Rebirth of the midwife

Dozens of Lao women are learning to be midwives as part of a national effort to bring down one of the region’s highest maternal mortality rates.



Two families lose a mother and nearly 20 babies are born dead every day, according to the UN Population Fund (UNFPA), which is supporting the government initiative.



Deliveries by untrained birthing attendants, unable to solve life-threatening complications during birthing at home or help a newborn take its first breath, are partly responsible for both maternal and infant deaths, according to Monir Islam, director of the World Health Organization’s (WHO) Making Pregnancies Safer department.



But persuading people to acknowledge the importance of midwives has not been easy. “The challenge is that midwifery is something that died off a long time ago here and people didn’t really take it as something that [is] very necessary,” UNFPA trainer Magdalen Drani told IRIN.



After not conducting midwifery training for 23 years due to lack of funding and interest from students, the government resumed courses in the eight training health centres in October 2009 with US$1 million of UNFPA support. As a result of this gap, there are fewer than 100 women nationwide working as midwives – many lacking even basic training – for a population of 6.2 million, according to the Ministry of Health.



Phounimit Vongvath, 38, one of Drani’s students, is hoping more people will come to health centres if they trust midwives. “If we are competent in birth deliveries and give health education to the villagers they will get the right message so they will come and use the health centre,” she said.



UNFPA skilled birth attendance coordinator, Della Sherrat, said: “Most birth issues are within the first week so if their postnatal skills are better, they [attendants] may be able to deal with this. If antenatal care is improved then you can encourage women to go to a clinic to at least get an opportunity for help.”



Some 405 women died out of every 100,000 live births in Laos in 2005, according to the Ministry of Health’s most recent data.



One of the biggest challenges of training midwives is finding patients. Only 20 percent of women delivered in a health centre in 2005, choosing instead to remain at home, according to the government.



As a result, sometimes students make do with textbooks only. “It’s very difficult because in the [provincial health centres] there are very few [pregnant women],” said Drani. “You can go on a night shift and the students are there but no mothers.” She said older women, who gave birth in their villages, encourage their daughters to do the same.



Sri Lanka model



Sherrat cited the success of Sri Lanka, which reduced maternal deaths by training community midwives in the 1980s. Some 43 women died out of every 100,000 live births in Sri Lanka in 2005 against 140 per 100,000 in 1995 – a 70 percent drop; skilled birthing attendants were present for 96 percent of deliveries, which took place in a hospital nine out of 10 times, according to WHO.



Laos’s long-term plan is to establish a national licensing system for midwives. But for now, the goal is to get midwives into the communities, said Sherrat. “We need people with real skills in places where women are. We need to get them into the right areas so that they can recognize issues quickly and if they can’t treat that person they can at least be able to do something to stop them dying.”



Somchanh Xaysida from the Ministry of Health told IRIN he hoped the training would reduce maternal mortality rates. “In the past they [pregnant women] came to the health centre and there was nobody there, but now we can give them the message that we have competent midwives ready to serve them in the health centre.”



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