Continued Efforts to Decrease Neonatal Mortality and Stillbirth
Advances in medical science over the last century have slashed the stillbirth and infant mortality rate.
Before the medical advances made in the 19th century, it is estimated that between 30% and 40% of children born alive did not make their first birthday, and at the beginning of the 20th century in an advanced economy of the United States, 600 women per every 100,000 giving birth died in childbirth or shortly after.
There is no denying that the situation has improved greatly worldwide through advances in contraception, hugely improved obstetric care and the discovery of effective antibiotics.
Progress has been slower in the developing world where there is still a long way to go to bring obstetric and neonatal care up to the standards enjoyed by parents in Europe or North America.
Leading Causes of Death at Birth or in the Neonatal Period
Differences are also seen in the reasons for neonatal deaths depending where in the world the mother gives birth. However, the main cause of stillbirth is asphyxia, and this accounts for a quarter of all neonatal deaths worldwide. Complications caused by premature birth are a factor worldwide, but other risks such as malnutrition of mother or baby, malaria, diarrhoeal disease and pneumonia tend to affect mainly babies born in developing nations. Better care in pregnancy may lower the rate of premature birth, and agencies across the world are working towards the Millennium Development Goals as set by the United Nations, three of which are concerned with neonatal deaths, maternal health and health issues such as malaria and HIV. One of the key components of any progress towards decreasing the mortality rates is improved training, and the way in which the training is delivered will vary depending on where in the world the learners are, and which specific issues are to be addressed in the local community.
Book Learning Versus Hands-On Training
All midwifery, nursing and clinical skills training combines lectures and formal instruction, observing other more experienced staff and hands-on
training where the doctor, nurse or midwife has the opportunity to put what they have learned into practise on a real patient. It is this real life experience which can prove the most problematic. In some countries of Western Europe or North America, expectant mothers are monitored throughout their pregnancies, and incidence of complications such as malaria or malnutrition is low. Compare that to the situation in Sub-Saharan Africa for example, where antenatal care is not routine and many women still give birth alone, only calling in medical assistance if the situation becomes desperate. A well-trained medical professional can make the difference between life and death in these situations, and it is therefore essential that medical professional are trained and prepared for all the scenarios they might have to face.
Simulation as a Training Tool
The decreasing number of mothers and babies dying in childbirth or shortly after means that many midwives will go many months or years without ever coming across a seriously ill mother or baby. This is why simulation is such an important tool for teaching new students, and for allowing professionals to refresh their skills and learn new techniques. Modern birthing and neonatal simulators are incredibly lifelike, and can be programmed by an instructor to indicate a variety of symptoms and problems. Students can therefore experience the reality of clinical decision making in a pressure situation but without any risk or implications for a real life patient. Putting students through a training programme where they come up against any possible real life situation should give them the confidence and clinical skills to recognise the symptoms which could indicate that a mother or baby is in danger, and take prompt and correct action to initiate treatment.
Requirement for Regular Refresher Training
Studies have shown that people start to forget new techniques within just a few weeks of having been taught, which is why regular refresher courses in CPR and other medical techniques are essential. If a hospital or training college has a birthing or neonatal simulator among its teaching resources, then they have the capability to train students or run professional development courses to a timetable, rather than hope a patient presents with certain symptoms so that students can be trained. As technology advances, this sort of teaching aid is going to become more commonplace, and in turn better trained doctors, nurses and midwives should lead to even greater reductions in neonatal and maternal death rates.