PRONTO training improves childbirth practices in Mexico

A significant portion of newborn and maternal deaths can be prevented through simple and cost-effective strategies. In Mexico, routine delivery practices are based on convention and out-of-date information. Some of these practices are potentially harmful, but remain in use because of a system grounded in authority rather than evidence.  

New research from the Bixby Center, National Institute of Public Health of Mexico and University of North Carolina looked at the impact of PRONTO International’s training to tackle the challenge of increasing the capacity and experience of multidisciplinary teams. The training, developed and piloted in Mexico in 2009, is a simulation-based training on the management of obstetric emergencies. PRONTO provides low-tech, low-cost tools to provide highly realistic birth simulations.

The study found that providers who received PRONTO training were more likely to implement practices the World Health Organization recommends to improve patient outcomes and prevent childbirth complications. They were 21% more likely to perform active management of the third stage of labor, and 26% more likely to provide skin-to-skin contact. The trained providers were also less likely to perform some procedures that can produce negative patient outcomes.

Providers who didn’t attend the training but worked in hospitals with PRONTO-trained providers also significantly improved their practices. There was no sign of decline in the impact of training over time. Changes in the use of the recommended practices was more linked to turnover in hospitals than people returning to old habits.

Despite this success, there is still work to be done. Providers continued to use some harmful practices, such as performing episiotomies. This reflects how deeply ingrained some of these practices are in the culture of care and underscores the importance of providing training earlier in people’s careers. It will also be important to implement continuous, ongoing training to account for turnover and ensure consistent provision of quality maternal and newborn care.