Empowering Midwives in Humanitarian Settings: Integrating Heat-Stable Carbetocin and Tranexamic Acid into Postpartum Hemorrhage Training

Alice Rosmini; Kidza Mugerwa; Awatta Walter Ochan; Sarah Muwanguzi; Jemelia Sake; Richard Mwesigwa; Okpwoku Sukere; Catrin Schulte-Hillen; Nguyen Toan Tran

doi:10.25259/IJMA_10_2023

Empowering Midwives in Humanitarian Settings: Integrating Heat-Stable Carbetocin and Tranexamic Acid into Postpartum Hemorrhage Training

Int J MCH AIDS. 2024 Sep 23;13(Suppl 1):S72-S80. doi: 10.25259/IJMA_10_2023. eCollection 2024 Sep.

Authors

Alice Rosmini¹, Kidza Mugerwa², Awatta Walter Ochan³, Sarah Muwanguzi², Jemelia Sake³, Richard Mwesigwa², Okpwoku Sukere³, Catrin Schulte-Hillen¹, Nguyen Toan Tran⁴

Affiliations

¹ United Nations Population Fund, Humanitarian Response Division, 7 rue de Varembé, 1202, Geneva, Switzerland.
² United Nations Population Fund, Uganda Country Office UN House, Kololo, Kampala, Uganda.
³ United Nations Population Fund, South Sudan Country Office UN House, Juba, South Sudan.
⁴ Australian Center for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, NSW, Australia.

Abstract

Background and objective: Maternal mortality remains extremely high in fragile settings, with hemorrhage as the leading cause. This study describes a new model for more effective training on postpartum hemorrhage (PPH) prevention and treatment.

Methods: Using a low-dose (of information) and high-frequency (of repetitions) approach (LDHF), the strategy comprised an introductory webinar, self-paced study, 2-day in-person workshops, cascade training, continuous facility-based skills drills, and a WhatsApp community of practice and supervision (CoP). Innovations consisted of the practical, midwifery-centered, and short-duration training, and the integration of tranexamic acid (TXA) and heat-stable carbetocin (HSC) into existing modules from the "Bleeding-After-Birth-Complete" toolkit. Effects were assessed through mixed-methods evaluation. Confidentiality and "do-not-harm" principles were respected.

Results: Nine training sessions were conducted in South Sudan and Uganda combined, engaging 126 participants. Average knowledge increases of 21% in South Sudan and 18% in Uganda were recorded. Feedback also indicated changes in practices and attitudes: enhanced competency, teamwork, clinical protocols adherence, appreciation for midwife-led practical sessions, the LDHF method, and continuous support through the WhatsApp CoP. In post-workshop action plans, facility teams outlined steps to apply acquired knowledge and skills. These included training colleagues, establishing quality improvement projects, conducting skill drills, ensuring job aid visibility, and systematically reporting on PPH in the data collection templates of the facilities.

Conclusion and global health implications: This case study highlights the value of a practical, LDHF refresher training strategy. This strategy bolstered providers' skills, knowledge, and confidence in using HSC and TXA for PPH prevention and treatment. Findings can guide future training in similar fragile, low-resource, and humanitarian settings. Strengthening midwifery leadership, fostering interdisciplinary collaboration, and using the LDHF training approach can contribute to resilient health systems and taskforce, aligning with global efforts to reduce maternal mortality.

Keywords: Heat-Stable Carbetocin; High Frequency; Humanitarian Settings; Low Dose; Midwifery Education; Postpartum Hemorrhage; Refresher Training; Sudan; Tranexamic Acid; Uganda.