A pioneering helicopter retrieval program, developed by HMRI and University of Newcastle researchers to help women in Nepal experiencing obstetric distress, has led to a 40 per cent reduction in maternal death.
Of the 625 women assisted by the helicopter program since its introduction to Nepal in 2019, only two died from birth-related causes.
The innovative approach to saving the lives of women in obstetric distress has been highlighted in a special report published in The American Journal of Obstetrics and Gynecology.
The report, ‘Reducing Maternal Mortality in Low and Middle Income Countries: The Nepalese Approach of Helicopter Retrieval’, was authored by researchers Dr Binod Bindu Sharma, Professor Craig Pennell, Dr Biraj Sharma and Distinguished Laureate Professor Roger Smith.
Distinguished Laureate Professor Roger Smith says, “In Low to Middle Income Countries (LMIC) maternal deaths have been linked to three delays. The first delay is the woman’s family realising that her life is at risk, the second delay is getting that woman to hospital, and the third delay is giving that woman the care she needs after she gets to the hospital.
“With things like post-partum haemorrhage which kills 28 per cent of the women who die from obstetric emergencies in Nepal, the time it takes to receive specialist care is critical.
“These three delays operate like links in a chain, with the strength of the chain determined by the weakest link; failure of any link leads to maternal death. This series of essential links provides a logistics challenge that is beyond the resources of many of these countries.
“The UN’s sustainable development goals cite they want to get maternal death in LMICs down to 70 per 100,000. This simply won’t happen unless the three delays outlined above are addressed in an achievable and affordable way. Nepal has managed to use the resources it has to significantly reduce the number of maternal deaths. My research partners and I believe this model of care could be applied to other LMICs,” says Professor Smith.
Poor roads are common in most LMICs meaning that getting a woman in obstetric distress to a hospital with the necessary specialist care may take many hours, days, or may be impossible.
Equally many LMICs have invested in helicopters for military defence.
“In Nepal we have repurposed military helicopters to provide evacuations of women with obstetric emergencies directly to hospitals that can provide caesarean section and blood transfusion. Repurposing military helicopters does not require an expensive investment, pilots require ongoing training, which is provided by involvement in emergency retrievals.
The Nepalese model of culturally acceptable methods of promoting birth by skilled birth attendants together with military helicopter retrievals for women with obstetric emergencies may therefore be applicable in many LMICs.
The Nepalese government included questions on maternal mortality in the 2021 national census, followed by a verbal autopsy. The data indicated a 40 per cent fall in the maternal mortality ratio from 239 in 2016 to 151 in 2021.
Professor Smith says, “There is still a long way to go to get this down to 70 per 100,000 but we are inching closer. The efficiency of the triage service continues to improve, suggesting that maternal mortality will continue to fall. This may provide a model that can be implemented in other LMICs, including the Pacific Islands, countries like Kenya and Indonesia.”
Read the full paper, Reducing maternal mortality in low- and middle-income countries: the Nepalese approach of helicopter retrieval‘.
