Friday, March 22, 2019

Slow and Steady Wins the Race

(Picking up where I left off on my recent Instagram/FaceBook post...)
Waiting for Ultrasounds

The Process of Growth

All new endeavors are overwhelming at the beginning. Growing at a slow, but steady pace can help you become well established as you begin to provide women with excellent maternal healthcare. There are many ways to build a maternal health program, no one way is correct. In order to make it less overwhelming for you as you dream of your future impact, we want to talk about the slow and steady way the Heartline Maternity Center model was built.

The Maternity Center began 12 years ago. (2007)

At the beginning we simply met occasionally with 15-20 pregnant women to talk about pregnancy and basic health issues. It was similar to a support group and was meant to be a supportive and friendly learning environment.  About a year into the meetings we started distributing Prenatal Vitamins and Iron supplements. We began taking vitals each week as the women arrived and started recording their weight, pulse, and blood pressure each week before class. About two years into the weekly class gatherings, two certified midwives moved to Haiti to begin doing full prenatal visits. We were careful not to offer anything beyond the training and experience of the staff. The two midwives began seeing the women for prenatal care after program each week on the same schedule an OB/GYN or Midwife would do visits in North America. Prenatal care and regular consultations were provided at Heartline, but the client still needed to deliver at home or find a hospital.

During the first two years we also offered a class for women to attend after they delivered. We began holding classes for pregnant moms on Thursdays and postpartum moms and new babies on Tuesdays. The evaluation of the postpartum class created a deep sense of community amongst new moms who were perhaps doing things differently than their own mothers had.

About three years into the program we began to offer labor and delivery services. Before we could offer these services we needed to be sure we could cover the Maternity Center with a staff member 24/7 365 days per year. Sadly, many clinics and hospitals in Haiti don't deliver babies on weekends or at night. We think that's nonsense! We made sure to have two skilled and trained midwives on staff before we began to offer that service.

About four years into the program we realized that we needed to keep women after delivery for longer than the six hours that is customary in low resource countries. We added postpartum care with around the clock care providers for as many days as each individual mother and baby needed.

In the fifth year we began offering a birth control program. Prior to that we provided education on child spacing and methods of contraception, but had yet to provide contraception at our facility.

In our sixth year we were gifted an excellent Ultrasound machine. Several staff members received training to perform U/S. We began to use U/S during interviews of newly pregnant women. This allowed our due dates to be very accurate. Often times LMP (last menstrual period) is uncertain.

As we continued to grow, we added approximately 10 pregnant women a year to the prenatal program. As we increased the number of prenatal program participates, we also increased staff. This brought us eventually to our max number of 70 to 75 pregnant women in our care at one time. As one woman delivers, a newly pregnant woman takes her place and begins the weekly classes and prenatal care in her first trimester.  

As we became more experienced and hired more medical professionals we also began to take on slightly more complicated pregnancies. In the early years all women with pre-existing hypertension, asthma, or gestational diabetes were risked out of our care. As we have grown we have been able to take on more of those clients and we risk out less women than we did at the start. (Of course, there are still women that must be referred to higher level care with a Doctor.)

As we grew, we established both medical and practice protocols. We hired more staff and went from zero Haitian medical professionals (just two Americans) to seven Haitian medical professionals, employed full time with insurance and benefits.
Five newly pregnant women receiving contract to join the Prenatal Program
 Overall, it has taken us 10+ years to hire and build up a staff that is fully on board with the mission and vision of the maternity center, and to grow into what we believe is our full capacity as a maternal health program.

Prenatal Class March 21, 2019

We don't aspire or plan to grow our numbers to more than 70 to 75 pregnant women at a time (this ends up to be about 120 babies born in a calendar year). The high quality care, education, and focus on building trusting relationships is part of the reason we have such great outcomes. We believe the high provider to client ratio is an essential part of the model of care. In order to provide excellent care we know we cannot keep adding more women. We believe quality over quantity ascribes dignity and honor to each woman we care for.

Because we don't plan to grow, we know the only way to keep reducing maternal and newborn mortality is to share the model and equip others to take it and run with it.

Please let everyone you know (that is working at an organization that is attempting to help with women's health) know that we are offering a class and manual about how to build this program and save Moms and Babies from PREVENTABLE death.