Table 2.

PreCourse Survey Questions

1) Nationally, who are the maternity care providers and what is their level of training?
2) Who will be attending the ALSO course? Where are they from and what is their level of training?
3) Where are births occurring—hospitals, homes, birth centers—and what is the level of care at each site (ie, what proportion of rural hospitals can perform a cesarean section)?
4) What are culture-specific attitudes and practices relevant to the birthing process?
5) What are the rural and urban cesarean section rates?
 Ecuadorian hospitals have rates of 50%, which may mean any woman with a mildly concerning strip, need of operative vaginal delivery, or prior cesarean section is delivered by cesarean. The talk on dystocia may need to be reformulated into a discussion on advantages of vaginal delivery versus cesarean section, issues of patient choice, etc.
6) What is cesarean section availability in rural and urban areas?
7) What are local practices regarding breech delivery? If vaginal breech delivery is the norm, this becomes a more important focus. ALSO materials could be supplemented with video footage of breech deliveries.
8) What are the leading causes of maternal and infant mortality? How common are perinatal conditions such as preeclampsia, preterm delivery, Group B streptococci infection, HIV, and other sexually transmitted diseasess?
9) Which of the optional ALSO workshops will be most useful?
10) Are newborn resuscitation program (NRP) courses available?
 A Spanish-translation of the NRP manual and CD are available. Offering the NRP course before or after the ALSO courses may amplify the potential of the courses to reduce perinatal mortality.
11) What is the availability of and experience with different technologies, including: manual vacuum aspiration for first trimester loss, prenatal ultrasound, vacuum, forceps, and fetal monitoring?
12) What is the availability of medicines, including: magnesium sulfate, terbutaline, carboprost, misoprostol, and methylergonovine maleate?
13) What is the cost and availability of laboratory testing?
 The recommendations for universal testing for group B streptococci and HIV testing may be reconsidered. Recommendations for Kleihauer-Betke testing may not be realistic.
14) What audiovisual aids and equipment are available?