In Uzbekistan, midwives learn to make calls that save lives

KANLIKUL, Uzbekistan – Soon after Munira Kholmurodova gave birth to her third child, a son, she started bleeding profusely. “I was so scared that I would not be able to hug my child,” she said.

Ms. Kholmurodova was suffering post-partum haemorrhage, which accounts for one fourth of maternal deaths worldwide and is a leading cause of maternal morbidity and mortality in Uzbekistan, according to the Second National Report on Confidential Enquiry into Maternal Death during 2013-2015. But post-partum haemorrhage is treatable and should not be fatal if it is immediately detected by a skilled birth attendant.

Fortunately for Ms. Kholmurodova, Venera Jumabayeva, the midwife who admitted her to the hospital and attended her birth at the maternity ward of the Kanlikul District Health Department, had received specific training in preventing and treating post-partum haemorrhage.

When the patient did not stop bleeding from her uterus after giving birth, Ms. Jumabayeva wasted no time in carrying out all the necessary emergency measures. She called in the doctor, performed the necessary bimanual compression of the uterus and assessed whether there was a risk for bleeding relapse.

After Ms. Jumabayeva helped stabilize her patient’s condition, Ms. Kholmurodova was examined by doctors who provided further care and treatment. She was soon able to recover and return home healthy with her baby.

“Thank God he was born. We named him Sulton,” Ms. Kholmurodova said. “I am so happy that I can hug my child.”

Massive haemorrhage cases declining

Ms. Jumabayeva is one of over 1,200 midwives working at specialized inpatient maternity hospitals and departments who have received training in preventing and treating post-partum haemorrhage under a partnership with the Uzbek Ministry of Health and the international humanitarian group LDS Charities co-funded by UNFPA. The initiative started in 2015 and there are plans in place to expand it to cover the entire existing workforce of more than 3,500 midwives.

“Until recently, the [role] of midwives during childbirth and labour, and in the management of post-partum complications, was very limited,” said Bekhruz Yusupov, a reproductive health expert with UNFPA in Uzbekistan. “Thanks to the skills obtained during the trainings, midwives have been able to become active team players in labour management, developing local protocols that define essential measures and steps to prevent life-threatening complications.”

As a result, he explained, Uzbek maternities covered by the trainings have seen a decrease in massive haemorrhage cases requiring robust medical interventions. Moreover, there have been no cases of haemorrhage-related maternal deaths in the hospitals and clinics where personnel received training.

Before the trainings, cases of bleeding after birth were often poorly handled due to lack of skills and set procedures, according to Gauvharay Abdullayeva, an obstetrician-gynaecologist in the maternity branch of the Kanlikul District Health Department.

“The delivery room [would be] full of medical staff, everybody screaming and running around in turmoil; no one is listening to each other,” she said. “Someone rushes into intensive care, and others are running for something else [...] A lot of time is lost.”

The workshops gave Ms. Jumabayeva and other hospital staff – including doctors, nurses and technicians – practical skills on teamwork, blood-loss estimation and its further prevention. This knowledge is "helping us provide quality service to women, prevent maternal deaths and ensure recovery,” noted Ms. Abdullayeva.