With the support of the Australian Government, Health Alliance International (HAI) is partnering with the Timor-Leste National Institute of Health to strengthen the skills of midwives in the workplace through Learning Labs.
Learning Labs are conducted in health facilities with midwives and designed as a post-training refresher in safe and clean delivery and essential newborn care. Learning Labs build midwife competencies through practical simulations using mannequins and other interactive adult learning methods.
Rara Dethan is a senior midwife educator with HAI and says Learning Labs are important as there is often limited follow-up support for midwives in health facilities after their initial training.
“By visiting midwives where they work, we are able to monitor their progress and help them feel more confident by practicing specific childbirth skills and competencies with them,” she said.
Real-life situation tests midwife skills
In December 2016, HAI travelled to Metinaro Community Health Centre to run a Learning Lab with two midwives. But the training turned into a real-life situation when a woman arrived at the centre who had failed to expel her placenta after giving birth at home.
When a placenta remains in the womb after childbirth, it is called a retained placenta and can be life-threatening for the mother, potentially causing infection and excessive blood-loss. Under the observation of the HAI midwife trainer, the two Metinaro midwives expertly managed the complication by removing the placenta and keeping the mother in the clinic overnight for monitoring.
The midwives then continued with the Learning Lab which involved delivering a baby using a mannequin and responding to a range of simulated complications, such as respiratory and fetal distress.
Partnering to address high rates of maternal and infant mortality
HAI is a key partner in Australia’s efforts to address the high rates of maternal and child mortality in Timor-Leste. One in 30 women in Timor-Leste are at risk of dying during childbirth, and more than one in 10 children do not reach the age of five.
Many Timorese women do not seek healthcare information and services during their pregnancies, often missing important check-ups and preferring to deliver their babies at home.
Rara explained that giving birth at home is commonplace in Timor-Leste.
“Many pregnant women and their families prefer to deliver at home with a traditional birth attendant, who often has no formal health education or training,” she said. “This puts both the mother and child at risk if complications arise.”
Evaluations have shown that Timorese midwives who participate in Learning Labs over a six-month period improve their competency in managing childbirth complications when compared against pre-training skills, and when assessed against midwives not taking part in the program.
But the training also assists mothers and their babies. Global studies show that women who seek prenatal and childbirth care led by a trained midwife have better health outcomes for both themselves and their child.