Skilled Birth Attendant
(SBA)
State Institute of Health & Family Welfare
Jaipur
SIHFW: an ISO 9001: 2008 certified institution 1
Skilled Birth Attendant
n An accredited health professional- (midwife,
doctor or nurse)
n Educated and trained, with skills needed
for:
n Managing normal (uncomplicated)
pregnancies, childbirth and the
immediate postnatal period
n Identification, management and referral
of complications in women and
newborns.
n Does not include TBA, even if trained.
SIHFW: an ISO 9001: 2008 certified institution 2
Why Skilled Attendance At Birth
n Most of the obstetric complications
are unpredictable
n Timely and life saving support and
intervention are a must
n Absence of midwifery skills-
Increased chances of casualty
SIHFW: an ISO 9001: 2008 certified institution 3
Maternal Deaths – Causes
Indirect Severe
causes Bleeding
Other 19% 25%
direct
causes
8%
Infections
15%
Obstructed
Labour Unsafe
8% Abortion
Eclampsia 13%
12%
Source-WHO
SIHFW: an ISO 9001: 2008 certified institution 4
Neonatal Deaths – Causes
Cord
Infections
2%
Birth Other causes
Injuries 18%
Diarrhoel 3%
Diseases
4%
Congenital Prematurity
malfunctions 51%
5% Acute
Respiratory
Infection
17%
Source-WHO
SIHFW: an ISO 9001: 2008 certified institution 5
4 Delays In Obstetrics
n 4 delays in
n problem identification
n decision making
n reaching facility
n providing emergency care
SIHFW: an ISO 9001: 2008 certified institution 6
Interventions That Can Help
n Skilled attendance at birth
n Comprehensive BEmOC & EmOC
n Organized referral transport system
to access these facilities
SIHFW: an ISO 9001: 2008 certified institution 7
Skilled Birth Attendant-Training
n UNICEF
n GOI revised the guidelines, enlarged the
scope
n Included in the PIP of NRHM
SIHFW: an ISO 9001: 2008 certified institution 8
Training: Objective
n To improve intra-partum and new
born care services in institutions.
n Develop understanding, knowledge
and skills of birth attendant
SIHFW: an ISO 9001: 2008 certified institution 9
Training Outcomes
Development of skill and confidence
Health facilities-
-Increased role of health providers
-Qualitative services
Reduce IMR ( MDG 4) and Improve
maternal health (MDG 5)
SIHFW: an ISO 9001: 2008 certified institution 10
Skill Required
§ Care during pregnancy
§ Care during labour and delivery
§ Care after delivery
§ Essential new born care
SIHFW: an ISO 9001: 2008 certified institution 11
Skill Development
n Care during pregnancy – 4 ANC visits
n BP measurement and diagnosis of pre-
eclampsia
n HB estimation/ proteinuria/ glucosuria
n Position of fetus
n Auscultation of fetal heart rate and diagnosis
of fetal distress
n Counseling
n Birth preparedness
SIHFW: an ISO 9001: 2008 certified institution 12
Skill Development
n Care during labour and delivery- Intra partum
care
n Monitoring progress of labour through partographs
(timely refer)
n Fetal heart rate
n Progress of labour-cervix dilation and
contractions
n Maternal conditions- BP and Pulse
n use drugs for prevention of PPH.
n use drugs in emergency situations before referral
n perform basic procedures at community level in
emergency situations 13
SIHFW: an ISO 9001: 2008 certified institution
SIHFW: an ISO 9001: 2008 certified institution 14
Skill Development
n Care after delivery – post partum care
nAssessment of mother for PPH/ sepsis/
eclampsia
n Initiation for breast feeding
n Essential new born care
n Immediate management –
wiping, drying, placing
n Assessment and management of asphyxia
n Keeping the baby warm
n Skin to skin contact with mother/ kangaroo
mother care
SIHFW: an ISO 9001: 2008 certified institution 15
The Important Skill
n Early recognition and management of
common obstetric complications
n Ante partum hemorrhage
n Pre-eclampsia
n Obstructed labour
n Post partum hemorrhage
n Convulsions/ seizures
n Post partum sepsis
n Use tablets and injections to prevent
emergency/ before referral e.g.
n Tab. Misoprostol (APH)
n Inj. Magsulf (Eclampsia)
16
SIHFW: an ISO 9001: 2008 certified institution
Training Methodology
n Theory-
n Interactive sessions, presentations
and discussion
n Demonstration and simulated practice
on mannequins
n Intensive hands on-
n ANC OPD
n Labour rooms for delivery and new
born care
n Post natal wards
n Laboratory
17
SIHFW: an ISO 9001: 2008 certified institution
Level I – Training of Trainers
n Conducted at-
n Midwifery Resource Center (Janana
Hospital, Jaipur)
n Now at - Action Research and
Training for Health ( ARTH-Udaipur)
n Participants-
n PHN/ NT
(HFWTC/DTC/GNMTC/ANMTC)
n SN (labour room)
n Training duration-
n 15 days (theory & practical sessions)
18
SIHFW: an ISO 9001: 2008 certified institution
The Trained Trainers
n MRC-
nJuly 06 – September 07
n 11 batches
n 136 trained
n ARTH-
n March 08 – November 09
n 9 batches
n 158 trained
SIHFW: an ISO 9001: 2008 certified institution 19
Level II-training of Birth
Attendants
n Conducted at-
n Theory- HFWTC/ DTC/ GNMTC/ANMTC
n Practical- DH/SDH/CHC
n 15 districts - 2 practical venue developed
n Training schedule-
n Theory – 6 days
n Practical – 15 days
n With 2 practical venue- training – 21 days
n 1 practical venue – training – 36 days
SIHFW: an ISO 9001: 2008 certified institution 20
Training of Birth Attendants
n No. of Participants-
n 16 (new guidelines recommend 4-8)
n Divide into two practical batches of 8 each
n Participants
n prime focus – ANMs
n Model Sub-centers
n Sub centers
n PHC
n LHVs and SN of identified FRU and 24 x 7
PHC
n Ayush doctor/ compounders
SIHFW: an ISO 9001: 2008 certified institution 21
SBA Trainings: Progress
n 07-08
n1249 trained
n 08-09
n 2194 trained
n 09-10
n 2111 trained
n 10-11
n 2014 trained
n 11-12
n 829 trained (till jan 2012)
Source: Directorate of Medical, Health &Family Welfare services, Jaipur
22
SIHFW: an ISO 9001: 2008 certified institution
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 23
SIHFW: an ISO 9001: 2008 certified institution
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
24
SIHFW: an ISO 9001: 2008 certified institution
Training Sites
S.No. District Theory Practical
23 Karauli Karauli DH
24 Kota Kota JK Lon
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
25
SIHFW: an ISO 9001: 2008 certified institution
Monitoring of SBA Trainings
n SIHFW – Nodal agency
n Monitoring cell established with
support of
n UNICEF – funds
n DM&HS
SIHFW: an ISO 9001: 2008 certified institution 26
Monitoring Cell
n Nodal Officer
n SBA Coordinator
n State level monitors
n Zonal Facilitators
n District Supervisors
SIHFW: an ISO 9001: 2008 certified institution 27
Activities
n Monitor the trainings
n Ensuring quality of trainings
n Develop formats for monitoring
and reporting
n Reporting to UNICEF and DM&HS
on the progress of trainings
SIHFW: an ISO 9001: 2008 certified institution 28
Monitoring Checklist
§ Training site preparedness –
§ Availability of trainers
§ Supplies –modules/ mannequins/
instruments/ partographs
§ Classroom observation-
§ Gaps in teaching/ interaction/
interest/ teaching methods
§ Assess learning through
§ Theory – questions
§ Practical – hands on
§ Boarding & lodging for participants
SIHFW: an ISO 9001: 2008 certified institution 29
Challenges
n Simultaneous trainings/ programs
n Supportive lag-
CMHO/RCHO/DPM
n Resistance from hospital staff
SIHFW: an ISO 9001: 2008 certified institution 30
We Hope To Move Towards
n Skilled birth attendants at all levels of
health facilities
n Well equipped and functioning Sub-
centers
n Reduction of MMR and IMR
SIHFW: an ISO 9001: 2008 certified institution 31
Thank You
For more details log on to
www. sihfwrajasthan.com
or
contact : Director-SIHFW
on
sihfwraj@yahoo.co.in
SIHFW: an ISO 9001: 2008 certified institution 32
