The American College of Nurse-Midwives' home-based lifesaving skills program: a review of the Ethiopia field test.

The Home-Based Lifesaving Skills program (HBLSS) is a family- and community-focused, competency-based program that aims to reduce maternal and newborn mortality by increasing access to basic lifesaving measures within the home and community and by decreasing delays in reaching referral facilities where obstetric complications, such as postpartum hemorrhage and newborn asphyxia, can be managed. HBLSS was field tested in rural southern Ethiopia where over 90% of births take place at home with unskilled attendants. The program review assessed 1) the performance of HBLSS-trained guides; 2) management of postpartum hemorrhage and newborn infection by women, family, and birth attendants; 3) exposure of women and families to HBLSS training; and 4) community support. There was improved performance in management of postpartum hemorrhage, a leading cause of maternal death. Findings for management of newborn infection were less compelling. None of the communities had established reliable emergency transportation. Exposure to HBLSS training in the community was estimated at 38%, and there was strong community support. Organizations incorporating HBLSS into proposals focusing on maternal and newborn health during birth and the immediate postpartum period are encouraged to conduct research necessary to establish the evidence base for this promising new approach.