UPDATE: One week after our interview with Dr. Suellen Miller, the UN Commission on Life-Saving Commodities for Women and Children, the Clinton Health Access Initiative, the Safe Motherhood Program at UCSF, and the Blue Fuzion Group released a Press Release, announcing a new joint partnership. The partnership will reduce the cost of the non-pneumatic anti-shock garment (NASG/Lifewrap) and will expand access to the device more easily. Read the full press release here.
Imagine a pregnant woman in a rural village in India, where basic amenities and the nearest hospital are hours away. Now imagine her waking up, feeling dizzy. She looks down and sees a growing pool of blood and knows that something is very wrong. The only option is to go to a hospital and yet—will she survive the two hour journey?
Sadly the situation described above, obstetric hemorrhage, is not a new phenomenon. It is, in fact, the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding.[i] In 2012, the World Health Organization reported that in Africa and Asia (where most maternal deaths occur), post-partum hemorrhage accounted for more than 30 percent of all maternal deaths.[ii]
One device—LifeWrap—hopes to rectify this situation. LifeWrap is a non-pneumatic anti-shock garment (NASG) used to treat postpartum hemorrhage. It applies pressure to the lower part of a women’s body, forcing blood to key organs including the heart, lungs, and brain. When fitted correctly, it can keep a mother alive whilst she is waiting to receive treatment at an emergency obstetric care facility.[iii]
The Safe Motherhood Program at University of California at San Francisco (UCSF) trains health care providers on how to effectively use LifeWrap towards the prevention and treatment of obstetric hemorrhage around the world.
Recently, the Center for Health Market Innovations interviewed the Director of the Safe Motherhood Program, Dr. Suellen Miller, about LifeWrap’s history, mission, and vision for the future. Dr. Miller is also a Professor of Obstetrics, Gynecology, and Reproductive Sciences at UCSF.
CHMI: When and why was LifeWrap first created?
SM: In the 1970s, there was a device called a PASG, which is the pneumatic anti-shock garment that was used in Vietnam and other places for transporting people with lower body injuries. In the 1980s, a team of NASA staff started to work on a non-pneumatic device that would be simpler and easier to use. That’s how this non-pneumatic device that we use was invented. LifeWrap is a brand for the non-pneumatic anti-shock garment (NASG).
CHMI: How did you use this device, developed by NASA, and apply it to women?
SM: Well, it was sitting around on the shelf after the 1980s. People weren’t using it for pre-hospital care. In 2002, I joined forces with someone who had used these devices on pregnant women in Pakistan. We began thinking that it would really matter for women in developing countries who live far from hospitals to enable them to survive long transport times. That’s when we started testing it to see if it would indeed reduce maternal mortality in these very isolated and low-resource places.
CHMI: Is there a specific training program for providers prior to using the garment?
SM: Yes, absolutely. We at UCSF developed two specific curricula. The first is for people on the front line (people with limited skills, such as family members or ambulance drivers) who learn how to put the anti-shock garment on [the pregnant woman]. The second training is a more complicated curriculum for health care facilities.
CHMI: On average, how long do women wear the garment?
SM: It’s really hard to say on average, because the transport times and the waiting times within hospitals [to receive definitive treatment] can vary. If I’d have to give a figure, I would say probably 4 hours at high-resource settings. But women have been in this garment for more than 72 hours.
CHMI: Are there any repercussions of wearing the LifeWrap garment longer than 72 hours? For example, does it stop working at a certain point?
SM: It’s continually working, like compression stockings worn after surgery, LifeWrap doesn’t rely on batteries or anything else. It’s unlikely that someone would need LifeWrap after 72 hours because that’s the longest that we’ve recorded. But the device will not stop working.
CHMI: Where is LifeWrap being used right now? You mentioned Pakistan, but I’m curious about some of the other countries as well.
SM: It’s actually used in the United States, especially by nurses and midwives who are conducting deliveries at home. It’s also used in the United Kingdom by a consortium of Jehovah’s Witness hospitals because Jehovah’s Witnesses don’t take blood transfusions. Nigeria and Ethiopia use it extensively. Also, Cambodia, Peru, Bolivia, India, Bangladesh, Nepal use it. In total, there are 20 countries around the world using LifeWrap.
CHMI: Do you believe that LifeWrap has the potential or the opportunity to expand beyond these 20 countries?
SM: Absolutely! This is going to be the year where this will take off. This year, we have already added two new countries—Tanzania and Timor Leste.
CHMI: Why do you think so many different countries are employing LifeWrap?
SM: LifeWrap is unique because it is a very simple device that anybody can put on and within minutes of putting it on, the bleeding slows down, the women’s shock is reversed, she stays stable, and she can survive these very long delays. There’s nothing else out there that does that. She needs to get a blood transfusion, but that blood transfusion could be days away. Nothing else can keep her alive except LifeWrap.
CHMI: How many women has LifeWrap been used on?
SM: It’s a little difficult for me to tell in general because I can only tell you about the numbers we’ve kept track of at UCSF. It’s around 9000 women.
CHMI: How has the device impacted these women?
SM: The women that we’ve spoken to whose lives have been saved by the LifeWrap are so thankful and their families are so touched. When women get into the condition where they need a LifeWrap, they’re often unconscious, sitting in a pool of blood that’s flowing all over the floor, and the family thinks they have died. Those women then wake up in this blue suit, saying how the suit saved their lives.
CHMI: You mentioned that it took a long time to compile evidence that supports LifeWrap’s mission. I’m curious to hear about some of the challenges and obstacles that you have encountered.
SM: It was mostly about having to conduct the high quality of research necessary to provide evidence. The WHO has high standards for what they will put in their guidelines, as do all of the other guideline-producing bodies. To be able to demonstrate that not only did the LifeWrap save lives, but it’s absolutely safe and doesn’t have any harm—it took us a long time. The other big challenge was that going to places where maternal mortality is high means going to places where resources are very low, so to conduct the world-class research that was necessary to get quality evidence was challenging.
CHMI: Are you happy with your progress, or is there room to grow?
SM: We are now on a cusp of new innovations and new technologies that are coming up. We really are in a place where we’re going to reach marginalized and vulnerable populations and bring to them simple and appropriate technologies. I’m just thrilled that we’re able to do that with LifeWrap. I’m hoping to see more [progress] so women will survive and there will be equity across the world.
CHMI: What motivated LifeWrap to join CHMI?
SM: Any way of disseminating information on a new technology that has to be incorporated into a country’s guidelines, policies, or procedures is essential CHMI is a way for LifeWrap to reach many more people than we would have.
[i] Walfish, M., A. Neuman, and D. Wlody. "Maternal haemorrhage." British journal of anaesthesia 103.suppl 1 (2009): i47-i56.
[ii] World Health Organization. "WHO recommendations for the prevention of postpartum haemorrhage." Geneva: World Health Organization: Department of Making Pregnancy Safer (2007).
[iii] LifeWrap. Retrieved April 14, 2015, from http://healthmarketinnovations.org/program/lifewrap