We are not unaware of the long history of giving birth at home. It is even more common in remote places like Kailash Rural Municipality of Makwanpur. People are still stuck with the mindset of not visiting health posts unless the situation is too critical. Expecting mothers are already vulnerable, and the risks only intensify if they deliver at home.
Birthing Centre
A birthing centre, not to be confused with a hospital, is a healthcare facility where people can give birth with the care of trained helpers such as midwives. It is considered more comfortable and homely than a maternity unit in a hospital.
The Birthing Centre provides a well-equipped place for safe delivery, initial care, post-delivery care of the mother, and training for improved nutrition of babies. And, if the mother in labour requires additional medical assistance, she will be transferred to a hospital.
Project Background
Although the Maternal Mortality Rate in Nepal is decreasing every year, the practice of delivering a baby at home is still in high numbers. But the rate increased in the year 2015 compared to 2014. According to macrotrends, a research platform, the maternal mortality rate in Nepal for 2015 was 236.00, a 2.16% increase from 2014. The increase was due to the catastrophic earthquake of May 2015.
The bigger the number of unsafe deliveries, the higher the infant and maternal mortality rate. The factors responsible were the lack of well-facilitated delivery centres, among other hurdles. The practice of delivering a child at home continued to prevail in the remote hills of Makwanpur, Kailash Rural Municipality, which is also one of the project areas of the Shangri-La Development Association.
The Katunje health post of Kalikatar had insufficient room to implement the national plan of safe deliveries. The need for a well-equipped separate delivery room was dire. Thus SDA, in coordination with the local government, constructed a Birthing centre as a One Time Project (OTP) in Kalikatar using the Interlocking Brick technology.
The low health literacy has held the community from attaining hygienic and healthy lives. In Kailash Rural Municipality, Chepangs are the predominant populace. Most families are the poorest of the poor and lack education which explains the absence of health-related awareness. SDA felt the need to establish a birthing centre to ensure safe deliveries and introduce a change in the delivery practice in the communities.
In doing so, the organisation hoped to bring a ripple effect of influencing the habits of the locals to prioritise health and hygiene. The focus of the birthing centre is primarily on mothers and newborns. However, the support they receive would motivate the folks from the community to pay attention to their health and visit health posts for better care on time. Thus, SDA built a well-equipped separate Birthing centre using the Interlocking Brick technology in the Katunje health post of Kalikatar.
Objectives of the Birthing Centre
The construction of a birthing centre had its objectives. The availability of a birthing centre would reduce home delivery and maternal mortality. Similarly, it would help tremendously in promoting safe motherhood. Likewise, improved health behaviours and access to primary health care for mothers and newborns.
Moreover, it would boost the capacities of local health workers. Furthermore, strengthened and built network institutions in the municipalities, especially the mother groups, to support and maintain the health and development activities.
The Birthing Centre provides a well-equipped place for safe delivery, initial care, post-delivery care of a mother, and training for improved nutrition of babies. Mothers who visit the birthplace receive follow-up care from the health post staff.
What Went While Undertaking The Birthing Centre OTP?
Before constructing the birthing centre, the team researched and visited three well-established rural birthing centres. They took pictures of the room and recorded the room concepts and technologies/ standards for the SDA Executive Committee and European teams.
The team responsible for the construction collected ideas based on the research and the visit from the different birthing centres before commencing the birthing centre. Afterwards, the birthing centre construction team prepared designs and drawings of the building and interior concepts for technologies.
The team found that the reinforcement of the existing health and development activities in the health post of the municipality overtook the running costs after the construction. Then the team opted for an interlocking block while constructing the birthing centre. Using blocks for construction lowered the costs since it is cheaper than other brick construction. Another advantage of the birthing centre was that it kept some locals employed temporarily.
For the proper execution of the Birthing Centre, SDA had brought experts from Kathmandu to transfer knowledge and skills to the locals. You can always trust SDA to vouch for knowledge multiplication since it has implemented it in almost all of its project and project activities. It is because even long after a birthing centre gets constructed, the skills and knowledge live on and can be transferred and used to earn livelihoods.
SDA followed the guidelines set according to National Building Code to guarantee that the birthing centre is earthquake-proof. The team maintained supervision during construction to confirm the earthquake safety of the building. Hence, the centre, earthquake resistant, is a safe building in the health post.
The Birthing Centre project involved consultant selection, albeit lengthy, done correctly. The team recommends the consultant selection for future projects too. In addition, the site visits in different locations before launching the project gave more ideas and insights regarding the project, which the SDA can implement in future projects.
The One Time Project also provided equipment support upon completing the birthing centre. The equipment is a suction machine, two beds, a digital baby weight machine, a baby examination table, a light, two surgical machines, and oxygen. The birthing centre, an ideal place to promote maternity and maternal health, started birth preparation training and pregnancy examinations soon after the inauguration.
Birthing Centre At the Present
The health post serves people of at least four wards of the Kailash Rural Municipality. From August 2021 to now, the birthing centre has been a safe space to deliver fifty-two babies.
The SDA has similar mandates to the government of Nepal regarding Antenatal Maternal Care (AMC). The expecting mothers should visit the health posts at least four times for AMC and deliver the baby at the health posts to receive the newborn support package under the neonatal care (NMC) from SDA. The package includes sanitary and hygiene materials for the mother and her newborn. The provision of the support package and the care during and right after delivering the baby has helped change the mindset of giving birth at home.
Since the establishment of the birthing centre, the health behaviours of the expecting mothers and mothers post-delivery have improved. Similarly, mothers and newborns get access to primary health care. Moreover, it is a space designed for safe motherhood. Mothers and women from the community now have a proper place for them to deliver a baby and get maternal care. The mothers get accompanied and a safe birth service. In critical cases, the patients get referred to hospitals in the city area. Besides the direct or targeted beneficiaries, the birthing centre has strengthened the capacity of local health care workers.
The health project of the SDA does regular health awareness activities. And the activities it conducts are linked to the birthing centre and relevant to the women in the communities. The activities encourage institutional deliveries and promote the safety and care of mothers and newborns. The birthing centre has been operating successfully since its inception. The mothers get the facilities, however minimal there and know how to take care of the newborns.
Knowledge Transfer
SDA health team coordinates with the Female Community Health Volunteers (FCHVs) and the mother groups of different clusters of Kailash Rural Municipality to relay information and discuss the Sexual and Reproductive Health and Rights (SRHR) issues. The FCHVs sit for meetings with mother groups and makes them aware of the dos and don’ts during the pregnancy. They also encourage pregnant women in their areas to visit the health posts for checkups.
Likewise, the women in the communities are aware of the preparation methods of emergency concepts and hygienic sets for births in communities if they cannot reach the birthing centres in time and have to deliver at home.
SDA has provided training about safe childbirth and nutrition for mothers and newborns to the mother groups. Once they receive the training, members of the mother groups multiply the knowledge and skills in the community.
The planned and hygienic preparation for birth at the birthing centre has influenced the women in the locality to follow similar measures when they or someone in the family is expecting. The existence of the birthing centre has normalised the practice of delivering babies at health posts. While it might seem like a small step, it is significant in promoting the improved health of mothers and newborns.