The Starting Place

Dr. Mahmoud Fathalla said, “Women are not dying because of diseases we cannot treat; they are dying because societies have yet to make the decision that their lives are worth saving.”

The reality of severely inadequate maternal care combined with crushing poverty has  devastating results in developing world countries. Haiti has the highest incidence of maternal, infant, and neonatal mortality in the Western Hemisphere. Only 36% of births in Haiti take place in health facilities with skilled birth attendants.

We have compiled twelve years of experience in holistic maternal health care in the developing world setting into a “how-to” manual and accompanying class called: The Starting Place: A Maternal Mortality Prevention Initiative .

We believe that the model we have slowly built at the Heartline Maternity Center works. We want to see this model duplicated around the world to bring quality maternal health care to many more mothers.

Developing nations often have a heartbreaking lack of maternal care for women which results in high-rates of maternal death and infant mortality. This means that 99% of all maternal deaths occur in developing countries - and 80% of those deaths are preventable.

There are approximately 32,000 children growing up in orphanages and institutions in Haiti. Children are overwhelmingly relinquished to orphanages and institutions as a result of maternal death. (Sources: WHO, UNICEF, Haitian DHS).

When a mother dies, a child is left without their primary source of love and care in the world. And when a mother dies, her young children are up to three times more likely to die themselves within the next year. 

303,000 women die from pregnancy and childbirth complications worldwide every year. Nearly 3 million newborns die in the first month of life and 2.7 million newborns are stillborn every year. 

In Haiti, 65% of women deliver without a skilled or trained provider whether that is a doctor or a nurse or a midwife who is able to recognize complications. Simply giving birth in Haiti puts a woman at risk:  she has a 1 in 80 chance of dying due to pregnancy or childbirth related complications. 

In the Starting Place class and manual, we go over everything from meeting a newly pregnant woman at the door, to offering her an effective and culturally appropriate method of family planning after her child is born. Our manual includes very specific outlines of all facets of care, setting up structures, help with budgeting, staffing, forms, charting, supply lists and protocols.

Our philosophy of care is based on 7 E’s. Empathy, Excellence, Engagement, Empowerment, Expectations, Environment and Educate.

Working in the middle of devastating poverty, one quickly learns that not every story has a happy ending. Trust matters, relationships matter, and empathy is more valuable than we can express. Our model provides excellence by hiring competent, compassionate caregivers, who stay current on new research in maternal health. 

Engagement - allows us to develop a relationship with clients and to provide safe, personalized care. Our model places a woman’s desires and requests at the center of the process, empowering her to make decisions regarding her health. We lay out clear expectations for participation in our program, provided in a safe environment. We seek to provide education and care for clients so that their lives are set on a positive trajectory.

This solution is directed to administrators, directors, midwives, nurses, and medical professionals desiring to work in any under-resourced area in the world. By duplicating the highly successful program at Heartline Maternity Center, we envision a world where all women are loved and supported with quality care during pregnancy, childbirth, and early motherhood regardless of their wealth or privilege. We envision a world where all moms and their babies flourish together. We envision a world where moms and their children are empowered to change not only their own story but the stories of their communities and their nations for good. We believe in tackling the root causes of poverty, oppression, and injustice by supporting and equipping the women as mothers.

Our mission is to provide compassionate, high-quality care, by using the midwifery model of care to provide necessary services to underserved women of the world. Our secondary mission is to share the model with everyone who works in low-resource settings.

Please note that our Maternity Center model is donor-funded program for clients that live below the poverty line. This class and our manual can potentially save an organization thousands of dollars as well as energy spent re-creating the wheel.

WHO’s State of the World’s Midwifery Report offers four key actions that will ensure more effective health coverage:

• Availability - educate more midwives with consistent international standards.
• Accessibility - bring midwifery services where they are needed most.
• Acceptability - provide respectful care and work to combat misperceptions about midwives
• Quality - offer high quality care with licensed and registered midwives.

The Starting Place is part of the global solution for women and babies. We believe this model of care can be replicated around the world. Furthermore, we know if replicated, women and their babies would thrive.

Since its inception Heartline Maternity Center has become a model for holistic maternal health care programs in developing nations.  The high quality care, education, and focus on building trusting relationships are part of the reason we have such great outcomes. We believe the high provider to client ratio is an essential part of the model of care. We believe that the continuity of care is key. In order to provide excellent care we know we cannot keep adding more women. We believe quality over quantity ascribes dignity and worth to each woman we care for and we believe it is best. Because of this, we know the only way to keep reducing maternal and newborn mortality is to share the model and equip others to take it to their own communities.

Another unique aspect of our solution is that we encourage participants to train and hire local individuals. This helps build the communities we are in and ensure sustainability.

Our solution, unlike others, covers everything needed to set up, run and maintain a highly effective maternity center in a developing country. 

There are many differences in the general social, economic or political background of the developed and developing country-groups, and developing countries are in desperate need for creative medical solutions. Technology in many forms is essential for a well-run maternity center. Our model offers several EMR programs designed specifically for midwifery care. Everything must be documented from prenatal intake to postpartum graduation. Our testing, ultrasound and medical equipment are all technology based. Our solution offers contacts on where to access all of these. One of our short term goals (1 year) is to have the starting place available in an online class format. This will allow us to reach many who would otherwise not be able to attend our training. Currently, our organization is competent in the use of technology to access our staff remotely. Much of our consultation, staff meetings, advertising, fundraising and research are done through electronic means. In order to duplicate what has worked so well at our maternity center we need to be able to offer solutions to other organizations on how to access, finance and utilize these forms of technology.

This is one example of how using technology to track statistics on eclampsia helped us learn to adjust our protocol and save lives. We share what we have learned at the Heartline Maternity Center in our manual and class.

pre-eclampsia – In 2015, we had a 26% preeclampsia rate. Research suggests that calcium and aspirin throughout pregnancy can help reduce the occurrence of preeclampsia. So in 2016, we began giving daily calcium and aspirin to all women who are pregnant for the first time and women considered high-risk for preeclampsia. We needed to give it time in order to report the findings, but we now have three-year stats to compare and see how well it is working! The 3 year preeclampsia rate (for 2016, 2017, 2018) at the MC has been reduced to 10.3%.

Naomi and Ruth – September

Baby Ruth had an incredibly difficult start to life. But thanks to the faithful support of friends like you, Heartline was there to provide the personalized, quality care this mother and baby needed to survive. During a prenatal checkup, the skilled Heartline Maternity Center staff identified that Naomi had preeclampsia, a condition resulting in dangerously high blood pressure and life-threatening complications for mom and baby.

In this scary moment, the incredible support of Heartline partners made all the difference. We were able to safely transport Naomi by ambulance to a local hospital where Ruth was born via emergency C-section at just 32 weeks.

visit https://heartlineministries.org/22056/invest-in-haitian-families/  for the rest of the story

Activities:

• Organizations attend “The Starting Place”
• Women accepted into the organizations prenatal/delivery/postnatal program.

Outputs:

• Organizations duplicate the model presented

• Effective monitoring of most common direct causes of maternal mortality
• Women have access to nutritious food, prenatal vitamins and necessary supplements
• Women empowered to exclusively breastfeed through education and support
• Women educated and empowered to make decisions regarding their health

Outcomes:

• Reduced rate of maternal mortality through treatment of pre-eclampsia, eclampsia, sepsis, hemorrhage and hypertensive disorders.
• Reduced maternal mortality rate by effective treatment of malnutrition and other indirect causes of maternal death.
• 100% of program infants breastfed.
• Decreased pregnancy related health risks occurring in closely spaced pregnancies

Goals

• Starting place model is replicated around the world

• Decrease in maternal and infant mortality
• Decrease in number of orphaned children

We currently serve 1500 women

In one year we hope to impact 4500 additional women

In five years we hope to impact 30,000 women

Vision

We envision a world where all women are loved and supported with quality care during pregnancy, childbirth, and early motherhood regardless of their wealth or privilege. 

We envision a world where all moms and their babies flourish together for the long haul. 

We envision a world where moms and their children are empowered to change not only their own story but the stories of their communities and their nations for good.

Mission

Our mission is to provide compassionate, high-quality care, by using the midwifery model of care to provide necessary services to underserved women of the world. Our secondary mission is to share the model with everyone who works in low-resource settings.

In one year we would like to have The Starting Place in a format that the class could be taken on-line. We currently have two replications of care from the classes given, one in Haiti and one in Madagascar. In five years we would like to see this increase to 20 organizations that use TSP method of care. We encourage people to start out smaller and grow slowly. We started with 30 program participants. The maternity center in Madagascar is the same size as Heartline, but it took them  5 years to grow to capacity. Not because there isn’t a need, but because the slow growth allows them to add and train staff, increase funding, and get systems in place to provide excellent care.

Due to covid 19, classes had to be rescheduled.

Funding of the transition to an online based class is another barrier.

Travel is tricky in and out of Haiti due to political unrest.

We are all learning how to adapt and change through this unusual time of pandemic. Heartline is particularly prepared for several reasons. First, we have always functioned remotely and are particularly suited to use some of the technology that others may just be getting familiar with. Second, living and working in Haiti has allowed us to become adaptable to many situations.

We are seeking help to get The Starting Place on line and also seeking avenues of funding.

We are innovative and willing to learn new things.

14 full time

In 2007, Heartline established their first Prenatal Care Program. . It began with twenty pregnant women. In late 2008 we began to offer prenatal consultations. By late 2009 we were able to add labor and delivery services.

After the devastating 2010 earthquake, Heartline completely shifted focus,  expanding the scope and reach of the maternal healthcare programs.We decided to take a run at the root cause: lack of quality maternal health care for mothers. We had a hunch that if we cared for and supported expectant women right from the early days of her pregnancy, through her delivery, and afterward with everything from education to economic opportunities to medical care, we could begin to see the need for orphanages disappear. 

Tara Livesay - Director and Midwife 

Tara is a certified professional midwife and the director of the Heartline Maternity Center. Tara and her husband, Troy, along with their seven children moved to Haiti in January of 2006 where they have lived and served for well over a decade.  In addition to overseeing The Heartline Maternity Center, Tara first dreamed of writing The Starting Place Manual in 2013. 

Beth  “KJ” Johnson - Midwife & Clinical Director

 KJ knew at an early age that she wanted to serve mothers and babies. At the age of eighteen KJ left home to begin her midwifery training in The Philippines. KJ has helped women deliver their little ones on three continents, As a co-author to The Starting Place, her experiences working abroad have been invaluable. 

Vitamin Angels -  www.vitaminangels.org 

DiaSpect ™ Hemoglobin  - https://www.ekfusa.com/analyze...

Rapid Diagnostic Test, Science With a Mission -  alynne@sciencewithamission.org

Equipment and Supplies: Dopplers, baby scales, and other birth-related supplies, Cascade

https://www.1cascade.com 

Best Doppler we’ve found: Hand-Held Doppler Unit McKesson LUMEON™ Obstetrical Probe 3 MHz  https://mms.mckesson.com 

Condoms, Global Protection Corp.

https://globalprotection.com

Sparrow Solutions Group: Sparrow sonography equips medical professionals to perform ultrasound exams with excellence 

www.sparrowsolutionsgroup.com 

Ultrasound training for developing world providers: Hope Imaging

 https://www.hopeimaging.org

WHAT IS THE STARTING PLACE?

In the class and manual, we go over everything from meeting a newly pregnant woman at the door for the first time, to offering her an effective and culturally appropriate method of family planning after her child is born. Our manual includes very specific outlines of all facets of care, setting up the structures necessary, help with budgeting, staffing, forms, charting, supply lists, sourcing ideas, and protocols.

After years of trial and error, the class and manual share what we know works. This class and our manual can potentially save your organization thousands of dollars as well as energy spent re-creating the wheel.

WHAT IS IT NOT?

This class does not teach Midwifery. This is not a medical training class, although the manual includes dozens of medical protocols. The assumption is that a medically trained and legally licensed medical professional will be present at your clinic/birth center/prenatal program. We expect that clinic administrators will want to take this class, and that your medical staff is trained and prepared for prenatal, labor and delivery, and postpartum care of the mother and baby. If you are seeking training to become a Nurse Midwife or Midwife, please know this class is not your first stop.

WHO CAN ATTEND?

Administrators, Directors, Midwives, Nurses, and Medical Professionals desiring to work in any under-resourced area in the world.  Please note that our Maternity Center model is donor-funded and is essentially a free program for clients that live below the poverty line.

For 2020 Total Heartline Maternity Center this is how we plan on funding our work.

Revenue
4010 Adoption Fees 800.00
4030 Contributions Income 875,000.04
4032 Sponsorships 55,536.00
4034 Grant Income 170,340.00
Total 4030 Contributions Income 1,100,876.04
4170 Program Sales 60,507.73
4190 EC Store Sales 9,999.96
Total Revenue $1,172,183.73

We are interested in not just the prize award, which will help us immensely, but the connections to other resources and partners that can help us get the word out about this work that we are so passionate about.

We are actually interested in any support available to us to help us improve and expand our solution.

Other grant opportunities, MIT expert advice, other solve team members

At Heartline, we believe birth is a human rights issue.

The Heartline Maternity Center combats the dismal maternal health reality in Haiti through excellent medical care, health education, nutrition, and compassionate support that effectively reduces the high incidence of maternal and infant mortality and prevents children from becoming orphans.

The Heartline Maternity Center provides expectant mothers in Haiti with a full prenatal program, labor and delivery services with certified midwives and nurses, and a six month postpartum program of weekly medical care, child development education, and breastfeeding support.

Medical clinics open to the wider community are also held each week to provide pregnancy tests, ultrasounds, and free birth control to promote healthy timing and spacing of pregnancy as a proven strategy to reduce maternal mortality and improve child survival.

When women and girls enter the Heartline Maternity Center doors, they find love, joy and celebration, compassionate relationships, empowering education, excellent maternal care, and respect.

Vision

We envision a world where all women are loved and supported with quality care during pregnancy, childbirth, and early motherhood regardless of their wealth or privilege. 

We envision a world where all moms and their babies flourish together for the long haul. 

We envision a world where moms and their children are empowered to change not only their own story but the stories of their communities and their nations for good.

Our mission is to provide compassionate, high-quality care, by using the midwifery model of care to provide necessary services to underserved women of the world. Our secondary mission is to share the model with everyone who works in low-resource settings.

At Heartline, we believe birth is a human rights issue.

The Heartline Maternity Center combats the dismal maternal health reality in Haiti through excellent medical care, health education, nutrition, and compassionate support that effectively reduces the high incidence of maternal and infant mortality and prevents children from becoming orphans.

Medical clinics open to the wider community are also held each week to provide pregnancy tests, ultrasounds, and free birth control to promote healthy timing and spacing of pregnancy as a proven strategy to reduce maternal mortality and improve child survival.

When women and girls enter the Heartline Maternity Center doors, they find love, joy and celebration, compassionate relationships, empowering education, excellent maternal care, and respect.

At Heartline, we believe birth is a human rights issue.

The Heartline Maternity Center combats the dismal maternal health reality in Haiti through excellent medical care, health education, nutrition, and compassionate support that effectively reduces the high incidence of maternal and infant mortality and prevents children from becoming orphans.

The Heartline Maternity Center provides expectant mothers in Haiti with a full prenatal program, labor and delivery services with certified midwives and nurses, and a six month postpartum program of weekly medical care, child development education, and breastfeeding support.

Medical clinics open to the wider community are also held each week to provide pregnancy tests, ultrasounds, and free birth control to promote healthy timing and spacing of pregnancy as a proven strategy to reduce maternal mortality and improve child survival.

When women and girls enter the Heartline Maternity Center doors, they find love, joy and celebration, compassionate relationships, empowering education, excellent maternal care, and respect.