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Managing Birth Asphyxia

Article in MCN The American Journal of Maternal/Child Nursing · January 2016

DOI: 10.1097/NMC.0000000000000195

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 Managing Birth Asphyxia: Helping Babies Breathe
Lynn Clark Callister, PhD, RN, FAAN
B
uilding on the Millennium
Development Goals, the Sus-
tainable Development Goals
include a global emphasis on “attain-
ing healthy life for all at all ages”
(www.un.org/sustainabledevelopment/
sustainable-development-goals/). A Call
to Action Summit 2015 held in India
in August 2015 that focused on
preventable maternal/child deaths
served as a prelude to the United
Nations Summit in September 2015
on the adoption of the post-2015
Development Agenda.
Vulnerable populations globally
are the unborn and the newly born,
especially in low resource areas. It is
estimated that half of three million
newborn deaths globally each year
occur during birth or within the
first 24 hours of life. Six million
newborns require assistance with
breathing immediately after birth
(Bang et al., 2014).
A remarkable evidence-based
intervention with documented signifi-
cant outcomes is Helping Babies
Breathe (HBB), a neonatal resuscita-
tion program embedded within essen-
tial services for mothers and newborns
(www.healthynewbornnetwork.org/
partner/helping-babies-breathe). This
American Academy of Pediatrics ini-
tiative partners with the World Health
Organization, United States Agency
for International Development, Save
the Children’s Saving Newborn Lives
program, the National Institute of
Child Health and Development, and
other global health stakeholders such
as Latter-day Saint (LDS) Charities
and Laerdal Global Health.
The critical goal of this initiative is
taking advantage during the Golden
Moment, or the first minute following
birth, to reduce newborn asphyxia.
The focus is on the essential interven-
tions of drying, warmth, clearing the
airway, stimulation to breathe, and
bag and mask ventilation if necessary.
62 volume 41 | number 1
MCN0116_Global_00094_Priyanka.indd 62
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Helping Babies Breathe is much
more than a classroom educational
experience. It extends to changing
healthcare systems in low resource
environments.
For example, LDS Charities,
sponsored by the Church of Jesus
Christ of Latter-day Saints, sends
volunteer physicians and nurses to
countries such as Indonesia to edu-
cate local healthcare providers
including midwives in rural settings,
who in turn train their local col-
leagues. This innovative “trainer to
trainer” program was implemented
in over 40 sites around the world in
2014. In-country, LDS Charities
partners with local organizations
that have demonstrated strength.
In Indonesia, LDS Charities has
partnered for nearly 10 years with
Perinasia, an organization of neona-
tologists, obstetricians, and pediatri-
cians (now extended to midwives)
with an impressive history of neona-
tal resuscitation training. The char-
ity provides a professional team of
educators and equipment. A resusci-
tator is provided to clinics, and in
remote areas where there is no clinic,
a resuscitator is given to midwives
for use in home births. Midwives
completing the training receive their
own personal suction device and
stethoscope. An $80 donation to
LDS Charities supplies two of these
much needed and valued kits to
midwives, with 100% of the contri-
butions funding Maternal and New-
born Care initiatives. If one out of
60 midwives educated is able to
successfully resuscitate only two
newborns during her career because
of HBB, the cost is only $54 per
newborn (www.ldscharities.org).
Impressive outcomes from HBB
since 2009 in Tanzania and India
have been documented (Goudar
et al., 2013; Msemo et al., 2013).
There has been a remarkable 47%
reduction in early neonatal mortality
(7 days postpartum) and a signifi-
cant reduction in “fresh” stillbirths
in Tanzania. Goudar et al.’s work
documented that provider knowl-
edge and skills were improved with
HBB training, with a significant
decline in stillbirths and resuscitated
infants survived the neonatal period.
Bang et al. (2014) described a
proposed 2-year prospective pre-
post study evaluating HBB and
essential newborn care among the
Global Network’s Maternal Neona-
tal Health Registry, so we can look
forward to those findings, including
lessons learned and best practices, to
ensure stillbirths and neonatal mor-
tality continues to be reduced in low
resource settings. The HBB program
is making an impressive difference
for vulnerable unborn and newly
born babies. ✜
Lynn Clark Callister is a Profes-
sor Emerita, College of Nursing,
Brigham Young University, Provo,
UT, and an Editorial Board Member
of MCN. Dr. Callister can be reached
via e-mail at lynn_callister@byu.edu
The author declares no conflict of
interest.
DOI:10.1097/NMC.0000000000000195
References
Bang, A., Bellad, R., Gisore, P., Hibberd, P.,
Patel, A., Goudar, S., ...,Wright, L. L. (2014).
Implementation and evaluation of the
Helping Babies Breathe curriculum in
three resource limited settings: Does Help-
ing Babies Breathe save lives? A study
protocol. BMC Pregnancy and Childbirth,
14, 116. doi:10.1186/1471-2393-14-116
Goudar, S. S., Somannavar, M. S., Clark, R.,
Lockyer, J. M., Revankar, A. P., Fidler, H.
M., ..., Singhal, N. (2013). Stillbirth and
newborn mortality in India after helping
babies breathe training. Pediatrics, 131(2),
e344-e352. doi:10.1542/peds.2012-2112
Msemo, G., Massawe, A., Mmbando, D.,
Rusibamayila, N., Manji, K., Kidanto,
H. L., ..., Perlman, J. (2013). Newborn mor-
tality and fresh stillbirth rates in Tanzania
after helping babies breathe training.
Pediatrics, 131(2), e353-e360. doi:10.1542/
peds.2012-1795
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