First Aid for Women and Newborns
Where Home Birth is Necessary or Common

Home Based Life Saving Skills
In much of the world levels of maternal and neonatal mortality are unacceptably high. Facility-based emergency care is inaccessible or inadequate. Most births take place at home under the care of attendants or family members who are poorly equipped to respond to emergencies. To address this reality, the American College of Nurse-Midwives has created a first aid¹ approach² called Home Based Life Saving Skills (HBLSS). Its goal is to develop emergency care practices that are not only safe but also culturally acceptable and clinically feasible in the home.

Developing and strengthening the links between home, community, and referral facilities through community mobilization is crucial to saving more lives. HBLSS addresses a home birth team that consists of all of those who are expected to be present at a birth, namely the pregnant woman, her family caregivers, and her birth attendant. In a cascade training strategy, a trainer teaches selected community members. Then the trained community members teach home birth teams in the community as they were taught. HBLSS has a flexible design, allowing the trainer and home birth teams to select the topics most appropriate to their needs and interests. The curriculum covers prevention, recognition, and initial home management of life-threatening conditions of the woman and the newborn.³ All topics include prevention of mother-to-child transmission of HIV. To complement the training in home-based care, facility-based skilled attendants receive training in giving emergency care in order to appropriately respond to referrals from the home birth team.

Take Action Cards: HBLSS uses an assortment of methods to maximize communication and learning for participants of varying ability to read. These include stories, case histories, discussion, problem identification with picture cards, demonstration, role play, and coaching using skill checklists called Take Action Cards. There is one Take Action Card for each topic or problem. Compiled in a booklet, the cards are used during training and taken home for reference. The ”problem” picture is on one side of the card, and the ”action to take” pictures are on the other side. In Kanpur, India and Negelle, Ethiopia, the Take Action Cards have proved powerful when providing emergency care as a diagnostic reference and a memory aid to remember what to do during the emergency. The cards are also used as a teaching tool and they have become a status symbol for trained community members and home birth teams. The cards are an essential part of the HBLSS strategy as they are used to teach others in the community during formal and informal meetings. (See example of Take Action Card, figures 1 and 2.)

Figure 1. Problem side of Take Action Card	Figure 2. Action side of Take Action Card

Programmatic Considerations
HBLSS programs in India and Ethiopia were built on existing community development programs. An HBLSS program should have an enabling environment that includes a willing community organization, referral capability or potential to upgrade, and collaborative partners who regard HBLSS as a valuable component of their programs. Organizations incorporating HBLSS into proposals focusing on maternal and newborn emergency care during birth and the immediate postpartum period are encouraged to conduct research necessary to establish the evidence base for this promising new approach.

Lessons Learned

• Adults learn best when they value what they learn. It is essential to conduct a community needs assessment before starting activities.
• The HBLSS process must be followed in order to foster mutual respect and trust.
• “Unskilled” attendants can save lives through appropriate home-based management of maternal and neonatal complications such as postpartum hemorrhage and neonatal sepsis.
• Funds must be allocated for continued community support and supervision.
• Community members can record essential data on pregnancy outcomes for program monitoring and for the Ministry of Health management  information system.
• All stakeholders from the household to government must be involved.
• Men are willing helpers in emergencies when they are involved in the HBLSS program. In Ethiopia, a health committee chairman commented, “Since HBLSS, we men are now involved in childbirth and help when problems happen. Before, we would run away. We were ashamed, did not know how to help.”

¹First aid is emergency care given at the time and place of the life-threatening problem, prior to referral.
²S.T. Buffington, L.M. Sibley, D.R. Beck, D.A. Armbruster. Home Based Life Saving Skills, 1st edition. American College of Nurse-Midwives, 2004. www.acnm.org
³Topics are: Introduction, Woman and Baby Problems, Prevent Problems, Referral, Too Much Bleeding, Sickness with Pain and Fever, Birth Delay, Swelling and Fits, Too Many Children, Baby Has Trouble Breathing At Birth, Baby Born Too Small, Baby Is Sick.

Prepared by S.T. Buffington (stbuff@aol.com), D.R. Beck (dbeck@acnm.org), and L.M. Sibley (lsibley@emory.edu)

Where to get more information: www.maqweb.org

Last Revised: 2/28/06

Produced in association with The Maximizing Access and Quality Initiative
Designed and produced by: The INFO Project at the Johns Hopkins Bloomberg
School of Public Health/Center for Communication Programs