Reducing Maternal and Neonatal Mortality in the Dominican Republic


Why is Nurses’ Education Important?

Compared to other countries in the Americas, the maternal and newborn mortality rates in the Dominican Republic (DR) are staggering. Approximately 2,830 babies and 200 women died during and following pregnancy and childbirth in the DR in 2018. Most neonatal deaths occurred due to bacterial sepsis and respiratory distress syndrome. On the other hand, hypertensive disorders and obstetric hemorrhages were the leading causes of maternal deaths. These events, which are easily preventable or treatable, added to the fact that more than 95% of prenatal, birth, and neonatal care is assisted by qualified healthcare personnel, make us reflect on the presence of significant gaps in the quality of the services offered.

In recent years, the DR’s Ministry of Health has prioritized reducing maternal and neonatal mortality by training healthcare personnel. Strengthening obstetric and neonatal nurses’ knowledge and skills were highlighted as an essential component of the strategy, mainly because there is extensive evidence regarding nurses’ contribution to reducing mortality in other Latin American countries. In the DR, especially in rural areas, nurses are the backbone of mothers’ and newborns’ care. Not only do they spend the most time in direct contact with patients during hospital stays, but they are also remembered and admired in their communities. In many cases, they represent the link between families and the healthcare system.

Dominican Foundation for Mothers and Infants’ Engagement in the Eastern Region

For more than 40 years, Angelica Floren, MD, FAAP, president of the Dominican Foundation for Mothers and Infants (DOFMI), has led great efforts to reduce maternal and neonatal mortality. From early in her career as a pediatrician, she has believed in the potential of community leaders, especially nurses and midwives, to support preventative health efforts. Having successfully provided obstetric and neonatal training for nurses in the Southern region in 2016, Dr. Floren was set to reduce morbidity and mortality in the Eastern region, the third region with more births. With a multidisciplinary team of a nurse-midwife, pediatricians, and local volunteer doctors, the DOFMI developed an education program to provide 30 nurses working in mother and baby units with the competencies to afford critical components of care.

The Education Program

The DOFMI was convinced that education was one of the best ways to empower nurses to reduce mothers’ and newborns’ preventable deaths. The 30 nurses participating were selected by the Eastern Regional Health Service (SRS Este, in Spanish) as representatives of ten hospitals and five primary care units. In July 2019, the nurses and the team met during the introductory module of a year-long workshop. A total of eight meetings were held, three in-person and five online, due to COVID-19 restrictions. Topics addressed ranged from newborn baby evaluation and neonatal resuscitation to pregnancy, labor and delivery, and postpartum assessment and complications. During the in-person meetings, nurses had the opportunity to practice what was learned using simulators (e.g., for delivery and newborn resuscitation) and acting as patients (e.g., for maternal blood pressure monitoring). In addition, relevant discussions were held, prompted by questions such as, “Why do mothers and babies die?” and, “What can the nurse do to improve maternal and newborn outcomes?”.

One notable aspect of this program has been the constant support and encouragement between the nurses and the team. This close communication, which continues until this day, was catalyzed using web-based chat. Since the start of the program, nurses, staff, and authorities from SRS Este have been in contact through a WhatsApp group chat. Participants were encouraged to use this chat as a safe space to ask questions, share their concerns and work limitations, and tell the group about their opportunities to integrate their recently acquired abilities into their daily practice.

Other components of the program were an educational video gallery, a binder with key study material, and donations of essential medical equipment for each facility, such as neonatal resuscitation kits, Doppler fetal heart frequency monitors, stethoscopes, and pulse oximeters.

Learn more about the outcomes and evaluation of the program at the upcoming ACNM Meeting!

During the program, a research team was set to collect nurses’ experiences through mid-program and final feedback forms and evaluate the quality of patient health forms completed by the nurses. These forms yielded important information regarding group B streptococcus screening documentation, one of the microorganisms responsible for bacterial sepsis, the second most common cause of death in newborns.

You are invited to join us at the Global Health Forum of the ACNM 66th Annual Meeting to learn more about our findings. You will learn how this program has served to empower, in many ways, the nurses of the Eastern region, who day after day give their all to improve the survival and quality of life of hundreds of mothers and infants.


Nola Holness, PhD, CNM, APRN, ANP-C, CNE, RN is a triple FIU Alumnus, having obtained her BSN, MSN, and PhD degrees in the Nicole Wertheim College of Nursing and Health Sciences. She is a full-time Clinical Assistant Professor in the Undergraduate Nursing Department. Dr. Holness obtained her initial nursing and midwifery education in Jamaica, her homeland. She worked for 27 years at Jackson Memorial Hospital as a Staff Nurse and Certified Nurse-Midwife providing care mainly to underserved women. She is a Certified Nurse Educator and an Advanced Practice Registered Nurse with a Board Certification as an Adult Nurse Practitioner. Dr. Holness is a delegate of the ACNM and serves in collaboration with other organizations to reduce maternal and infant morbidity and mortality. She is a member of the ACNM Division of Global Engagement, Education Committee. She does consultation work in the Dominican Republic to educate nurses on improving maternity knowledge and skills, and coordinates research activities with physicians in the Eastern Region of the Dominican Republic. Dr. Holness also performs missionary work in Honduras as a nurse-midwife. Her research interest is to enhance the reproductive health of adolescents. Dr. Holness has published on adolescent pregnancy and presented at regional, national, and international conferences. She was awarded the Undine Sam’s Research Grant toward her research on preventing a repeat adolescent pregnancy. She was recognized by the Dominican Foundation for Mothers & Infants as an outstanding researcher and educator.

Estefanía Henríquez Luthje, MD
Coordinator and researcher for the Rural Nurse of the Eastern Region Education Program, Dominican Foundation for Mothers & Infants. She recently obtained her medical doctor degree from the Instituto Tecnológico, Santo Domingo, Dominican Republic. Interested in education, public health, and research.

María Fernanda Díaz S., MD
Project volunteer and research assistant for the Rural Nurse of the Eastern Region Education Program, Dominican Foundation for Mothers & Infants. USMLE Mentorship Program Coordinator at Instituto Tecnológico de Santo Domingo. Interested in pediatrics, neonatal health, hematology/oncology and research.

Jasmin Garcia, MD
Project volunteer and research assistant for the Rural Nurse of the Eastern Region Education Program, Dominican Foundation for Mothers & Infants. Recently graduated from the Instituto Tecnológico de Santo Domingo, Dominican Republic. Interested in pediatric endocrinology and research.