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Giving Birth Lao Style: Reasons for Homebirth

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1. Distances to clinics are great, costly
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2. Poor treatment by staff, iInadequate clinic resources
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3. Moms can’t leave older children for long periods
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4. They want to observe traditional practices

Wonderful that Vanphanom Sychareun et al have brought attention to the issues surrounding Laos’ high rate of maternal and infant deaths.   Their August 2012 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.

Clean Birth Kits Tally from July: 116!

Number of kits distributed up to 116!

We still haven’t heard from 3 clinics.

Why? Noi, our on the ground tracker, says, “because of the rain made the communication more difficult.”

Makes you realize how remote these places really are when all communication ceases due to rain.

Photo: Number of kits distributed up to 116! Still haven't heard from 3 clinics. Why? Noi who has been tracking them down says, "because of the rain made the communication more difficult." Makes you realize how remote these places really are when all communication ceases due to rain.

Homebirth in Laos

80% of women in Laos choose home birth — with only 20% attended by “skilled health personnel” — over hopsital birth despite maternal mortality rate of 400 per 100,000 live births.

Why?

Cost — hospital charges (50-80% hospital income from user fees/sale of pharmacueticals), transportation, lost labor (mother and family accompanying)

Distance to hospital — increases cost, makes hard for family to be present

Cultural practices ignored –Family must be present, trained health workers don’t respect traditional practices, no baths/saunas, no “rest over fire,”  burial of placenta at home

Negative aspects of hospital care — Embarrassing birth position (high bed, on back), episiotomy, lack of privacy, rise in (costly) C-sections

Influence of mothers/grandmothers — They delivered at home

The author, Dr. Donald Marsden, concludes:

However, it is obvious that until many of the social and cultural issues are addressed, homebirth is likely to be favoured by a large proportion of the population into the foreseeable future, despite the manifold dangers.

Read the full article here: http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/774-48-homebirth-in-laos.html

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