Affette Mccaw-Binns Transcript

Transcript of interview with Affette McCaw-Binns

We had problems in Jamaica with trying to determine what was the actual rate of perinatal morbidity and mortality, and what were some of the challenges in delivering good care to mothers and their newborns. So we wanted to methodically and comprehensively evaluate the service delivery process and what was happening to these mothers – why, in particular, some would lose their babies and what were the health problems, because we wanted to design health programs that were evidence-based. At that point in time, a lot of what we were being told to do was based on research in other jurisdictions, usually in the developed world. And we wanted to know how much of that applies to us. Are some of the risk factors the same or are they different? And how should we organize our services to most effectively provide care to our mothers and their children?

I think we were able to change a lot of things. There are still many more things that need to be done, but we were able to change quite a few things, based on our findings. One of the big things that we have changed is women delivering at home. Women got into problems in the districts far away from health services. Our earlier studies on maternal mortality found that the maternal mortality rates, the outcomes were worse for women who lived far away from health facilities, and therefore we tried to encourage all high-risk women to deliver in hospital. What that ended up doing, basically, was making everybody come to hospital, because once you had that first child in hospital , then you never went back again.

The other thing is that as women became more aware of what were the potential problems, and who needed to look after them, they shifted their delivery choices toward referral hospitals where obstetricians were on the health-care team, because they knew that that’s where they would get the best care for themselves and their children. What you found is that these referral hospitals were overcrowded and didn’t have adequate facilities to manage the demand for services. We were able to show through our data that the demand was far outstripping the ability of these facilities to provide care. We were able to get international funding to expand the obstetric units in these regional referral hospitals quite significantly.

Some of the challenge was that shortage of staff was affecting the quality of care that the mothers were receiving. And so we changed even the way we lay out the labour and delivery suite, because with few midwives, we couldn’t afford to have women labouring in private individual units where one midwife had to be running from one cubicle to the next – it was affecting outcomes. So we have changed the layout of the labour and delivery suite to enable the midwives to supervise more than one mother at the same time more effectively. That also became the prototype for how we build and how we rebuild for perinatal outcomes. I think we are proud of what we were able to achieve in terms of our impact on health care for women and their babies.