Program sees stillbirths drop

The rate of stillbirths in developing countries fell more than 30 per cent after birth attendants received basic training in newborn care, researchers have found.

The randomized, controlled trial included 62,366 infants in six countries: Argentina, the Democratic Republic of Congo (DRC), Guatemala, India, Pakistan and Zambia. 

'The reduction in stillbirth is extremely encouraging.' — Dr. Carl Bose

The World Health Organization estimates there are more than three million stillbirths worldwide each year, and nearly four million infants die in their first month of life.

Traditional birth attendants, who are typically lay midwives, attended 40 per cent of the deliveries and nearly 75 per cent in the DRC.

Participants were trained in routine newborn care, including:

• Resuscitation of babies who have stopped breathing.
• Keeping the baby warm.
• "Kangaroo care" of skin-to-skin contact between mother and baby.
• Common illnesses.

Researchers also provided local health-care workers with scales to accurately measure birth weight, hand-held pumps and masks to fill babies' lungs with air and clean kits to prevent infection during delivery.

One health-care worker from each country travelled to the U.S. to learn the techniques and then returned home to train others until 3,600 rural health-care workers were reached.

After the trial, there was a 30 per cent reduction in stillbirths, from 23 stillbirths per 1,000 births before the intervention to 16 after the intervention, the study's authors reported in Thursday's issue of the New England Journal of Medicine.

First breath

"This is a simple intervention and this study demonstrates that it can be effectively taught to traditional birth attendants, who deliver most of the babies born in developing countries such as the DRC," said study co-author Dr. Carl Bose, a professor of pediatrics at the University of North Carolina at Chapel Hill.

Given the way the study was designed, researchers can't say for certain that it was the training that led to a reduction in stillbirths.

But the researchers believe the improvements occurred among infants who had not drawn a breath on their own and would have been misidentified as stillbirths before birth attendants received the training.

"The reduction in stillbirth is extremely encouraging," said Dr. Waldemar Carlo of the University of Alabama at Birmingham, who led the research team.

"Stillbirths among births attended by midwives and traditional birth attendants declined to nearly the same levels seen among births attended by physicians," he added in a release.

Nurse and midwives were the largest group attending at deliveries (30 per cent) followed by family or unattended births (17 per cent) and physicians (13 per cent).

Canada's stillbirth rate remained at 6.4 per 1,000 total births (live births and stillbirths) from 2005 to 2006, Statistics Canada reported in 2008.