FEATURE | San Lorenzo Ruiz Women’s Hospital: Providing a comforting, nurturing and safe environment for mothers and newborns in a hospital

Its discreet location, tucked at the far end of an almost unnoticeable alleyway along the national road, is certainly not comparable to the quality of care that San Lorenzo Ruiz Women’s Hospital (SLWH) in Malabon lives up to. We may be a very small hospital but we have managed to maintain a good reputation in delivering quality care and service to our patients. Hopefully, we want to have the same for EINC,” shares the charismatic Dr. Maria Isabelita “Happy” Estrella, hospital director and EINC Working Committee Chairman, that afternoon we dropped in for a visit.

Upon entering the premises, one senses that at SLWH things are done in a manner not quite typical of any government hospital. And yet its cozy atmosphere common of small town communities betrays the level of excellence that the hospital strives to achieve, for there is surely nothing “small town” about SLWH’s commitment to achieve the goals set by MDG 4 & 5. Their passion to constantly improve their compliance of the EINC practices while also soliciting the active involvement of their immediate community is noteworthy. Dr. Happy Estrella hopes that by involving the other health providers in Malabon and its nearby areas, the city of Malabon in their own “small way” can contribute to reducing the country’s maternal and infant mortality by 2015.

San Lorenzo Ruiz Women’s Hospital is a 10-bed capacity special First Level Referral hospital catering to the health needs of women and children residing in Malabon, parts of Valenzuela, Caloocan, Obando as well as Tanza, Navotas. It is also Philhealth accredited as a secondary hospital. Normal spontaneous deliveries and obstetric cases remain the leading cause of admission.

While not solely a maternity hospital, Dr.Estrella remarks that there is that unavoidable impression “that is why adopting the EINC is an advantage to us” since the program will strengthen their capacity to meet the needs of both mother and baby during delivery and birth. She proudly adds that implementing EINC is, if not one of, their more important accomplishments for the year.

Seven months after its implementation, EINC has “now become part of the hospital” withcorresponding hospital guidelines and policies supporting already issued from staff assignments all the way to the revision of forms, scope of work and doctors orders. More importantly, the staff—from the doctors down to the midwives and nurses, even those not part of the Working Committee—has by now internalized the program.

And in fact, already learning to devise creative solutions when not so ideal situations arise.  Such as the time when they asked a father to do skin-to-skin contact in place of the mother who was unable to hold her baby because she was vomiting immediately right after delivery. “It was a very touching moment,” narrate the nurses and midwives. Chief of Clinic, Pediatrician Dr. Marilou Nery adds, “The father felt more involved in the process.” Furthermore, “(it) has brought out the creativity in us [as] the passion somewhat grows on you then you strive to be better each time.”

Change is indeed a concerted effort. That is to say that even a small hospital like SLWH, where administration and organization may deceptively seem simple, is still not exempt from a few uncoordinated practices that bigger hospitals experience.

Dr. Estrella narrates how it was initially challenging to convince the other midwives to carry out the program. Understandably, change is never an easy thing to do, most especially as this entails reconsidering “old and tried methods” and learning new ones. After much work, they’ve eventually come around—seeing the benefits of the program as well as appreciating their role in providing safe and quality healthcare to mothers and babies.

“You have to devise strategies that will challenge the staff to do better,” says Dr. Nery.  Episiotomies for instance used to be routinely done by the midwives to avoid laceration, but has since been declining after persistent guidance and monitoring with 39% out of 18 normal deliveries from June 5-18. And while consistency in recording deliveries can still improve, there has been good compliance with the performance of full EINC in both normal and CS deliveries with 92.2% for May and 100.00% for the first half of June. Likewise, unnecessary interventions, such as fundal pressure, manual exploration of the uterus, unnecessary suctioning, and NPO have impressively gone down. The routine administration of intravenous fluid has also dramatically decreased with 66.7% of normal deliveries performed without IV fluids for the month of May and >80 % for the first half of June. Equally worth mentioning is 100% compliance in Oxytocin IM administration for the Active Management of the Third Stage of Labor.

It really is about creating a homely, comforting, nurturing but safe environment for the mother and the newborn. “When we started implementing the program, no sooner did we come to realize that EINC practices were relatively in tune with the reason(s) why some mothers opt for home births,” shares Dr. Estrella.

With EINC, mothers feel more at ease and satisfied with the birthing experience as they are encouraged to assume a position of choice during labor, delivered in non-supine position, and even given the option to have a companion of choice during labor and delivery.

They’ve since been receiving positive feedback from their patients, mostly of whom have expressed how much they enjoyed the (birthing) process compared to how it was before. Conversely, the staff and doctors equally feel satisfied. “We’ve learned to be more compassionate to patients. “Now we’ve come to appreciate better what mothers are going through and know how to support and care for them during the process,” says Dr. Estrella.  Implementing the EINC has also made them realize how their previous “preventive” practices were bent more on assuaging their own fears for potential complications that may arise during delivery rather than a response to the patient’s needs. Dr. Nery for instance notes that performing the four core steps of newborn care have led them to more definitive diagnosis of sepsis which has partly contributed to the drop in reported cases, “before as soon as a patient is admitted, the newborn is immediately considered for sepsis, hence, the routine administration of antibiotic even without the confirmation of a blood culture.” True enough, the sepsis rates for May to June 2011 have gone down from 5.9% to 6.9% for the last week of June and first week of July 2011. Of course, these rates may yet change but with EINC implementation, the outlook is very optimistic. The use of drop light among newborns has also been done away with since skin-to-skin contact with the mother is already enough to keep these babies warm.

The key to SLWH’s success is constant communication between the midwives, pediatricians, obstetricians and patients. Midwives, for instance, have learned to become more open to the needs of their patients.  Furthermore, they’ve begun to appreciate the integrated care needed by for mother and baby during delivery, inevitably requiring teamwork.  “I used to be afraid of handling neonates, immediately handing the baby out to the pediatrician once I’m done delivering it. My thought then was “I’m only an OB and should have nothing to do with that.” But now, I make it a point to check on the babies I’ve delivered when I do my rounds,” Dr. Estrella shares. And while the hospital’s current floor plan has yet to truly reflect these new “discoveries,” plans for expansion are underway.

The enriching experience brought by implementing EINC in their hospital has undoubtedly inspired SLWH to reach out to their immediate community. Believing that these marked improvements need not be confined to walls of their hospital but must also be shared to the rest of the community, at least those within their reach. Capitalizing on their existing network of Breastfeeding Coordinators in the community, they’ve initiated a series of meetings to advocate and promote EINC beyond the hospital. Already, initial communications with RHU-based coordinators have been set-up to align delivery and care practices of private practitioners and home birth with EINC and other mother-baby friendly care practices.  

While SLWH’s experience proves that more often than not it’s little details such as the simple warmth of a mother’s skin that matter, more importantly their experience only shows that being small is by no means an obstacle to thinking and aspiring big.