The journey began when a group of researchers ventured into three districts: Nauta, Parinari, and Saquena, between November 2018 and January 2019. They conducted a household census in 79 rural communities scattered along a 350-kilometer stretch of river, gathering data from 1,027 mothers and their newborn babies. None of these communities had access to clean water, electricity, or sewage systems.
To understand how newborns are cared for in the Peruvian Amazon, nine key indicators of essential newborn care were used: 3 related to thermal care, which included immediate drying of the baby, skin-to-skin contact between the mother and baby, and delaying the first bath for at least 24 hours; 3 related to umbilical cord care, which involved proper clamping or tying of the cord, a clean cut with a sterile instrument, and timely disinfection; and finally, 3 related to breastfeeding, which encompassed colostrum consumption, immediate initiation of breastfeeding, and exclusive breastfeeding for the first 3 days. So, what was the situation in these remote communities?
It was discovered that Essential Newborn Care (ENC) in the remote communities of the Peruvian Amazon fell far short of expectations. Whether it was home births or deliveries in medical facilities, they faced significant challenges. 70% of babies were born at home, and of these, 93% were born without the assistance of trained personnel. There was a lack of basic infrastructure; for example, no health posts had electricity or clean water, there was a shortage of trained and supervised staff, and the lack of access to emergency obstetric care was very common.
One of the most surprising findings was the common belief that colostrum, the first milk, was harmful to babies. In reality, colostrum is vital for the baby's health. However, this belief persisted and had a negative impact on early and exclusive breastfeeding.
Another mystery was the practice of bathing newborns. WHO recommendations advise delaying the newborn's first bath for at least the first 24 hours to preserve the protective layer on their skin and prevent infections. However, bathing babies early and inadequately was a common practice. Strangely, it was more common to bathe newborns very early in healthcare facilities than in home births. Many mothers also did this at home.
The care to maintain the baby's appropriate temperature after birth and the hygiene of the umbilical cord were inadequate both at home and in medical facilities. Immediate skin-to-skin contact was rarely practiced, and the lack of information led mothers to use traditional substances like ash or oils to heal the cord after cutting it at home; these and other practices increased the risk of infections. Additionally, limited access to postnatal care worsened the situation.
This initial research journey revealed that newborn care in the Peruvian Amazon needed urgent improvements. Identifying gaps in ENC practices allowed for the design of a specific intervention to enhance newborn care in these communities.
The Mamás del Río project emerged in response to this need. A multidisciplinary team of healthcare and social science professionals joined forces with key local actors: Community Health Workers (CHW), who, with the support of traditional midwives and healthcare personnel, implemented a unique and effective approach to promote maternal and child health in these rural communities.
The CHW are community members, both men and women, chosen by their neighbors. Thanks to their dedication, they became the backbone of the project, providing vital support and education in the community. Traditional midwives, guardians of ancestral knowledge, establish a unique bond with mothers and their babies. Through the project, they received training to ensure clean deliveries.
The Mamás del Río journey began with the training and mobilization of these key local actors, as well as community awareness. The results began to show: more mothers started going to healthcare centers to give birth, and newborn care practices significantly improved.
In 2020, the Covid-19 pandemic presented an unexpected challenge. Despite the restrictions and risks, Mamás del Río continued to operate, adapting to the new reality. The ACS became beacons of information about this virus that reached their communities and provided vital support during a time of uncertainty. During the pandemic, healthcare centers closed, and residents could no longer travel on the rivers, but the agents were there, in their communities, safeguarding their health.
How effective was the project? This was measured by conducting annual follow-up studies over 3 years, through censuses in the same 79 rural communities in the districts of Nauta, Parinari, and Saquena, using a survey on the essential care provided to newborns. Then, the results of the initial census were compared with those of the second-year census and the third-year census to see if the changes were sustained over time.
Skin-to-skin contact increased from 9% to 59%
Increase in colostrum usage from 39% to 85%
Umbilical cord care increased from 59% to 78%
Increase in cord clamping from 78% to 93%
These follow-up studies revealed that newborn care practices improved significantly in home births, even taking the pandemic into account. The care practices that saw the most improvement include skin-to-skin contact, colostrum feeding, and hygienic care of the umbilical cord. However, cord clamping and tying, delayed bathing, and exclusive breastfeeding also improved, and almost all of these practices have been sustained over time!
Delayed baby bathing: from 80% to 94%
Increase in clean cord cutting from 80% to 91%
Exclusive breastfeeding (1st 3 days) 87% to 97%
Increase in institutional births from 35% to 46%.
The mothers of the jungle have embraced safer and healthier practices, thanks to the tireless efforts of the Community Health Agents (ACS), midwives, and the entire team behind Mamás del Río.