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Published: December 5, 2023

Helping babies breathe in their first minutes of life

A baby’s first cry can carry so much meaning. To a mother, it means their child has finally joined the world, full of life and vitality. To a healthcare worker, the baby’s cry is a simple but essential sign that the baby is in good health. Yet most health providers can recall a time when a birth was not accompanied by a cry–meaning the baby was unable to breathe.

For Benedeta Muruga Chacha, the maternity nurse in charge at Muhuru Subcounty Hospital, it was a few years ago when she was caring for a young, first-time mother. The second stage of the delivery was long and arduous, and when the baby was finally born, he was not breathing. Benedeta did chest compressions and sucked fluid out of the baby’s nose–the baby finally started to breathe, but abnormally. Although Benedeta did everything she could, she still had to refer the baby to a higher-level facility in Migori County for advanced care. Fortunately, the baby and the mother both survived.

“I’ve had so many cases where mothers give birth to babies unable to breathe. Those moments are very tense. You try to do everything you can, but you never feel like it is enough.”
- Benedeta Muruga Chacha, Maternity Nurse In-Charge, Muhuru Subcounty Hospital

Charting the course to save all newborns

One of the leading causes of newborn death worldwide is birth asphyxia, or inability to breathe at birth. Yet this is preventable if health workers are trained and have the right equipment to resuscitate newborns and stimulate breathing post delivery–the Helping Babies Breathe (HBB) initiative is how we achieve this. HBB is a clinical training program from the American Academy of Pediatrics aimed at improving neonatal resuscitation in
low-resource settings. The training model rests upon a set of basic equipment, including a penguin sucker used to remove fluid from a baby’s airways and a bag and mask that serves as a resuscitation device to pump air into a baby’s lungs. In other settings like Tanzania, HBB was associated with a 47% reduction in newborn deaths and 24% decrease in fresh stillbirths.

Lwala’s journey to implementing HBB began in 2019. At the time, Migori County had a significantly high rate of perinatal mortality. Before, methods to assist babies who did not breathe at delivery were complicated, uncoordinated, and in the case of chest compressions, could cause internal organ damage to newborns. Tools used for HBB, on the other hand, are low cost, can be implemented without electricity, and do not cause harm to infants.

Since 2019, more than 2,000 health workers across 179 health facilities in Migori County have been trained on HBB and equipped with tools–meaning that 83% of health facilities conducting deliveries in Migori are now equipped to save a baby's life when they are born not breathing. Additionally, we use a training-of-trainers approach, which promotes sustainability. Migori County now has a cadre of trainers ready to cascade HBB to facility-based providers. By 2024, we will reach every facility in Migori where babies are born.

“HBB is a life changing set of skills for health care providers,” says Felix Owuonda, a Clinical Officer at Muhuru Subcounty Hospital. “We can now evaluate a newborn, identify birth asphyxia, and perform HBB protocols in the first minute of life.” When we began implementing HBB, the rate of resuscitation for newborns delivered with difficulty breathing was 78%. With training and mentorship over the last three years, 93% of these babies are now successfully resuscitated.

Evaluating Helping Babies Breathe

As we implement HBB, Lwala is documenting best practices and learnings, contributing to a global body of evidence. We are currently rolling out a study to evaluate the effectiveness of our training-of-trainers approach in improving the rate of successful neonatal resuscitation in 26 Migori County health facilities. The study will compare the change in babies successfully resuscitated at birth, before and after the intervention. It will also monitor knowledge and skills retention of the trained providers. The findings of the study will help guide our programming, inform Ministry of Health policy, and provide a training blueprint for peer organizations that want to implement HBB.

Protecting newborns through policy and systems change

Yet training alone is not enough–providers must also have the right tools and equipment needed to stimulate breathing. At many facilities, poor infrastructure and malfunctioning equipment have diminished the quality of newborn care. To change this, Lwala is working with the Migori County Health Management Team to conduct a situational analysis of the equipment and infrastructure needed for comprehensive newborn care. This  analysis will enable us to identify facility needs, ensure equipment maintenance and mentorship, and improve infrastructure as needed.

Policy change is also required to ensure that health providers across Kenya are trained and equipped on HBB. At the national level, our advocacy led to the inclusion of HBB in the National Emergency Obstetric and Newborn Care (EmONC) curriculum launched last year–meaning that every health provider should learn about HBB protocols and interventions during routine inservice training. We are also advocating for HBB commodities to be  added to the national Essential Medicines List, which would unlock widespread distribution and use.

Changing the story of newborn survival

Because of HBB, Nurse Benedeta now has new stories of the babies she delivers–stories where she is confident and equipped to save a baby’s life. She recalls a recent delivery, where a mother named Nancy gave birth to a baby who was not breathing. “I could see the newborn was in distress,” Benedeta says. “But in that moment, I only felt calm–I knew I had the right tools to intervene. First, I used the penguin sucker to remove fluids from the baby’s nose. Then my colleague Felix and I used the bag and mask to pump air into the baby’s lungs. Soon the baby took his first breath, and we let out our own breath of relief.”

Other health providers show similar enthusiasm–and relief–at having the training and tools they need to reduce newborn deaths from birth asphyxia. “HBB training and advocacy are so important because many babies have been saved,” says Meshack Wafula, the Clinical Training Coordinator at Lwala. “Each time I visit a facility, and I hear a baby cry, I know we are making a difference in our communities.”

Agency, health, and wholeness of life.

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