Skilled Birth Attendant

State Institute of Health and Family Welfare, Jaipur

 Skilled Birth Attendant
Ø Skilled birth attendant is
ØAn accredited health professional-
midwife, doctor or nurse
ØEducated and trained ,with skills
needed for
ØManaging normal (uncomplicated)
pregnancies, childbirth and the
immediate postnatal period
ØIdentification, management and
referral of complications in
women and newborns
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 In Simpler Terms
Ø Skilled birth attendant is a person who can
ØHandle common and major obstetric
and neonatal emergencies
ØRecognize the situation beyond his/ her
capability and refers the woman or the
newborn to a FRU/doctor.
ØDoes not include TBA, even if trained.

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 Why Need SBA
Maternal Deaths – Causes (WHO report-2005)

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Why Need SBA

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 4 Delays in Obstetrics

Ø 4 delays in
Øproblem identification
Ødecision making
ØReaching facility
ØProviding emergency care
Ø

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Interventions that can help

ØSkilled attendance at birth

ØComprehensive emergency
obstetric care
ØOrganized referral transport
system to access these
facilities
Ø

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Skilled Attendance at Birth

ØMost of the obstetric complications

are unpredictable
ØTimely and life saving support and
intervention are a must
ØAbsence of midwifery skills-
Increased chances of causality

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Skilled Birth Attendant-Training

Ø UNICEF and other agencies advocated



Ø GOI revised the guidelines on midwifery

trainings and enlarged the scope


Ø Included in the PIP of NRHM

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 Training

Ø To improve intra-partum and new born

care services in institutions.
Ø Develop understanding, knowledge and
skills of birth attendant

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Training Outcomes

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 Skill Required

Ø Care during pregnancy

Ø Care during labour and delivery
Ø Care after delivery
Ø Essential new born care


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 Skill Development
Ø Care during pregnancy – 4 ANC visits
ØBP measurement and diagnosis
of pre-eclampsia
ØHB estimation/
proteinuria/glucosuria
ØPosition of fetus
ØAuscultation of fetal heart rate
and diagnosis of fetal distress
ØCounseling
ØBirth preparedness
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 Skill Development
Ø Care during labour and delivery- Intra partum
care
ØMonitoring progress of labour through
partographs (timely refer)
ØFetal heart rate
ØProgress of labour-cervix dilation
and contractions
ØMaternal conditions- BP and Pulse
Ø Use drugs for prevention of PPH
Ø Use drugs in emergency situations before
referral
Ø Perform basic procedures at community level in
emergency situations
n
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 15
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Ø Care after delivery – post partum care
ØAssessment of mother for PPH/
sepsis/ eclampsia
ØInitiation for breast feeding
Ø Essential new born care
ØImmediate management – wiping,
drying, placing
ØAssessment and management of
asphyxia
ØKeeping the baby warm
ØSkin to skin contact with mother/
 kangaroo mother care
Ø
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 The Important Skill
Ø Early recognition and management of
common obstetric complications
ØAnte partum hemorrhage
ØPre-eclampsia
ØObstructed labour
ØPost partum hemorrahage
ØConvulsions/ seizures
ØPost partum sepsis
ØUse tablets and injections to prevent
emergency/ before referral e.g.
ØTab. Misoprostol (APH)
ØInj. Magsulf (Eclampsia)
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 Training Methodology
Ø Theory-
ØInteractive sessions, presentations and
discussion
ØDemonstration and simulated practice
on mannequins
Ø Intensive hands on-
ØANC OPD
ØLabour rooms for delivery and new born
care
ØPost natal wards
ØLaboratory
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Level I – Training of trainers
Ø Conducted at-
ØMidwifery Resource Center (Zanana
Hospital, Jaipur)
ØNow at - Action Research and Training
for Health (ARTH-Udaipur)
Ø Participants-
ØPHN/NT
(HFWTC/DTC/GNMTC/ANMTC)
ØSN (labour room)
Ø Training duration-
Ø15 days (theory & practical sessions)
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Ø
 The Trained Trainers-
Ø MRC-
ØJuly 06 – September 07
Ø11 batches
Ø136 trained
Ø ARTH-
ØMarch 08 – November 09
Ø9 batches
Ø158 trained

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Level II-Training of Birth Attendants
Ø Conducted at-
ØTheory – HFWTC/ DTC/ GNMTC/ANMTC
ØPractical – DH/SDH/CHC
Ø15 districts – 2 practical venue
being developed
Ø Training schedule-
ØTheory – 6 days
ØPractical – 15 days
ØWith 2 practical venue- training – 21
days
Ø1 practical venue – training – 36
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days
 Training of Birth Attendants
Ø No. of Participants-
Ø16 (acc. to new guidelines 4-8 are
recommended)
ØDivide into two practical batches of 8
each


Ø Participants
Øprime focus – ANMs
ØModel Sub-centers
ØSub centers
ØPHC
ØLHVs and SN of identified FRU and 24 x
7 PHC
ØAyush doctor/compounders
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SBA Trainings: Progress

Ø 07-08
Ø1236 trained in 72 batches
Ø 08-09
Ø1976 trained in 126 batches
Ø 09-10 (till Dec.)
Ø1456 trained in 88 batches
Ø
Ø
Ø
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 Training Sites
S.No District Theory Practical
12 Dausa Dausa DH
13 Dholpur Dholpur DH
14 Dungarpur Dungarpur DH/ CHC-Sagwara
15 Ganganagar Ganganagar DH
16 Hanumangarh Hanumangarh DH/ CHC-Bhadra
17 Jaipur Jaipur CHC- Bassi/ Kotputli/ Chomu
18 Jaisalmer Jaisalmer DH
19 Jalore Jalore DH/ CHC-Ahore
20 Jhalawar Jhalawar DH
21 Jhunjhunu Jaipur CHC- Bassi/ Kotputli/ Chomu
22 Jodhpur No trainings conducted
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 Training Sites
S.No. District Theory Practical
23 Karauli Karauli DH
24 Kota Kota
25 Nagaur Nagaur DH
26 Pali Pali DH/ SDH-Sojat City
27 Pratapgarh Pratapgarh DH
28 Rajsamand Rajsamand Dh/ CHC-Nathdwara
29 S.Madhopur S.Madhopur DH
30 Sikar Sikar DH
31 Sirohi Sirohi DH
32 Tonk Tonk DH
33 Udaipur Salumbar PDMC/ CHC-Salumbar
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 Training Sites
S.no. District Theory site Practical Site

1 Ajmer Beawar DH
2 Alwar Alwar DH/ CHC-Rajgarh
3 Banswara Banswara DH/ CHC-Partapur
4 Baran Baran DH
5 Barmer Barmer DH/ CHC-Balotra
6 Bharatpur Bharatpur DH/ CHC- Kumher
7 Bhilwara Bhilwara DH
8 Bikaner Nokha CHC-Nokha
9 Bundi Taleda DH
10 Chittorgarh Chittorgarh DH/ CHC-Nimbaheda
11 Churu Churu DH/ CHC-Ratangarh
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Monitoring of SBA Trainings

Ø SIHFW – Nodal agency

Ø
Ø Monitoring cell established with support of
ØUNICEF – funds
Ø
ØDM&HS

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 Monitoring Cell

ØNodal Officer
ØSBA Coordinator
ØState level monitors
ØZonal Facilitators
ØDistrict Supervisors
Ø
Ø
Ø

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 Activities

ØMonitor the trainings

ØEnsuring quality of trainings
ØDevelops formats for monitoring and
reporting
ØReporting to UNICEF and DM&HS on
the progress of trainings
Ø

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 Monitoring Checklist
Ø Training site preparedness –
Ø Availability of trainers
Ø Supplies –modules/ mannequins/
instruments/ partographs
Ø Classroom observation-
Ø Gaps in teaching/ interaction/ interest/
teaching methods
Ø Assess learning through
Ø Theory – questions
Ø Practical – hands on
Ø Boarding & lodging for participants
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 Challenges

Ø Simultaneous trainings/ programs

Ø Supportive lag-CMHO/RCHO/DPM
Ø Resistance from hospital staff


n
n

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We Hope to Move Towards

Ø Skilled birth attendants at all levels of

health facilities
Ø Well equipped and functioning Sub-centers
Ø Reduction of MMR and IMR

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 

 Thank You