Above: Through Teefey’s creation of the Safe Birth Project, midwives in the Masaka District of Uganda are trained to use ultrasound technology to screen pregnant women for high-risk conditions.
Cost, distance and tradition. These three factors keep impoverished pregnant mothers in the rural Masaka District of Uganda from seeking the care of trained midwives in village health centers (VHCs), increasing the mothers’ risk of obstetric fistulas and the risk of death for themselves and their babies when complications arise during delivery. But thanks to the Safe Birth Project — launched in 2017 by Sharlene A. Teefey, MD, a professor of radiology at MIR — the introduction of ultrasound at 16 VHCs has increased the number of prenatal visits and improved outcomes for mothers with high-risk pregnancies.
Teefey — who is a board member of MicroFinancing Partners in Africa (MPA), a St. Louis nonprofit that is active in the Masaka District — was asked by Bishop John Baptist Kaggwa of the Masaka Diocese to address the high rate of obstetric fistula.
“The obstetric fistula rate in Uganda is second highest in the world after Ethiopia,” Teefey says. “Bishop Kaggwa asked, ‘Can you help?’ How do you say no to a bishop? You don’t.”
Midwives trained through the Safe Birth Project now use ultrasound to screen pregnant women for three high-risk conditions: twins, placenta previa and abnormal fetal lie. “When one of these three conditions is diagnosed, the midwives will educate the mothers about the risks of delivery and make a referral to either a village health center with an obstetrician or to a local hospital,” Teefey says.
Obstetric fistula can only be diagnosed at the time of labor using a partograph and requires a cesarean section. The midwives are trained to use the partograph and, when indicated, will emergently refer a mother for surgery.
In the six months after adopting ultrasound, the first three VHCs reported no fistulas. They saw 605 pregnant women and had 1635 prenatal visits and 422 deliveries — about twice as many as in the previous six months. The most recent data continues to show an increase in the numbers of prenatal visits and deliveries. The screenings have also strengthened the bond between mother and child. “Many mothers come in because they’re very motivated to see their babies on the ‘TV,’” Teefey explains.
Because so many pregnant women cannot afford their health-care costs, microfinancing projects were introduced to the VHCs, who in turn will teach impoverished mothers about microfinancing. Nearly all 16 centers are funded and in various stages of development.
“This is going to have a great impact,” Teefey says, “because now we’ll be able to help mothers afford their care.” Additional VHCs will receive ultrasound machines and funding by January 2021.
Clockwise from upper left: Teefey bonds with two mothers who had recently undergone obstetric fistula repair.
// For remedial training, Safe Birth Project sonographers complete rounds at all of the village health centers with ultrasound equipment. // Piggeries (in background) are one type of microfinancing project at village health centers. Ugandan mothers are granted a piglet (see upper left photo) which eventually enables them to finance their health-care costs. // A midwife records the findings of an ultrasound she just performed.
Photos // Sharlene A. Teefey, MD