologist making a 24 country flight piloting her own Cessna to deliver knowledge and supplies to obstetricians and midwives. And she leaves in August!

We love her approach because it is one part advocacy and two parts practicality. Maternova Research will be sending life-saving obstetric supplies including the non-pneumatic anti-shock garment. We’ll also be working with Dr. Webster on how best to communicate the steps involved in creating the lowest cost balloon tamponade on the planet—the condom balloon tamponade.

What is particularly exciting about this journey is that it allows all of us to receive feedback, in rapid succession from a range of obstetricians and midwives working in the most difficult settings to save lives. Dr. Webster will be raising awareness but she will also be teaching. The clinicians will have a chance to provide direct feedback on protocols and technologies. What set of interventions is most appropriate for massive bleeding and shock in their settings? What does the government recommend? What is the protocol for eclampsia? We look forward to amplifying these voices as the Flight for Every Mother happens.

We are raising funds for life-saving technologies to be carried by Dr. Webster and her team via our new non-profit affiliate,(Maternova Research.

We are also using our networks to help Dr. Webster and her team find the best partners to visit during their journey. Please send us ideas!

Is syphilis lurking behind many of the global preterm births and stillbirths?

Maternova — Wed, 05 Jun 2013 00:00:00 +0000

Every once and a while we need to get back to basics. Yes, we need to focus on the day of birth because of the high incidence of maternal and newborn mortality that occurs on this critical day.

But what insidious factors are at play and underlie problems on the day of birth? What causes that day of birth to occur TOO EARLY IN THE PREGNANCY? What if a certain sexually transmitted disease was easy to detect and easy to treat?

According to the World Health Organization (WHO), each year more than 2 million pregnant women are diagnosed with active syphilis (Treponema pallidum), 65% of which result in adverse pregnancy outcomes: fetal death in early to late gestation (fetal death and stillbirth) or neonatal death soon after birth.

Surviving children diagnosed with congenital syphilis (mother to child transmission) are often born with low birth weight and develop serious problems, such as blindness, deafness, and cognitive impairment. Studies have shown that early intervention by testing and appropriate treatment with penicillin, can eradicate syphilis with a success rate of 98%.

Despite the threat of contracting syphilis in some countries being high, up to one third of the women attending antenatal care (ANC) clinics are not tested for syphilis during pregnancy check-ups. Research shows women who have access to antenatal care in the first two trimesters of their pregnancy and who receive the proper care and follow up, are more likely to have a healthy infant, compared to women screened and treated in the third trimester; making it imperative that effective intervention and care be available early in pregnancy.

Syphilis testing and treatment are relatively inexpensive even in low-resource settings, compared with other interventions, with tests typically costing less than $1 US, and treatment (often a single dose of penicillin) less than that. The magnitude of the congenital syphilis burden, globally, cannot be underestimated; it rivals that of HIV infection in neonates yet receives little attention.

It has been estimated that untreated syphilis in pregnancy can directly cause adverse outcomes in around 50% of cases. In comparison, HIV, if untreated, will result in in-utero transmission around 20%. Syphilis is an entirely treatable disease, however, left untreated, it puts an already at-risk population in even more uncertain circumstances. Paramount to the success of syphilis detection and treatment is the coordination of government policy with health care systems, building awareness, and their respective agencies, who provide screenings and treatment, so that proper antenatal care can lead to healthier mother and child outcomes.

Credit: The research for this post and the post were contributed by Isolde Maher, intern from Mt. Holyoke

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001396(Accessed 5/31/13)
ibid(Accessed 5/31/13)
http://www.cdc.gov/std/syphilis/STDFact-Syphilis-detailed.htm (Accessed 6/1/13)
http://www.who.int/bulletin/volumes/91/3/12-107623/en/index.html (Accessed 6/1/13)
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0056713 (Accessed 6/1/13)
6.http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001396#s4
7.http://journals.lww.com/stdjournal/Abstract/2007/07001/The_Need_and_Plan_for_Global_Elimination_of.3.aspx (Accessed 5/31/13)
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0056713(Accessed 6/1/13)

Coming full circle: back to the communities for birth in rural Canada

Maternova — Mon, 03 Jun 2013 17:13:30 +0000

We believe there is a tipping point for each community--a point where the access to full backup in the case of obstetric emergencies is perfectly balanced with the preservation of important community psychological and spiritual supports.

In the week after the national Women Deliver conference, it's a good time to pause and reflect briefly on where we are. As a global movement, maternal health has made great strides. More women have access to professional skilled attendants, yet we know that quality of care and respectful care is an unrelenting challenge.

This interesting story from Alberta, Canada, provides an great counterpoint to the push for facility based births(http://www.newtrail.ualberta.ca/en/FeatureStories.

The traditional infant carrying parka, the amauti, is shown here. An excerpt from the article appears here with permission from the author (Sarah Ligon)

"When U of A professor Beverley O’Brien began working in the North as a nurse practitioner in the early 1980s, she rarely attended births. Although the communities in what is now known as Nunavut where she lived were small — Pagnirtung (current pop. 1,550), Igloolik (1,450) and Hall Beach (650) — they had some of the highest birthrates in all of Canada. But at the time, the policy of shipping all expectant mothers down south was at its height. “I was told by my supervisor that it would only be my mistake that resulted in a baby being born at a nursing station,” says O’Brien.

The survival of a community has a lot to do with the ability to give birth and to continue the community. If they can't do that, it's almost the death of the community. Isn't it? -Beverley O'Brien

O’Brien’s experiences in the North — and the birth of her own son years later — taught her that there had to be a better way to have babies. So, she trained as a midwife and embarked on an academic career that has focused on providing midwifery care to women in Africa, Asia, the North and here in Alberta. Then, in 2006, she was approached by Nunavut Arctic College to develop a program that trains local women as midwives and maternal care workers — one that includes traditional Inuit knowledge about birth while meeting high Canadian midwifery standards

Now, as the acting co-ordinator of the midwifery education program, she works with a team of administrators and southern midwives to select students in three communities across Nunavut — Rankin Inlet, Cambridge Bay and Iqaluit — and craft an educational program suitable to their unique needs and their location."..

"Although most residents of Rankin Inlet are fluent in English, many of the women from smaller surrounding communities are more comfortable speaking their native tongue. “We find that when somebody is in pain, their mother tongue tends to come out,” says Jones. “I’ve heard a lot of women say it was so much easier to be in labour and to be able to speak Inuktitut.”

The article provides a cautionary tale-- in the rush to get women to facilities, we need to be very careful not to remove the 'community' from the birth process, nor the birth process from the community.

Credit: Thanks to Elizabeth Holland from RISD for alerting us to this important article
Citation: University of Alberta Alumni Magazine, November 2012.

A Powerful Moment for the World's Women: Marking Progress and Charting the Future at Women Deliver 2013

Maternova — Tue, 28 May 2013 18:52:51 +0000

What an exciting week for global women's health. The third Women Deliver conference is taking place in Malaysia. We are in booth 244!

So much energy has gone into putting together the agenda for this event and creating the background reports, marking progress and charting the future.

We'd like to focus just briefly on the Countdown to 2015 report just published. The authors highlight many challenges but this paragraph rings true:

But, ultimately, this report is about hope. The country profiles contain many success stories
which show that commitment, investment, and coordinated action can result in concrete
achievements that will save countless lives.

Let's focus on a truly stunning statistic:

"Thirty Countdown countries achieved reductions of 50% or more in the maternal mortality
ratio between 1990 and 2010, and three countries (Equatorial Guinea, Nepal, and Vietnam) achieved reductions of at least 75%."

We believe that in the short-term the key to moving quickly is getting the right supplies to the midwives and frontline health workers. The global community must work to train more obstetricians, to post skilled birth attendants in rural areas and to radically improve the quality of care. But supplies at the periphery can also be game-changing. Handheld ultra light low cost ultrasounds can be used by midwives in rural areas-- and we will soon be carrying these. The non-pneumatic anti-shock garment can transport a woman from rural areas in to receive IV and blood--and we are helping to distribute this. Rapid blood tests and syphilis tests can be done in the periphery and give advance warning of HIV or syphilis with profound positive effects for mother and infant.

The clarion call of the Women Deliver Conference is "it's time to invest in women and girls." We agree.

New butter/Nutributter® now being tested for pregnant moms

Maternova — Tue, 21 May 2013 17:26:39 +0000

By this point, you may be familiar with Plumpy'Nut®, the miraculous peanut paste in a foil pouch that is being used to treat children with severe acute malnutrition in communities around the world. To recap: the genius of this innovation is that children can be treated at home rather than as inpatients.

But what you may not know is that a variation of Plumpy'Nut®'s sister product, Nutributter® is being tested for improving the odds for pregnant women and their infants. Nutributter® is also a micronutrient-fortified semi-solid paste. It's also known as a lipid-based nutrient supplement (LNS). And the new formulation is called LNS P&L-- we can be sure that they'll come up with a catchier name when the studies are done. LNS P&L is being studied in government hospitals in Ghana (Atua and Akuse, and the St Martins de Porres Catholic Hospital at Agormanya (Manya Krobo District of Ghana), and the Somanya Polyclinic at Somanya (Yilo Krobo District of Ghana).

We found out about this trial from our friends at Edesia , the factory down the road which pumps out metric tons of Nutributter®, Plumpy'Nut® and Plumpy'Sup® every month.

Here is a snippet from the study design listed on clinicaltrials site:

> LNS-20gM) will, in addition to the multiple micronutrients provided in the MMN, supply
> energy (118 kcal/d), fat (11 g/d), protein (2.6 g/d), the essential fatty acids linoleic acid
> (=1.29 g/d) >and a-linolenic acid (0.29 to >0.6 g/d), as well as calcium, phosphorus,
> potassium and >magnesium.

The study will assess key metrics in the mothers (BMI, anemia, breast milk composition and interestingly, depressive symptoms). In addition, children will be studied until 18 months of age for their physical growth, motor skills, neurobehavioral skills and development, anemia and more.

Here's a question: What happens if at birth all of the health metrics of mother and infant are dramatically improved? Will the project report interim results? Will the world know? We aim to bring you updates as soon as they are available.

Checking in on... the State of the World's Mothers Report

Maternova — Wed, 15 May 2013 13:11:56 +0000

The first day of life is also the most risky, both for the infant--and often for the mother. This year's report on the State of the World's Mothers came out last week. The focus of this report is on the first day of life. Save the Children, authors of the report, developed the first-ever "Birth Day Risk Index" to assess newborn odds of survival on that very first day that they are born.

What is really striking in this report and in this new index is the extreme vulnerability of newborns during their first month, first week and first day and hours of life. The report breaks it down in a stark series of statistics. 60% of newborns die in the first month of life. Of these, 2 million die during the first week of life. And of these, 1 million die in the first day of life.

What also stands out is how poorly the United States fares as compared to other industrialized nations. In fact it it is dead last amongst its peers. In fact the report finds that the U.S. has 50 percent more first day of life newborn deaths than all of the other industrialized nations combined.

Part of the reason that newborn deaths now stand out is because such great progress has been made in reducing child mortality.

So what is to be done? The number one recommendation, with which we concur wholeheartedly is "Address the underlying causes of newborn mortality, especially gender inequality." Educated, well-nourished girls with access to family planning can make choices which enable healthier families.

For the direct clinical interventions, the report stresses:

Antenatal steroid injections to prevent preterm labor

Chlorhexidine for umbilical cord care

resuscitation during the golden minute right after birth

injectable antibiotics for pneumonia

education about breastfeeding and warming the baby

These simple interventions prevent 3 out of 4 newborn deaths.

Miracle Cleanse for the Umbilical Cord: Chlorhexidine and Neonatal Navels

Lizi — Wed, 24 Apr 2013 21:48:33 +0000

The period between birth and the first week of life is one of the most treacherous for a newborn and its mother, and in low-resource settings the high risk of infection compounds the dangers to both. One of the more common threats to newborns, particularly in these settings, are umbilical infections, which render a newborn’s umbilical cord both a line to life and an anchor for deadly infection.

Recent studies in Nepal, Bangladesh, and Pakistan have unveiled a solution that is simple, inexpensive, and highly effective: applying chlorhexidine solution to newborn navels during the first week of life staves off umbilical infection. According to a study out of Johns Hopkins University, more than 40% of the 8.8 million children under 5 who die each year are neonates--and in resource-poor regions, more than half of them die of serious infections.

Infants’ risk of infection and death during the first weeks of life is reduced by 24% if chlorhexidine is used to clean the umbilical cord for 7 of the first 10 days after a child is born, the study reports. More importantly, this method is a “simple, safe, effective and inexpensive intervention,” as JHU’s Abdullah Baqui explains. What's more, “large-scale implementation of this intervention with universal coverage has the potential to avert an estimated half a million neonatal deaths a year.” Half a million!

Like all the best solutions, the chlorhexidine method requires minimal training, reports a USAID brief, and is adaptable enough to be delivered in settings of all kinds. The supply stream is straightforward and broad-reaching, as “chlorhexidine can be delivered to women through existing health services as well as through retail outlets and by community health workers.”

These findings began with Plan International’s efforts in Nepal in 2010. Plan Nepal partners with community-based organizations in regions throughout the nation with all manner of children’s health-related focuses, from improving newborn health to child protection and child-centered disaster risk management. Within the realm of neonatal health, its LIBON (Local Innovators for Better Outcomes for Neonates) program has made remarkable progress in the last year alone:

According to ts annual report, Plan Nepal trained 257 health workers, established 400 pregnant women groups, taught pre- and post-natal care to 6000 women, equipped and established 46 birthing centers, and performed antenatal checkups in health camps for 9000 women. The program involved teaching women how to monitor their own pregnancies, communicate concerns about behavioral change, recognize the seven signs of danger during a pregnancy and what to do when they arose. It also solidified the care network in place using the Local Health Governance Strengthening Programme to expand local civic, health care, and government involvement in improving maternal and children’s health.

The studies in Bangladesh and Pakistan followed the successful work begun in Nepal, and have resulted in joint efforts such as the Chlorhexidine Working Group, an “international collaboration of organizations committed to advancing the use of 7.1% chlorxhexidine digluconate for umbilical cord care through advocacy and technical assistance.” For you technophiles, there's more: just this March, contributing partners released a technical brief on the wide-ranging successes of this method.

This is the kind of solution we like in global health: uncomplicated, inexpensive, easy to deliver, simple to teach, and above all, highly effective. So please, send the word down the line: chlorhexidine cleanse on a newborn for the first week of life, especially in resource poor settings, has a dramatic effect on the likelihood that child will survive. After all, umbilical cords should be newborns’ lifelines, not anchors for life-threatening infections.

By: Lizi Jones

Maternova Joins the Fight for More Frontline Health Workers

AECote — Tue, 23 Apr 2013 16:33:04 +0000

Simply put, the world needs many more frontline health workers. If we’re looking for an approximate number it would be adding 350,000 to global health efforts through 2015. Seems like an attainable goal, right? Not so fast… the job description isn’t glamorous, low pay (if any pay at all), and nearly zero benefits. People are hardly clamoring to dive into a vocations with a notoriously high burnout rate.

Why is this so critical? In many countries there are less than one physician per 10,000 people. If you are lucky enough to be seen by the doctor, the wait time has to be life threatening in itself. It’s also safe to presume that even the best physicians get tired, and quality of care has to be impacted when there is absolutely no respite or help provided.

One group is looking to change the landscape for global public health forever. The Frontline Health Workers Coalition brings together nearly all the power players in NGO’s alongside fantastic corporate partners. This unified front is aiming to reinvent the frontline health worker role. By providing training, support, supplies, and in some cases compensation, the tide is beginning to turn.

Maternova has been accepted as a member in this prestigious and motivated group. True, we’re not a Pfizer, or CARE, but we’re a loud voice for championing the causes affecting women and children globally. Helping speed up the success of the Coalitions’ mission will be our focus and I’m sure we’ll keep you all in the loop as we set off among very good company for a game changing mission. Join us! Together we CAN change the world.

a.e.cote 4/2013

More on the improvised anti shock garment made of bicycle inner tubes

Maternova — Mon, 15 Apr 2013 18:39:06 +0000

A bicycle inner tube? Where were we on this? Well to continue the story, in 2009 Drs. Mark Hauswald, Nancy Kerr and colleagues published in the International Journal of Emergency Medicine. Their findings were on an improvised pneumatic anti-shock garment. At that stage, the device was three inner tubes, one around each leg and one around the pelvic area. The tubes were pumped up to 45 psi. They found that both the improvised (bike tire) device and the non-pneumatic anti shock garment decreased distal aortic blood flow but that the improvised device decreased it by a higher margin.

As you can see in the photo above, the team has progressed rapidly. Fast forward to today where the team has a Saving Lives at Birth grant securely under their 'belts' and is piloting the project in Nepal. The training and pilot took place over 8 months and the midwives who were trained all still have their devices at the ready in their villages. Hauswald notes that the Nepali midwives are well-trained and very, very opinionated. This will ultimately result in a long development process but a much better end product. At present it is sewn with a (kelly green) bedsheet and bicycle inner tubes that could be manufactured inexpensively almost anywhere.

Though training and use of the device is going well, Hauswald and team want to do a trial in a community hospital next. He points out that if this is seen as a 'smart, modern solution' useful in hospital settings, it will the be better accepted by midwives and nurses in non-facility settings and by higher level policymakers. He would also like to another trial in another setting and another culture.

In the course of our conversation, Dr. Hauswald also mentioned the use of a 'soccer' or football or a knee (yes, knee) to exert pressure and counter arterial bleeding. As he said, 'you need to do what the marines do in the field.'

We'll keep you posted on the next steps in this exciting development in the battle against maternal mortality.

Under Pressure: Count bicycle tire tubes among the new solutions to help mothers in low-resource settings

Maternova — Thu, 11 Apr 2013 16:03:30 +0000

We've been following the MOM-CAPP device with great interest. Since we are already fans of the non-pneumatic anti-shock garment, how could we not be intrigued by a potentially faster/better version, a pneumatic anti-shock device, that could be locally made?

So let's first cover the definitions-- pneumatic means that the clinician pumps up the device (in this case with a bike pump) while non-pneumatic means.. no pumping involved.. just pressure from the tightness of the velcro and the ball built into the NASG which presses against the abdomen.

It occurs to me here that if our ancestors had come up with a simple pressure device to stop postpartum hemorrhage around the time they came up with the wheel we would be in a lot better shape today as a society. In any case...

We had the pleasure of talking with Mark Hauswald, and ER doctor, who along with his wife, Nancy Kerr, an obstetrician, works in Nepal on the CAPP. The CAPP, a circumferential abdominal pelvic pressure device, wraps around a woman suffering from postpartum hemorrhage. Mark's team presented multiple results at the FIGO meeting in the fall.

The current prototype MOM-CAPP was made in Nepal out of sewn bedsheet cloth and a bike pump and bicycle tire tubes. 58 nurses and auxiliary midwives were trained in the device were part of the study. 25% of them ended up using the device in a clinical emergency because they needed them and they were available. To find out the results, stay tuned for our next blog on the subject.

But we leave you with a thought: leaders in the field say again and again, we know what to do, we just need to scale it up. Well that's true in some cases, but innovation always plays a role in making is smaller, faster and cheaper. We did not know, even three years ago that this MOM-CAPP idea would work.. and now it appears, we do.