Little Changes, Big Difference

Zack LangwayBlog, Midwifery, Tanzania

For Wreatha Carner, it’s the little things that she knows can make the biggest difference.

A Certified Nurse Midwife based out of Las Cruces, New Mexico, Wreatha has spent this year serving as a Global Health Service Partnership (GHSP) Volunteer teaching, training, and working alongside midwives in Tanzania.

“As a clinical instructor, some of my 4 or 5 person student groups perform as many as 15 births between them in 8 hours,” said Wreatha, describing the busy conditions under which midwives work. In a country facing a dire shortage of midwives and other skilled health professionals, only 4 midwives are in service for every 10,000 patients across Tanzania.

So in addition to training and teaching the next generation of Tanzanian midwives – helping to build capacity, strengthen the pipeline of skilled midwives in Tanzania, and ultimately “train the trainers” for future generations – Wreatha is looking to the little things that can make a huge difference in the efficiency and efficacy of her fellow midwives’ work.

“Simple equipment, with proper training in use, is what leads to the best labor management and delivers the best outcomes for mother and baby,” noted Wreatha. In fetal assessment, often times a Pinard horn is used for a midwife to determine the baby’s heartrate. Yet complicating factors – distracting sound, imperfect counting, confusion between baby and mother’s heartbeat, the intimacy of this examination – can create a margin of error.

“Listening for a whole minute with a Pinard is hard to do,” remarked Wreatha, noting the difficulty even for more experienced midwives. “And timepieces for many people are now cell phones, which don’t have a second hand. The timers and stopwatches on phones are hard to use – you can’t watch digital numbers and accurately count the heart rate at the same time.”

Because electronic fetal monitoring, which is common in the US, is not practical for facilities in Africa due to the purchase cost and need for lots of paper and ink, “just learning to use a simple Doppler rather than a Pinard can help make the work of the midwife a little easier.”

So one “little thing” Wreatha is working on, in addition to her teaching and training, is brining additional Doppler equipment to her facility in Tanzania. Through grants from Seed Global Health, and awards like her recently-received W. Newton Long award from the American College of Nurse-Midwives, Wreatha is helping more midwives use a simple, affordable device to improve their care for mom and baby.

“A Doppler uses its computer chip to average what it’s ‘hearing’ during examination,” explained Wreatha, “and it moves things along in real time with a low margin of error.”

With these awards Wreatha is receiving, she is helping to deliver equipment that will not only serve mothers but also allow local midwives to become better trained on their use with the guidance of a skilled instructor, like Wreatha and her fellow educators.

“A process improvement like this can help develop the ability of midwives to do correct intrapartum fetal assessment and follow labor management guidelines to create safer care,” said Wreatha. And when it comes to the health of mom and baby – and the 15 patients Wreatha’s students may attend in labor and birth in a day – even this seemingly-simple process improvement can make all the difference for a midwife’s confidence, mom’s health, and baby’s best start in life.