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By Julia Keast, an intern with HealthBridge Vietnam
My second trip to Son La province brought more stunning landscapes as we ventured up into the mountains to visit commune health centres and meet with doctors, midwives, village health workers and new mothers and fathers.
The purpose of this visit was to conduct the situational assessment for the project Saving Lives of Mothers and Children in Nepal and Vietnam. This involved gathering information through interviews and discussion groups, and observing conditions at health centres to get a sense of the current maternal, newborn, child health and nutrition situation in the project districts. Staff wanted answers to a number of key questions: What are the health facilities like? Do they have the supplies they need? What level of clinical skills do doctors and health workers have? What are women’s habits during pregnancy? What do pregnant women, newborns and children under 2 eat? Where do women give birth, and what kinds of barriers prevent them from accessing health services?
Chatting with women and men
Project staff from the Center for Creative Initiatives in Health and Population and HealthBridge Vietnam were divided into two teams so they could visit both project districts –Yen Chau and Thuan Chau. I accompanied the team that went to Thuan Chau, located just beyond Son La city. I had the opportunity to visit the district hospital and two of the three communes that will participate in the project. My favourite part of the field visit was the discussion groups with women and men in the communities.
Since I can’t speak Vietnamese, I was extremely fortunate to have Kenny (a Vietnamese student currently studying in the US) there to help translate for me. Some parts of the discussion particularly stuck out. First, women and men often didn’t know the danger signs to watch out for during pregnancy and in newborns. Knowing specific signs – like fever during pregnancy or weakness or lethargy in newborns – is really important for making sure that pregnant woman and their newborns are able to get timely care if they need it.
Women prefer delivering at home
The other thing that was unsurprising, but resonated with me nonetheless, was that very few women chose to deliver their babies at health facilities. If they did go to a health facility for delivery, it was most likely because they experienced excessive, prolonged pain during labour. Women preferred home delivery for different reasons – they wanted assistance from immediate family members like their husband or sister, or they wanted to follow certain cultural rituals surrounding childbirth that could not be accommodated in health centers. Some examples include the use of birthing stools or the ability of women to wash their bodies using water that is boiled with local leaves immediately post-birth.
These stories highlight the need for more education about antenatal and newborn care, and the importance of delivering in a health facility – or, at a minimum, with the assistance of a skilled birth attendant. Most maternal and newborn deaths happen within the first 24 hours after birth, and many of these deaths are preventable with access to appropriate medical care. Having a skilled birth attendant present during childbirth – someone who knows how to handle both normal and emergency cases and when to refer women and their newborns to higher levels of care – has the potential to significantly reduce maternal and newborn deaths.
The stories also hint at the role of culture in influencing women and their families’ preferences on labour and delivery. While cultural rituals may not be harmful in and of themselves, women and their babies have the best chance of surviving and thriving when the birthing process is supported by a skilled attendant with the requisite medical training. Raising awareness of important cultural factors – and how they affect health outcomes for women and children – is therefore critical when training health workers and providing education to local families. In some cases, it could be the difference between life and death.