Tuesday, January 14, 2014

Outline of my workshop with photos

Workshop outline with photos

Training in the Russian Hospital in Phnom Penh


To create a cross cultural dialog about maternal and newborn health

To reinforce the maternal and newborn health polies of the World Health Organization as a unifying multi-national norm.

To reinforce the millennium goals of the United Nations regarding maternal and newborn health as a multi-national norm.

To demonstrate curiosity and respect for traditions related to childbirth; to reinforce the concept that many cultural and historical practices may not be harmful and can be continued.

To teach the curriculum of Helping Babies Breathe

To teach the value of skin to skin contact after birth

To teach the value of early initiation of breastfeeding and exclusive breastfeeding for 6 months.  

To help make health centers aware of The Baby Friendly Certification as a unifying mulit-national goal.

To discuss and answer questions regarding things that may cause a baby not to breathe.  (Position of the mother, drugs, shoulder dystocia, breech)   This is based largely on concerns the midwives generate.   Shoulder dystocia was brought up many times.

To answer questions about birth in the United States and discuss topics based on their interest (C-section rate, support people in the room, position, water birth)

To give each birth center an ambu bag kit.

To interview traditional birth attendants/ midwives and document their stories; to thank them for their work.  

At the end of each training the health center was given new supplies from Helping Babies Breathe.
These supplies were made possible by the donations of friends and family

Teaching materials

Picture of a midwife at Angkor Watt to demonstrate traditional birth practices in Cambodia.

Helping Babies Breathe Materials – NeoNatalie Dolls to practice with ambu bag and suction.

Films from utube when possible 

Demonstrations with a cloth baby, placenta and pelvis

Newborn baby stomach kit ( showing the size of a newborns stomach)

Demonstrations of maternal position and role plays 

Practicing how to help a baby breathe with an ambu bag
Breathe- two- three

Workshop set up

If possible, gather in a circle with the babies and birth equipment on a table or on a mat on the floor.  

Wear pants for ease in demonstrating positions during birth

Pass pictures and teaching aides around the circle

Arrange for refreshments and travel funds as appropriate

Give certificates and breastfeeding education kits to each midwife

Create several stations for practicing with the ambu bags and Neo Natalie

If possible , arrange for short films of natural latch, skin to skin, kangaroo care


Introductions, followed by a  simple hands up activity  for a  large group. In a smaller group we simply introduced ourselves and shared our experiences and training as a midwife.

Raise your hands if
You are a midwife
You are a student
You are a doctor or medical student
You are a nurse
Raise your hands if
Have practiced for 1 year, 2 years, 5 years, 10 years, 20 years
If someone in your family was a midwife ( let them share )
If you were born at home
If you live near by
If you ever had a baby yourself

Raise your hands
If you ever had a baby not breathe at a birth
If you ever had a baby be born prematurely
If you ever saw a women with eclampsia
If you ever had a woman bleed too much

I raised my hand for all of these.  

 Share the agenda.  


 Share global statistics as well as in country statistics including under 5 data.  I share United States statistics, highlighting the problems with prematurity, high c-section rates, low 6 month exclusive breastfeeding rates and high induction rates. These can be found on line. I let them know we all have work to do to make the lives of women and children and society better.

I let them know that midwives are so important in any country and thank them.  I encourage them to ask their own birth story and to talk with traditional midwives in their community.

Ancient Akgor

In Cambodia I passed around a photo of a woman giving birth from Angor Watt and the midwives.  It is powerful because she is squatting and being very tenderly cared for by many women.

Setting up for a birth

 Demonstrate, with the midwives help, setting up and being prepared as in the HBB Curriculum.  Most birth rooms do not have the right ambu bag, one that works, or it is in another room or building.   

Normal birth/ routine care

This takes about an hour and is a good time for films, if possible.  Most health centers and hospitals suctioned, took the baby away and encouraged bottles for the first few days.   Given the high under 5 and under 1 mortality rates, I devoted time on the first 30 minutes after birth as a way to prevent some of these early deaths.

Skin to skin for 30 minutes

No suction in a baby that is breathing

Natural latch

Letting the cord pulse for at least 3-5 minutes.

When the baby does not breathe

I tried to go on a tour of the birthing rooms before the workshops so I could see the set up and practices.  At this time I also inquired about the protocols around babies who do not breathe at birth.   I ask how often the midwives are trained in NRP and what they do.  I ask about the centers statistics.

Helping Babies Breathe

I flowed the HBB curriculum with an emphasis on the Golden Minute and practice.  My groups were far too large.  They suggest 1:6 ratio of instructor and learner and I sometimes had 50 midwives.   This photo was taken at a training at a district hospital in Cambodia.   The lead midwife actively assisted the new midwives in learning how to use the ambu bags.   They have asked for 50 of the new suction devices and their won teaching materials.   The head midwife is responsible for many  rural health centers.


After practice I let the midwives ask questions about the USA or birth problems they encounter.   They often had concerns about shoulder dystoria and I was able to show two positions that have good results.  

Thanks, photos and certificates

We often ended with photos and kind words and in two cases I was quickly ushered into births to show them what I do.  This was difficult but I did the best I could, emphasizing skin to skin and trying to get the woman up off her back.  It would take some time to model such things but I tried with the rooms bursting with all the participants.

Follow- up

Many were interested in future workshops.  
Things I would do in the future

Expect more participants than planned
Bring business cards to give out
Pass out helpful internet links
Bring more teaching sets
Give each midwife the baby’s stomach set and some teaching cards

Future workshops

I came away feeling that Vietnam and Cambodia were both eager for training opportunities and that government officials were supportive.   This is what I would suggest to myself and others:

Work with a whole district on a set goal such as being a Baby Friendly Hospital with UNICEF recognition

Bring more trainers.  Make sure the trainers have time to learn about the culture and some language before working.   Train these trainers. 

Work on a district level to train the trainers. Leave them training material

Work on a health center level to train the midwives and model if appropriate.

Model postpartum home visits as part of breast feeding goals

Teach family first aide in small villages

Bring midwives small gift bags with baby stomach models and teaching cards and a small gift.

Embed history and culture into the visits.  Ask the midwives to teach something too and pay them.  They are all great at stitching and giving IV’s.  

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