infantmortality Archives - CleanBirth - Saving Mothers and Babies in Laos

Oct 15 2013

Global Handwashing Day!

One of CleanBirth.org’s main objectives is to prevent infection. Our AYZH Clean Birth Kits give moms everything they need for a hygienic birth.

While handwashing before delivery may seem so obvious, it is has not been the historical practice.

We have Ignaz Philipp Semmelweis, a Hungarian doctor, to thank for changing that. In 1847, Semmelweis proved statistically that the incidence of puerperal fever, aka childbed fever, could be drastically reduced by enforcing hand washing standards for OB doctors and nurses.

Thanks Dr. Semmelweis! No go wash your hands!

Oct 14 2013

Giving Birth Lao Style: Reasons for Homebirth

longroadtahoy — 1. Distances to clinics are great, costly

clinic2 — 2. Poor treatment by staff, iInadequate clinic resources

fourkids — 3. Moms can’t leave older children for long periods

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.

Oct 09 2013

Giving Birth Lao Style: Part 2

newmom If we want the families we serve to accept the AYZH Clean Birth Kits, it is crucial that they feel that their beliefs are respected and that they are able to comply with traditions surrounding birth. Studies, which I will talk about in a post tomorrow, show that lack of respect for cultural mores is a leading reason women chose not to birth at a clinic.

Our goal is to have a CleanBirth Volunteer in each village who will give women birth kits and explain the importance of having hygienic birth.

Since the Volunteers are from the same villages and share the same traditional beliefs and practices, we hope that they will convey the information in a culturally appropriate way.

Here are some of the traditional practices prevalent in Laos, according to the UNFPA report “Cultural Beliefs and Traditional Rituals about Childbirth Practices in Lao PDR.”

Preparation

Many families did prepare items like sarong, nappies, baby clothes, rope, ginger, herbal medicine, boiled water, wood, and bamboo bed. Yet others feared advanced preparation:

“I did not prepare anything for my baby. I was told by the elderly that I do not need to prepare anything in advance for my baby. It is believed that it will be a stillborn or death of the uterus.” (New mother, 24 years old)

During Labor

This report revealed that during labor mothers and husbands took care of the laboring mother, applying herbal medicine and eggs on the abdomen to make labor and delivery easier. Laboring women drank coconut milk.
“I used a herbal medicine called “Wane” which I put in the water, and I used this water to put on the head of my wife which could lead to an easy labor and reduce the pain during labor.”
(Husband, 32 years old)

Another husband said, during labor,

“I used the water “Nam Mon” [water that has been blessed with sacred words]

when I take a bath and it is believed that my wife will have an easy birth.” (Husband, 27 years old)

Cutting the Cord

Most umbilical cords were cut using a bamboo called “Mai Ka See” or razor blade. Some mentioned that they used alcohol to wash the razor and they used a black or white rope to tie the umbilical cord. After giving birth, the baby was given a bath and then placed on the bamboo bed beside the mother.

“I used to cut the umbilical cord using a sharp bamboo piece (tew may phai) because I did not have a delivery kit. I think it was clean and safe, and it was easy and available in our community. Based on my experiences, there were no cases of umbilical tetanus with the use of “tew mai phai”.” (Traditional Birth Attendant, 58 years old)

Postpartum

As discussed in yesterday’s post, postpartum practices are specific and culturally important.

“According to the ritual practice, the postpartum women had to sit on the banana leaf with salt for about 40 minutes in order for wounds to get heal quickly. After that, the women had to take a hot bath with herbal medicines before staying on the hot fire, drink about four pots of hot herbal medicine mixed with water, and also, take hot baths early in the morning without cleaning the skin for two weeks.”
(Mother, 50 years old)

Breastfeeding

Newborns are routinely given water after delivery out of fear that they baby is thirsty and to protect again jaundice and conjunctivitis. There was a belief that the mother did not have enough breast milk.

“After delivery, I suggested they feed the baby water or honey using clean cotton soaked with water or honey, which is then softly pressed onto the lips of the baby because the mother was not ready to breast feeding yet.” (TBA, 58 years old)

Oct 07 2013

Giving Birth Lao Style

Looking at the many pictures I have from clinics in Laos, I wanted to learn more specifics about why birthing practices such as the “hot bed” are so important to postpartum recovery in Laos.

I found this blog post which excerpted a “Vientiane Times” July 2006 article that sheds some light:
“A grey-haired woman chews betel nut as she puts a pot of glowing charcoal under the bed of her daughter, who lies there weakly after giving birth a few days ago.
The young mother’s body is covered in sweat due to the heat of the fire, which is as hots as the coals on which she normally grills fish.

I asked Mrs. Yad, who is taking care of her daugther Van, why it was necessary for her to lie over a bed of coals.

Mrs. Yad smiled and said that there were two accepted methods of post-natal recovery, referred to as cool or hot.

The “cool” method involves only taking traditional medicine and does not require the mother to lie over a fire. The “hot” method requires the mother to lie in bed over burning charcoal for at least 15 days.

While both these methods are traditional and have been in existence for as long as anyone can remember, almost every young mother without exception follows the “hot” method as requested by her family. This method is the more effective, according to Mrs. Yad.

The fire must stay alight all the time until the mother has completed her recovery, at a date determined by her own mother. This is done because it is believed that the heat of the fire will heal the uterus and birth canal more quickly. ‘If a new mother doesn’t do this, she may develop backache and an aching waist,’ she explained.

Mrs. Yad believes that if mothers can withstand the heat for this length of time, they will be healthier in the long run. The longer they lie over the fire, the sooner they will recover.

During this time, Van will drink several litres of hot water every day, boiled in a cooking pot and containing herbs to ensure that she will produce enough milk to breastfeed her baby. She also has to shower three of four times a day, again using warm water with traditional herbs. This is the Lao way, and it is rigorously adhered to.

The new mother is not allowed to eat normally after giving birth, and her diet is limited to prevent her becoming ill. In the first three days after delivery, she will only eat fried galangal with salt. AFter this she can eat friend meat of a black feathered chicken and of a black buffalo.”

Sep 20 2013

Two Mamas Write About Newborns in Laos

I read two blog posts today that are must-reads for anyone interested in infant health in Laos.

Both are personal experiences. Both written by mamas. One living in Laos, one from Laos. Both women are very aware of the high rates of infant mortality in Laos. Both are very supportive of our work to make birth safer.

First, CleanBirth.org volunteer liaison in Laos, Dee Warren Harlow, wrote this amazing piece about her experience in Salavan province, where we work. Here’s an excerpt:

For me to know the long and difficult road that these two mothers have taken to give birth safely made the miracle of birth all the more awesome to me. To know that unless they traveled all way to a provincial hospital, they most likely did not get any prenatal check ups, or vitamin supplements, or ultrasounds. Although the standard of care that we consider basic are indeed accessible and cost relatively little because they are subsidized by the government, they are only available in large urban centers. This means that the 70% of the Lao population who live in rural areas either require a lot of resources to receive this care, or get none at all.

The second article by the fabulous Theek aka the Laotian Commotion draws attention to the reality that only 40% of Lao babies are breastfeed exclusively to the appropriate age. Her personal experiences with her own mother bring to life the ingrained beliefs about breastfeeing that persist, even though her mother is living in the US:

My mother tried to convince brand-new postpartum me that my crying newborn was hungry because I wasn’t making enough milk. I would have entirely believed her if I wasn’t so precise in reaching the front door with squirting breast milk from our living room couch. My mom had a bunch of “Lao remedies” at the ready anyway. She would spoon-drop some water into his wailing mouth. She also suggested the most common Lao baby feeding method, regurgitated sticky rice to make him feel full longer. Sticky rice for infants is the Laotian equivalent to what we know as rice cereal in Western culture. The idea is the same as well where the introduction of solid foods will fill out their little bellies.

Thanks to these amazing women for sharing their own experiences and working to make birth and infancy safer in Laos.

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