Professional midwifery services during pregnancy and childbirth are
critical to lowering the mortality rate of women and babies, a
conference heard on Nov. 10.
Speaking at the event
organised by the United Nations Population Fund (UNFPA) and Ministry of
Health, Representative of the UNFPA in Vietnam, Bruce Campbell said that
while most births in developed countries were aided by skilled
attendants, one in three women in developing countries gave birth alone
or with only relatives.
Figures from the report revealed
that 1,000 women died as a result of pregnancy-related complications and
about 5,500 newborns died in the first week of their life for lack of
adequate daily medical care.
Another 35,000 women suffered
severe illnesses or disabilities, including obstetric fistula, severe
uterine prolapse, depression and infertility, it said.
The
report also pointed out that unless about 112,000 midwives were trained
and deployed in a supportive environment, 38 of 58 countries surveyed
might not meet their target of 95 percent of births attended by a
skilled midwife by 2015, as the Millennium Development Goal required.
Currently, the globe is facing a shortage of about 350,000 midwives. On
average, the community needs at least six midwives per 1,000 births.
"Pregnant women and newborns will continue to die needlessly without an
increase in the number of midwives and improved clinical skills,"
Campbell said.
"If midwives are in the right place and
can accompany the most severe complications to specialised hospitals or
health clinics, up to 90 percent of maternal deaths could be prevented."
Deputy Minister of Health, Nguyen Viet Tien said that
midwives and midwifery practice played a crucial role in Vietnam 's
maternal and newborn health care system.
The initiative of
training village-based midwives was practical and effective, especially
in remote and hard-to-reach areas where home births were common due to
poverty that hindered access to health care services, he said.
Dr Tran Thi Huong of northern mountainous of Ha Giang Province's Health
Centre said that difficult roads, poverty and customs required only
husbands or relatives to take care of women during and after delivery,
resulting in 80 percent home delivery.
Huong said that the
model of village-based midwives had been more effective than local
health workers, who hardly knew the ethnic minority language and only
went to remote areas once a month.
Di Thi Rum, an ethnic
minority midwife in Coc Re Commune, Xin Man District in Ha Giang
Province, said she completed a six-month training on midwifery two years
ago and then persuaded many pregnant villagers with potential breech
deliveries to go to local health clinics.
"The roads are
so difficult that walking is the only choice when I go to pregnant
women's houses. My job is to check their health, provide reproductive
information, persuade them to go to hospitals if necessary and sometimes
help them deliver at home," Rum said.
Rum said her
villagers only listened to advice from their locals, adding that local
residents had gradually quit the habit of cutting placenta with broken
terracotta pots or dirty knives.
PhD Luu Thi Hong, deputy
director of the ministry's Department of Maternal and Child Heath, said
that the quality of midwives was generally limited.
A
recent survey among 232 midwives at the district and commune-level
showed that most didn't have sufficient skills for birth attendants and
none correctly practised three of the most important skills to aid
mothers and newborns.
The reason, according to Hong, is
the lack of training time, which only lasts six to 18 months for
village-based midwives and two years for district-level ones.
A shortage of official training programmes and low payment for
village-based midwives also contributed to the low quality improvement.
For example, village-based midwives in northern Dien Bien
Province were paid only 50,000 VND ($2.5 USD) per month for their
jobs. Most still had to work in the fields to earn their livings.
Health representatives suggested that the profession of midwifery
should be further improved by increasing payment and supportive policies
for midwives, especially those in remote areas.
The
health sector should increase the quality of training for midwives,
especially with the basic skills of birth attendants while working with
international and domestic organisations to boost supportive programmes
on mothers and newborns.
Office-in-charge of the World
Health Organisation in Vietnam Wo Guogao agreed, saying that midwives
should have appropriate employment, protection, remuneration, incentives
and motivation.
"Midwives don't only deliver babies, they
also offer many related services before and after the delivery. They
are crucial in the communities and to the survival of women and
children," he said./.
