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New Study: Why Lao Women Choose Homebirth

Wonderful that Vanphanom Sychareun et al bringing attention to the issues surrounding Laos’ high rate of maternal and infant deaths.   Their study “Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study” reveals the reasons for women’s preferences and gives basic recommendations.

The method was focus group discussions (FGD) and in-depth interviews with 71 mothers, husbands and grandmothers.  Reasons for homebirth:

1. Distance and cost of transport

2. Poor treatment/practices like horizontal birth position, episiotomies, no privacy, male staff

3. Desire for family/other children near

4. Desire for traditional birth practices: squatting position and “hot bed” (fire underbed) post-partum

What to do?  Clinics should respect traditions/wishes of mothers.  Further, mothers/family should be educated about high risk pregnancies so that they go to the clinic regardless of preference.

Laos: Worse Maternal Mortality than Afghanistan

I just read the CIA World Factbook list of countries with highest rates of maternal mortality and Laos is at #20.  The only non-Africa country.  Worse than Afghanistan which comes in #21.  Are you kidding me?  It’s neighbors Cambodia (#44), Vietnam (#101), Thailand (#110) and China (#116) are not in the same category.  So sad but also motivates me.

Here’s the list: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

 

 

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.

Midwives: Rural Areas in Developing Countries Not Appealing

I have often said that while my immediate focus is to combat birth-related infections in remote villages in Southern Laos, my longer term goal is to fund midwifery training.  But how do you ensure that midwives trained in the relative prosperity and comfort of the capital Vientaine return to their villages?  This study examines this exact issue in Ghana and reveals that it’s not easy.

The staffing of public sector health facilities in remote rural areas is a serious challenge for many ministries of health in low- and middle-income countries.

Results
Three themes were identified through a broad inductive process: 1) social amenities; 2) professional life; and 3) further education/career advancement. Together they create the
overarching theme, quality of life, we use to describe the influences on midwifery students’ decision to accept a rural posting following graduation.

Conclusions
In countries where there are too few health workers, deployment of midwives to rural postings is a continuing challenge. Until more midwives are attracted to work in rural, remote areas health inequities will exist and the targeted reduction for maternal mortality will remain elusive.

As an aside, I am shocked to see that Ghana actually has much better maternal and infant stats than Laos (400 per 100k, 80% give birth alone, 27% antenatal care):

Maternal death in Ghana is currently estimated at 350 per 100 000, in part a reflection of the low rates of skilled support during birth [13]. According to the Demographic Health Survey,
43% of Ghanaian women give birth alone or with a non-skilled attendant [14] although 62.8% of women surveyed had attended the minimum standard of four antenatal visits [15].

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