CleanBirth - Saving Mothers and Babies in Laos

CleanBirth.org - Donate $5 Saves 2 Lives

Birth in Laos: 300 Midwives/6.5 mn People

Reading this UNFPA article from 2009 about birth in Laos, I was shocked to see that only 86 midwives were to be found in the whole country.

A later 2012 article shows that, with the inclusion of the first 2 cohorts of midwives trained in decades, the number is around 300.   In training midwives, the government has made a commitment to improving maternal health. Progress is being made but much more needs to be done.

Here’s some points from the articles:

  • Women in rural areas give birth at home to avoid the 3-4 day trek to a hospital or because the rainy season makes travel impossible.
  • Health centers are understaffed and community health workers lack midwifery skills
  •  Laos has the highest rates of maternal death in Southeast Asia
  • 18-20 per cent of all Lao births are attended by health personnel
  • Average day: two families lose a mother and nearly 20 babies are stillborn
  • Each week: 100 infants die many due to insufficient neonatal care
  • 2 per cent of Lao GPD is spent on health
  • A “free” visit to a Lao clinic/hospital can cost a family up to one month’s salary in expenses for transportation, accommodations, food and medicine.

 

Breastfeeding Education for Laos

We all know breast is best.  In Laos, where I will be distributing and training women in the use of clean birth kits, breast should be the only choice.  The reasons are clear: lack of clean water access, inability to adequately clean bottles and the expense of breast milk substitutes (formula).

OK so assuming that breastfeeding is the only choice and it is a natural thing, why would women need information about it?  Because not everyone in Laos is exclusively breastfeeding.  According to the UN:

Although at least 90% of mothers are reported to breastfeed in Laos, only about 26% of babies are breast-fed exclusively to six months, according to the Ministry of Health.

…“Most mothers in Laos are actually already breastfeeding their children to six months and beyond,” said Dr Khamseng Philavong, Exclusive Breastfeeding Coordinator and pediatrician at the Centre of Mother and Child Health. “So the challenge is not to convince mothers to begin breastfeeding, but to encourage them to do it exclusively to six months. We’re reminding mothers that adding anything else to their children’s diet – formula, rice, juice, even water – is unnecessary and can be dangerous.”

Here’s what they had done to as of September 2008:

It has already involved the training and activation of some 3,000 village-level volunteers, known as ‘breast milk messengers’, who work directly with mothers and local caregivers to provide information and counseling. Trainings and orientations have also been conducted for health staff and officials in an initial nine target provinces.

I will be interested to see how this campaign initiated by the Lao government and “international partners” (including the UN), has played out three years on in the remote areas of Laos where I will be training and distributing clean birth kits.

Preventing Maternal Hemorrhage in Laos

I was reading an article today “Uganda’s maternal mortality ratio reduces” and began to think again about hemorrhage, the leading birth-related killer of mothers.

I don’t want to get ahead of myself, but as I get closer to bringing the clean birth kits to Laos, I am constantly thinking about how the kits will be used and to what effect.  The kits specifically target infection which is certainly a step toward lowering mortality of moms and babies.  But Active Management of the Third Stage of Labour is so important to maternal survival…and very very unlikely to be well-known in a home birthing environment in rural Laos.

On the maternova site, I have read about an aerosol Oxytocin that is in development that would eliminate the need for sterile injections and refrigeration. Another device being developed by Arsenal Medical, Inc. can be inserted in the uterus after childbirth and expands to control bleeding (funded by the Gates Foundation).

One step at a time…

Here is an excerpt from the article that talks about Active Management of the Third Stage of Labour:

 major cause of death for pregnant mothers in the region (East Africa) is postpartum haemorrhage which is over-bleeding after childbirth. It accounts for 36% of the deaths.  [The doctor interviewed] said that despite this, an assessment carried out in Uganda, Tanzania and Ethiopia in 2007 on whether health workers in the health facilities in these countries could correctly use the Active Management of Third Stage of Labour to prevent bleeding, only 5.7% of the health workers were correctly using the technique.

Active Management of the Third Stage of Labour is a technique used to prevent and treat mothers for over bleeding after delivery and is recommended for all natural deliveries.

The procedure requires a midwife to give a mother drugs to prevent bleeding within one minute of giving birth; to gently tag at the cord during delivery of the placenta and massage the mother’s uterus after delivery of the placenta.

Yoga Reduces Depression in Pregnant Women

In addition to being a clean birth kit advocate, I am a prenatal yoga teacher in New Haven, CT.  I was happy to see this article showing how beneficial yoga can be for pregnant women.

Prenatal yoga may help women cope with depression

Yoga

Photo : University of Michigan Health System

It is estimated that about one in five pregnant women experience major depression, and now new research has suggested that yoga maybe beneficial for pregnant women.

Researchers  say that the study is the first to provide evidence that mindfulness yoga may be an effective alternative to pharmaceutical treatment for pregnant women showing signs of depression.

The findings were published in Complementary Therapies in Clinical Practice.

Women who showed signs of depression and who were between 12-26 weeks pregnant participated in 10-week 90-minute mindfulness yoga sessions that focused on poses for the pregnant body, as well as support in the awareness of how their bodies were changing to help their babies grow.

Researchers found that the women who participated saw mentionable reduction in depressive symptoms and a stronger attachment to their babies in the womb.

During pregnancy, hormones rage and depression and anxiety have become a serious health concern. A variety of factors contribute to women experiencing persistent irritability, feelings of being overwhelmed and inability to cope with stress.

If the aforementioned symptoms are left untreated to, health risks, for both the mom and baby, can include poor weight gain, preeclampsia, premature labor and trouble bonding with the new baby.

Lead author Maria Muzik said developing feasible alternatives for treatment is critical.

“Unfortunately, few women suffering from perinatal health disorders receive treatment, exposing them and their child to the negative impact of psychiatric illness during one of the most vulnerable times,” Muzik said.

Previous studies show that many pregnant women are reluctant to take antidepressants, although proven to effectively treat these mood disorders, out of concern for their infant’s safety.

Evidence suggests women are more comfortable with nontraditional treatments, including herbal medicine, relaxation techniques and mind-body work.

Yoga continues to grow in popularity but in the United States, many classes concentrate on yoga as “exercise,” omitting the practice of being fully present in the moment and aware, authors say.

Meanwhile, mindfulness yoga – which combines meditative focus with physical poses – has proven to be a powerful method to fight stress and boost energy.

Read more at http://www.counselheal.com/articles/2470/20120808/yoga-reduces-depression-in-pregnant-women-boosts-maternal-bonding.htm#m60YG7Qw7Krw9xyG.99

Clean Birth Kits as “Frugal Technology”

This is an interesting summary from the Lancet about the impact of high tech medical equipment exported to the third world. Makes you think. An astounding 40% of medical equipment in the developing world is broken compared to 1% in the developed world.  Well-intentioned equipment from first world donors accounts in part for this.

Instead of high-end tech, the study suggests that “frugal technologies” like a rural ambulance made of a motorbike and stretcher sidecar are better bets.  The report also points to improvements in sanitation and roads as a ways to positively impact health.

I feel pretty good about the frugality of clean birth kits.  Low tech, focus on hygiene through education.  And they don’t break.

Here’s the whole article:

Technologies for Global Health

Published August 1, 2012

Collaboration between The Lancet and Imperial College London, UK, has resulted in a new Commission, which examines how medical technology should best be used to improve health in low- and middle-income countries. The report concludes that in many cases, medical technology—almost exclusively developed in rich countries—is simply inappropriate for use in poorer nations.

Executive summary

According to hospital inventories, an estimated 40% of healthcare equipment in developing countries is out of service, compared with less than 1% in high-income countries. The inappropriate deployment of medical technologies from wealthy countries plays a major part in this high failure rate.

Instead of relying on hand-me-down technologies from wealthier countries, which can be costly, inappropriate for local conditions, and even dangerous, the authors urge a renewed effort towards developing what they call “frugal technologies”—cost-effective technologies that are developed specifically to cope in local conditions. Examples of frugal technologies which have been developed to meet local needs include: the Jaipur foot, a rubber prosthetic for people who have lost their leg and foot below the knee; PATH’s Uniject injection system, which allows once-only use of needles for injectable contraceptives; and the eRanger, a durable rural ambulance, based around a motorbike and stretcher sidecar (which can be modified to carry one or two people).

The report also advocates a wider understanding of what we mean by medical technologies, pointing out that technological improvement to sanitation and road conditions could also have a far-reaching impact on public health in many low- and middle-income countries. Furthermore, the authors argue that advances in technology need to be accompanied by innovation to have a significant effect on health—this includes the development of effective delivery mechanisms and novel approaches to financing.

Pin It on Pinterest

Shares
Share This