Designing User-Centric Birth Preparedness, Labor Mobilization & Delivery Management

One in every 320 women dies while giving birth in Bihar and 10 percent of these deaths can be attributed to long and obstructed labor. In view of this, the Lab has been tasked with the responsibility of building an ‘easy to use’ aid or tool to enable ANMs and Doctors to track the labor progression of expectant mothers and detect labor complications timely and accurately.

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The field tells us that most/a significant number of pregnant women reach the institution in an advanced stage of labor and need to be rushed to delivery, making labor tracking and the Partograph redundant. Probe further and a plethora of challenges that have a direct and massive impact on Labor Management emerge: delayed alarm raising by the pregnant woman, time taken in cervix examination by ASHAs and DAIs to rule out false labor, delayed labor mobilization as families want to spend as less time as possible in facilities that mostly have poor and unclean infrastructure, families perceive more labor time in facility = high chances of C-Section, less labor time-spent at facilities = natural delivery, lack of birth-prepardness means reactive behavior at the time of labor, inconsistent access to transport cause further delays, ASHAs incentivized for and ensure only institutional delivery but not timely mobilization, obsolete SOPs that require even visibly complicated cases to be taken to PHC and then to be refered, even when ambulance drivers are capacitated to take such better informed decisions high labor traffic with limited health-workers at institutions, no user friendly tool to track key labor vitals on, delayed clinical decision making in the absence of tracking tools…..and so on!

These are highly complex and interconnected challenges and each of them needs to be tackled to reduce maternal and infant mortality at the time of Labor. In character, like all complex challenges, they span from being behavioral, attitudinal, informational, infrastructural, clinical and so on…Let there be no doubt that placing one silver piece of the jigsaw will not complete the puzzle. As we embark on designing this journey and its components, here are some initial ideas: Help us make the most promising ones a reality!

  • A Woman’s Personal Calendar that helps track Last Date/Month of Period and Auto-Generates Expected Due Date
  • Tayari Tool: Labor Action Plan/Birth Readiness Framework for Families

–     Including PHC Map, Medical History, Delivery Wallet, Local Transportation Contact Numbers, When to Raise Alarm Education

-     Near-EDD/Labor ASHA Visits to monitor preparedness

  • Early Registration for Delivery at District Sadar for Pregnant women who have had C-Sections previously, or are profiled as vulnerable
  • Home to PHC distance based Labor Mobilization Plan (check time taken to travel to the PHC)
  • ‘Know Your Ward’

-     1 out of 3 ANC for a pregnant woman to be conducted at the PHC,

-     Tour of the Labor ward, for the mother to feel comfortable and acquainted with the environment in advance

-     Advance trip plants geographic memory; steps traced back quickly at the time of labor.

  • Elected Community Transport Call Tree: Syncing Mobilization and Local Transportation Systems
  • ‘Mobile Me’ App for Pregnant Women: 

-       Tracks Birth-Prepardness Details

-       ‘Mobilize Me’ button when pressed sends a call to 3 emergency numbers (ambulance or local tempo driver, ASHA and a family member) and a notification to the PHC.

-       Callers respond by pressing the ‘enroute’ button signifying that they are on their way to mobilize the woman in Labor.

-       PHC makes preparations for delivery.

-       PHC ANM/Paramedic is on call with Mobilizers to constantly track patient basis a predefined vitals checklist.

  • ASHA Incentives for timely Labor Mobilization:

-          ASHAs paid incentive for timely labor mobilization which is decided by the ANM / Doctor on call.

-          If the ANM recognizes that she has brought in a patient in an advanced stage of labor her incentive is takes a mild cut.

  • Decision Making Support for Ambulance Drivers and ASHAs: Identifying danger signs, circumventing PHCs and directing visibly complicated cases straightforwardly to Sadar Hospital.
  • IVR based symptom check-lists for Mobilizers/Accompanying Care-givers for remote diagnosis
  • Common Partograph Dashboard for Labor Waiting Wards that track vitals of all women in labor admitted at the facility. Helps Health-providers to track progress, divide attention and take timely decisions
  • LED backlit Partograph –In a situation where 2/3rd of the deliveries are night deliveries and overall lighting is poor, this Partograph shines!
  • Smart Partograph Application with Audio Feedback
  • Simplified Paper-based Visual Partograph
  • Referrals Decision Making Support for Midwives and Doctors
  • Framework for Referral – Risk:

-          Alignment between PHCs, Sadar Hospitals and Private Hospitals in terms of patient information flow and portability, smooth patient referral systems and complication advance preparedness SOP as referred patient is in transit

-          Map facilities according to Complication Handling Capacity, Translate into a Health Map with Phone numbers for easy reach

-          Live updation of Medical Staff Availability to handle complication within 10 km       radius

I invite you to write to us at divya.datta@cks.in with ideas, arguments, thoughts that will help us make this a reality. I look forward!

 

 

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