The Chain of Survival: Improving Birth Rates

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By Kary Vannice

Worldwide, more than 287,000 women die in childbirth every year from obstetric complications and 99% of maternal deaths occur in developing countries.

Look up the national statistics on infant and maternal mortality for the country of Mexico and you will find that the infant mortality rate is 16 for every 1,000 live births, and the maternal mortality rate is less than 50 for every 10,000 births.

Concisely laid out World Health Organization graphs and charts will tell you that these rates are getting significantly better in recent years for Mexico as a whole.

But sit down with Dr. Haywood Hall, the founder of a non profit organization, PACE, aimed at raising the standard of emergency medical care in Latin America, and you will soon find that the mortality rates for the state of Oaxaca (one of the most rural states in Mexico) look decidedly different.

I recently had the opportunity to meet Dr. Hall and talk with him about how his organization is working to help reduce the infant and maternal mortality rates throughout Mexico but in rural areas in particular.

“Anywhere where the demand outstrips infrastructure, death rates are going to be higher,” explains Dr. Hall. And indeed, the statistics for the state of Oaxaca support his assertion, with the rates of both infant and maternal mortality being higher than the national average.

PACE is dedicated to raising the standard of emergency medical care throughout Mexico through specialized training programs for medical personnel. They offer both a basic and advanced course in emergency obstetrics.

It is no mystery what causes most deaths during childbirth: 24% occur because of excessive haemorrhaging, another 12% are the result of eclampsia, or seizures in the mother and 8% are caused by obstructed labour.

The majority of deaths in these scenarios can be prevented if medical staff  know what to look for and take action at the right time.

Dr. Hall says “We make sure that physicians and other providers can actually recognize and treat emergency conditions.  We also teach teamwork and develop systems to respond in a coordinated way to emergencies. The result is improved management of emergency conditions at all levels…the chain of survival.”

It may surprise you to find out that these training courses are only a one-day training for the basic course and a 2-day training for the advanced course. That doesn’t sound like much, but these programs have helped to reduce the maternal mortality rate by a whopping 31% in the state of Chiapas.

Both programs rely heavily on the use of a mannequin that simulates childbirth to educate students about different emergency situations.

The basic course is for medical professionals like midwives, nurses and EMTs. In this basic hands-on class, students learn everything from how to reposition the fetus for safe delivery, to life-saving techniques for postpartum hemorrhage, to neonatal resuscitation on an infant-sized mannequin.

The advanced two-day course, for OB-GYNs, Pediatricians and Emergency and ICU Specialists covers topics like premature labor, ultrasound diagnosis during labor and delivery, and cesarean delivery along with many other more technical complications.

When asked if the success rates were the same with both programs, Dr. Hall had this to say…

“In general, basic care is done with less need for technology and infrastructure and a lesser knowledge base…so advances can be dramatic.  There is some law of limiting returns as you go to higher technology.  Look at (the) amazingly expensive health care system in the United States.  So, I am biased towards the basics, the fundamentals.”

And ‘the basics’ are what is needed in areas such as Oaxaca where medical professionals near the bottom rungs, such as EMTs and midwives, receive very little ongoing training in these areas.

The Advanced program is also responsible for saving a lot of lives as Dr. Hall explains “Our Advanced Life Support for Obstetrics Program has become a near gold standard.  We can honestly say we have saved many lives of mothers giving birth.  We have a contract to train almost 2500 people next year in the State of Mexico, the state with the highest number of deaths in Mexico.”

Because PACE is a non-profit organization, the cost of these trainings is extremely low considering the benefits. Dr. Hall explains, “It is about 2000 pesos per person for the one day (class) and about 4000 for the two day course. There are some other factors such as travel costs and a minimum (number of participants) to make courses viable.”  So why aren’t more hospitals and clinics taking advantage of this life saving training? For one of two reasons; either they don’t know it is available, or they don’t have the funds to support the training.

With clinics like Cruz Roja (Red Cross) running on donations and the small amounts of money paid by patients, they just can’t afford even a one-day training without outside help.

When I asked Dr. Hall what the average person could do to help bring this program to their area. He gave this advice “I think that the best thing that can be done is to support local training at all levels.  If people are not trained, it does not matter what equipment, medicines, or services exist.  You will have the ‘Shiny Ambulance Syndrome’”.

Indeed, it doesn’t matter how shiny the ambulance is that shows up to help a birthing mother in distress if the people on board don’t know how to help her. She may become another sobering statistic on one of those World Health Organization charts.

You can help save the lives of pregnant mothers and unborn babies where you live by helping to bring a PACE training program to your area. Contact your local Cruz Roja and we can all take pride in seeing significantly lower numbers for infant and maternal mortality in 2013!

***PACE also offers training programs in First Aid, CPR, Basic Life Support, Advanced Cardiac Life Support, Pediatrics Advance Life Support, Focused Assessment with Sonography in Trauma, Pre-hospital Trauma Life Support, Ultrasound, and Assessment and Treatment of Trauma. In addition, they offer a Med-Spanish Immersion course to English speaking medical professionals to help them better serve their Latin patients.

*PACE has a Spanish-only website for their training programs offered in Mexico at:

And an English-only website about their MedSpanish course:

  • Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth.
  • 99% of all maternal deaths occur in developing countries.
  • Maternal mortality is higher in women living in rural areas and among poorer communities.
  • Young adolescents face a higher risk of complications and death as a result of pregnancy than older women.
  • Skilled care before, during and after childbirth can save the lives of women and newborn babies.
  • Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%

Source: World Health Organization

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