Training Malian Matrones To Reduce Postpartum Hemorrhage

Use of active management of the third stage of labor (AMTSL) has been shown to reduce postpartum hemorrhage and associated maternal mortality. In Mali, training in AMTSL has been offered to nurses and midwives at health facilities, but many Malian women receive childbirth assistance from skilled birth attendants and midwifery assistants called matrones.

Cheick Toure, Mali Country Director for IntraHealth, will present the study “Improving Safe Delivery via Matrones in Mali” at the 10th Annual Society for African Gynecologists and Obstetricians (SAGO) conference on December 17, in Bamako, Mali. Part of the session “On Causes of Maternal Death: Hemorrhages,” Toure’s presentation will explain the rationale for training matrones and skilled birth attendants in AMTSL,  describe the study protocols for testing the feasibility and safety of this training and discuss how the results of the study affected Mali’s Ministry of Health policy.

The Malian Ministry of Health chose three districts for this study, conducted with funding from USAID through the IntraHealth-led Capacity Project and with the POPPHI Project,  as well as support from ATN and PKC . At the study’s end, participating project facilities showed 90 percent coverage for AMTSL and reduced postpartum hemorrhage rates. Women attended during childbirth by AMTSL-trained matrones showed no proportionate increase in obstetric complications. The study also suggested that the reduction of postpartum hemorrhage resulting from AMSTL encourages more women to come to health centers for birth.

As a result of this study, the Capacity Project, together with the POPPHI Project, recommended that Mali’s Ministry of Health allows matrones to practice AMTSL on a national level, continues the efforts to make uterotonics more available and improves its monitoring system to include AMTSL-related indicators. The Ministry of Health agreed to these recommendations and will be working with the Capacity Project and other organizations to scale up matron training.