“Last month, I assisted 115 deliveries,” says Vimla Katiyar, one of India’s Auxiliary Nurse Midwifes. Day and night, Vimla works at a pink-painted public health facility adjacent to her home, a few miles from the district of Kannauj. “…A delivery almost every night.”
Vimla provides maternal heath care at a small public health facility in Uttar Pradesh. More women die from complications in pregnancy and childbirth in Uttar Pradesh than anywhere else in the country. Vimla’s health sub-center, like many in rural India, faces challenges related to poor infrastructure and limited staff. As the government and its partners address these issues—making progress to end preventable maternal death—Vimla plays a key role. She is passionate about saving women’s lives.
“I never say no to anyone. I make sure to attend to everyone that drops by the facility,” says Vimla. “My children tell me, ‘don’t stay awake during nights. You will fall sick. You have blood pressure problems.’ I tell them, ‘people come to me from distant villages, and if I don’t do this work, where will they go?’”
Vimla’s daily work includes providing maternal and newborn care, immunizing mothers and children under five, and providing family planning counseling.
Today, a pregnant woman calls on Vimla for antenatal care—her second visit.
“Have green leafy vegetables regularly. Take good care of yourself,” advises Vimla. Authoritative but warm, Vimla explains to her client that her hemoglobin levels are below normal. She needs a diet rich in iron.
Vimla has spent almost half of her life working at the health center, and is best known for her midwifery skills. She provides care to mothers and babies with passion and confidence, and has the constant urge to update and improve her skills—to help more women deliver safely. But she cannot do it alone.
Pathfinder supports me here,” Vimla says.
Vimla has been visited three times by a group of dedicated individuals—staff from Pathfinder International’s MATRIKA project and a senior doctor from a government facility. The team’s goal is to improve the quality of maternal and newborn health care by providing on-site supervision and guidance to providers like Vimla. Together, the visiting team observes Vimla, identifying good practices as well as gaps in the services she provides. Then they share their observations with her and suggest ways to continuously improve.
These visits have been particularly helpful for Vimla. The Pathfinder team has expanded her knowledge about postpartum hemorrhage—a leading cause of maternal death.
“Before, I knew a little about how to recognize postpartum hemorrhage, but the onsite training gave me an opportunity to learn in detail how to identify it in time and manage it.”
To effectively manage excessive bleeding after childbirth, providers like Vimla may be tasked with using a non-pneumatic, anti-shock garment. This first-aid device made of neoprene and velcro is wrapped tightly around the lower sections of a woman’s body. It forces blood to flow back to vital organs, buying the woman time until she can reach a higher-level health facility capable of treating such severe hemorrhage. When used correctly, this garment can help save a woman’s life.
“I was confused…didn’t know how to tell if the garment is wrapped properly,” admits Vimla. During Pathfinder’s visit, she learned. “The doctor told me that if it makes a sound—snap—then it’s tied properly. I haven’t had a chance to use the garment yet. But if need arises, I’ll be able to use it confidently.”
Vimla is grateful for this information. And there is something else, something she urgently needed to know.
“I gave 1 ampule injection,” Vimla says, describing the dosage of Oxytocin she used to provide women during childbirth. “But during the visit, the doctor told me that the correct dosage is 2 ampules!” Vimla thinks about all the deliveries she has performed; too many to remember. “With God’s grace, nothing [bad] ever happened.”
Through the MATRIKA project, Pathfinder has trained 188 doctors and nurses like Vimla in the recognition and management of postpartum hemorrhage and other aspects of pre-natal and post-natal care. Pathfinder has conducted at least three quality improvement visits to 88 public service facilities. The results are encouraging. Today, across Uttar Pradesh, providers like Vimla appear more confident and capable.
“With Pathfinder’s support, I am better prepared to tackle any cases of complicated pregnancy and save lives,” Vimla says. “People trust me a lot, and I want to give them my best…”
Vimla gets ready for her next delivery.
This is my duty.”