The sound of an unborn baby’s heartbeat pulses through the breezy labor ward of University Hospital in Mirebalais, Haiti.

The loud, muffled rhythm is amplified by a machine that monitors fetal heartbeat as the mother’s labor progresses. It’s one of the things that makes Marlene Damas, a nurse-midwife and manager, glad to be working here in the third decade of her career.

“I can hear her vital signs because there’s equipment to identify problems,” Damas said. “It wouldn’t be the same in another place. In some places all you have is a stethoscope, so you can’t hear a change in the patient’s condition.”

“Staff and stuff”—trained, experienced nurses like Damas, equipped with the tools they need to do their jobs—can save lives in a country that still loses too many women in pregnancy and childbirth. In Haiti, just 25 percent of births in rural areas take place in a health facility, many of which lack adequate resources. An estimated 1 in 285 births will result in a woman’s death, a ratio about 16 times higher than in the United States, according to the World Health Organization.

“I like to work with women, because they need help,” Damas said. “There’s a lot of maternal mortality in Haiti, and I’m working to reduce it.”

Damas and the 52 other nursing staff in the University Hospital maternal health ward have participated in extensive trainings since the teaching hospital opened in March 2013. They do hands-on simulations of emergency events, including how to stop post-partum hemorrhage and resuscitate newborns who aren’t breathing. They discuss the latest science on maternal health through journal clubs, where they read and discuss medical articles. And they receive supervision as they learn to conduct procedures such as inserting an intrauterine device to prevent pregnancy.

This year, the women’s health team is also working with community health workers to train them to identify pregnant women in communities and accompany them to prenatal visits and to deliver. One of the main reasons women don’t give birth in hospitals is because of the distance they have to travel, often on foot, Damas says. Community health workers can help overcome that barrier by traveling with patients or helping them stay at the hospital before they’re in labor.

Sometimes Damas receives women on the ward who delivered at home and encountered a problem, and sometimes it’s too late for her team to help. That motivates her to keep working, she says, and she’s excited to see that the quality of care provided at the hospital is encouraging many patients to seek care there.

“This hospital provides great service,” Damas said. “It’s free, so people come from everywhere to receive care from qualified people who are competent and have resources.”

University Hospital delivers more than 200 babies each month, and serves as a referral center for smaller PIH-supported facilities around the Central Plateau. When women are expected to have complications, or do during normal labor, they are transferred to University Hospital for the complex care staff can provide. For that reason, the hospital has a high rate of cesarean deliveries—about 20 to 25 percent of deliveries over the last year. In fact, the hospital has one operating room devoted to C-sections—to make sure the procedure is available around the clock when medically necessary.

Adonis Francoe rests with her daughter, born by cesarean section at University Hospital. Photo: Stephanie Garry/Partners In Health

Next to the labor and delivery ward, Adonis Francoe rested with other women and their babies in the post-partum ward. Francoe, who had her second baby by C-section, also works in the hospital’s community health department and travels to communities to discuss health issues and describe the services available at the hospital. Her first child was born at the small community hospital in Mirebalais, which University Hospital replaced—and it was a much different experience.

“I’m more comfortable here. There’s food and things like a bed for the baby,” she said. Francoe is also glad for the economic opportunities the hospital offers, including her job, which helps her provide for her growing family. “The hospital is great because it gives jobs. Before you had to go far to find work. This is a lot better for the community.”