By Zoe Quint

While disparities in the quality of healthcare facilities are undoubtedly present in America, we take many standard practices, including clean birthing procedures, for granted. These practices include, but are not limited to, proper hand washing and hygiene and maintaining clean birthing rooms, tables and instruments. In the United States, we expect clean running water and electricity at all of our hospitals and healthcare facilities. In fact, it is hard to imagine a hospital that lacks access to running water, or that doesn’t have electricity 24 hours a day. Unfortunately, a basic lack of fundamental resources is a reality for many hospitals in developing countries around the world, particularly in many countries in Africa and South Asia.

Resource scarcity during labor and delivery prove to be especially difficult for preterm or low birthweight (LBW) babies. According to the World Health Organization (WHO), over 9 million LBW babies will be born in South Asia and another 3 million in sub-Saharan Africa this year. These babies are particularly vulnerable and usually need extra care to prevent their death from avoidable causes, such as hypothermia (cold), hypoglycemia (low blood sugar), or infections. Tragically, not all get the care they need and do not survive.

Expecting mothers in the U.S. might be deciding whether they want their birth to happen at home, in the hospital or in a birthing center. However in many developing countries, it is not uncommon for women, especially those in rural settings, to give birth on rags, or directly on a dirt floor. Many of these women develop sepsis (infection after prolonged vaginal delivery), which can be fatal. Sometimes, the infant can also contract sepsis as well. The biggest form of assistance that has shown a marked improvement in reducing the number of infant and maternal mortality is the introduction of clean birthing kits (CBK). A basic birthing kit aims to promote the WHO’s “6 Cleans”:

 

1. Clean hands
2. Clean perineum
3. Clean delivery surface
4. Clean cord cutting implement
5. Clean cord tying
6. Clean cord care

 

A kit will typically include a plastic sheet, plastic gloves, a clean razor and cloths. A clean razor is especially important so that umbilical cord infections can be prevented. Kits are usually provided by nonprofit aid organizations, such as Cleanbirth.org.

It is important for caregivers to be aware if the laboring mother begins to have obstetric complications. This often proves difficult, as many women in developing countries give birth without a skilled provider by their side. This can prove fatal if emergency resuscitation or another intervention is needed for the infant. While most babies are able to begin breathing independently at birth, up to 10 percent of newborns require some form of assistance to initiate breathing. Failure to breathe at birth most often occurs with preterm babies.

Helping Babies Breathe is an educational initiative that is overseen by the American Academy of Pediatrics, WHO, USAID and a number of other global health organizations. It is geared towards helping teach neonatal resuscitation to skilled birth attendants in resource-limited areas.

Overall, regardless of where you are in the world, clean birth practices are integral to ensuring a safe birth for both mother and infant. Clean birthing kits are helpful, but there must also be educational intervention at the individual, community and healthcare facility levels. A successful birth, natural, preterm or otherwise, is nearly always a communal and supportive effort.