The Golden Minute: Helping Babies Breathe

Lynn Clark Callister, PhD, RN, FAAN

eeting the objectives of Millennium Development Goal

(MDG) #4 (Reduce Child
Mortality) is a continuing challenge,
especially in low-resource countries
where neonatal mortality rates are
extremely high. The Helping Babies
Breathe (HBB) initiative promotes the
following basic interventions in the
first golden minute after a child is
born: (1) skilled attendance at birth,
(2) infant thermoregulation, (3) stimulation to breathe, and (4) assisted ventilation if necessary. The American
Academy of Pediatrics in a public/
private partnership (Global Development AllianceGDA) that includes
the United Nations Agency for International Development, the National
Institute of Child Health and Human
Development, Saving Newborn Lives/
Save the Children, and the Millennium
Villages Project. The WHO developed
the curriculum funded by Laerdal
Foundation and other groups such as
Latter-day Charities (LDS).
The HBB curriculum is available
online and in print in English and
Spanish for implementation globally.
Low-cost newborn simulators and
other educational equipment are
part of a kit available for purchase
on the HBB Web site (www.helping
babiesbreathe.org).
The train the trainer approach,
used to educate healthcare providers,
including traditional birth attendants,
is being used in clinics and in rural
settings where homebirths are common. The program is designed with
educational flexibility depending on
the healthcare systems in different
countries, including but not limited to
MDG #4 targeted countries such as
Haiti, Kenya, Malawi, Mexico, South
Africa, Uganda, and Zambia.
LDS Charities currently presents
40 training programs a year. For
example, in Indonesia, LDS Charities
works with a local healthcare organi-

zation, Perinasia, which includes

neonatologists, obstetricians, and
pediatricians. Perinasia is now
including the education of midwives,
who share their newfound knowledge and skills with colleagues in
West Java where only 30% of births
take place in medical facilities. In
2013 and early 2014, 600 midwives
received HBB training in Indonesia.
The training begins with a pretest,
then demonstrations by master trainers followed by hands-on experience
with baby simulators. At the end of
the training, both clinical and written
finals are given. The midwives completing the program are given a ventilator bag and mask, suction device,
and stethoscope for their own clinical practices. It is estimated that if
1 of the 600 Indonesian midwives
save 2 newborns during their career
because of the provision of HBB
training, the average cost is $54 per
child. What a priceless gift of life can
be provided to a child born in potentially life-threatening circumstances.
Recent clinical studies conducted in
Tanzania and India build on earlier
studies that document significant
reductions in fresh stillbirth and newborn mortality rates within 24 hours
following birth (Goudar et al., 2013;
Msemo et al., 2013). RichardsKortum and Oden (2013) call for the
development of devices for lowresource care rather than sophisticated
medical technologies used in highresource settings, which assume that
basic infrastructures exist everywhere.
Hallmarks of the HBB initiative are
that it provides high-quality education, is evidence-based with ongoing
documentation of intervention outcomes, is relatively inexpensive, and
provides technical assistance by volunteers from high-resource countries.
Principles on which the GDA is based
are inclusiveness, supporting ownership by the specific country, and

encouraging integration with existing

maternal/child health programs. Dedication and commitment to the reduction of infant mortality in low-resource
countries is also a defining principle
(www.healthynewbornnetwork.org/
partner/helping-babies-breathe).
Sakhina Begum is a skilled birth
attendant practicing in Bangladesh
who participated in HBB training.
Her new knowledge and skills were
used in less than a week to save the
life of little Taiyaba. As Sakhina dried
and wrapped the newborn, she noted
there was no respiratory effort. After
trying to stimulate the limp child
without success, she successfully
resuscitated Taiyaba who began
breathing. This scenario and others
provide evidence that this principlebased intervention can have a significant impact on essential obstetric and
newborn care (www.healthynewbornnetwork.org/blog/asia-regionalmeeting-interventions-impact-e...).
Lynn Clark Callister is a Professor
Emerita, College of Nursing,
Brigham Young University, Provo, UT, and an Editorial Board
Member of MCN. She can be
reached via e-mail at callister-lynn@
comcast.net
The author declares no conflict of
interest.
DOI:10.1097/NMC.0000000000000043
References
Goudar, S. S., Somannavar, M. S., Clark, R.,
Lockyer, J. M., Revankar, A. P., Fidler, H.
M., ..., Singhal, N. (2013). Stillbirth and
newborn mortality in India after helping
babies breathe training. Pediatrics, 131(2),
e344-e352. doi:10.1542/peds.2012-2112
Msemo, G., Massawe, A., Mmbando, D., Rusibamayila, N., Manji, K., Kidanto, H. L., ..., Perlman, J. (2013). Newborn mortality and fresh
stillbirth rates in Tanzania after helping
babies breathe training. Pediatrics, 131(2),
e353e360. doi:10.1542/peds.2012-1795
Richards-Kortum, R., & Oden, M. (2013). Engineering. Devices for low-resource health
care. Science, 342(6162), 10551057.
doi:10.1126/science.1243473

July/August 2014

MCN

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