Wednesday, September 30, 2015

Critical early days - giving birth in a health facility

By Virginia Henderson
Baby Nang Mya with his mother and family at home in Loi Lomt village, Southern Shan State
©UNICEF Myanmar/2015/Virginia Henderson
Taunggyi, Southern Shan State, September 2015: On a pouring rainy day in October 2014 in the remote village of Loi Lomt, 24 year old Nang Khe gave birth to her fourth child with the assistance of a male traditional birth attendant. After delivery, Nang Khe fell semi-unconscious suffering from very low blood pressure due to a retained placenta. 
A runner was sent to the nearby village to find the midwife for help.  Auxiliary midwife Daw Nan Bwa had just completed the Department of Health refresher training on danger signs during and after delivery so was able to recognise the urgency of the situation.
“I realised Nang Khe needed to get to hospital right away”, recalls the experienced midwife, Nan Bwa. “We had supplies of saline drips in the meantime and thanks to the new mobile telephone network in this area I was able to call the Township nurse to get instructions. I believe this helped to save the mother”.
Loi Lomt village is impossible to access by vehicle in the rainy season. Nang Khe’s husband and three other men carried the frail mother in the rain in a bamboo-and-blanket stretcher over the rough terrain, then used a trowlergis (tractor for carrying rice sacks) to transport her to Khe Lu village.
“The pain was excruciating and I could not see anything around me. I thought that I was going to die at that moment,” recalls Nang Khe.
At Kyauktalone Hospital, Nang Khe’s placenta was manually removed and she received initial medical treatment. When her blood pressure returned to normal, she was moved to the large and better-equipped Taunggyi Hospital where she received medical care for five more days before returning home.
People in Myanmar must pay from their own pocket for extra costs associated with any healthcare, including transport and some medicines. This hinders families from going to hospital and clinics, especially poor households. In urgent cases, such as this difficult childbirth, the choice means life or death.
Nang Khe’s mother-in-law, Daw Pan who witnessed the drama of the homebirth says, “I was really concerned. Nang Khe was in very bad shape, it was pouring with rain and we had no money. When they took her off for treatment, I was left behind to take care of the new-born baby and I was crying all the time.” While Nang Khe was away, her sister breastfed baby Nang Mya.
Mother Nang Khe with her mother-in-law and health worker Htay Htay Myint whose prompt action saved Nang Khe’s life and that of her newborn baby
©UNICEF Myanmar/2015/Virginia Henderson
 “Midwife Nan Bwa saved my life. If she had not helped me to get to the hospital, I definitely would have died”, says relieved Nang Khe.  “I’m thankful to all the health staff involved and have decided to deliver my next child with a skilled person at a medical institution” 
 As well as supplying the basic delivery kits that are issued to midwifes and auxiliary midwifes, UNICEF supports the training and collaboration between all the parties. UNICEF is also working with the Department of Public Health to address traditional misconceptions around pregnancy and to improve pre-natal, delivery and post-natal care, including nutrition and hygiene. Community awareness campaigns help to spread the word about healthy mother and child practices.
Now 18 months old, Nang Mya was weaned at 13 months. “He’s in good health and I am too. I eat everything, including lots of protein, chicken, fish, vegetables, soyabean,” says the joyful mother.
Myanmar also has one of the highest maternal and under five years mortality rates in the region. Each year, around 65,000 children under five years and 2,500 women during pregnancy or within 42 days of termination of pregnancy die in Myanmar.   Newborns make up about 50 percent of all under-five-years child deaths, most dying on their first day. The primary causes of newborn death are complications of prematurity and birth asphyxia. Only 36 percent of the country’s children are born in a health facility.  There are large disparities across states and regions.
UNICEF is working with the government of Myanmar to encourage national investment and promote a coherent package of critical interventions in the first 1000 days of a child’s life. These include improving mother and child health and nutrition, full immunization, expanding the provision of clean water and sanitation and supporting children’s psycho-social development, care and protection.
Significant reductions on maternal and child mortality can be achieved through a few simple health interventions, such as giving birth in a health facility, or at least in the presence of a skilled birth attendant. Other key interventions include immunisation against childhood illnesses, oral rehydration therapy for diarrhoea, and antibiotics for pneumonia.
In January 2014, Nang Thein Yi ,31, who was thirty-nine weeks pregnant and overdue, went for a walk visiting around her village of Warr La. Feeling little dizzy, she returned home and fell unconscious on the floor. Five hours later Nang Thein Yi was having a Caesarean section in Taunggy Hospital.

“I only regained consciousness the following day. I was completely unaware the baby had been born,” reported the surprised mother. “Even though two of my previous children died at birth, I thought that as this was my fourth baby and because all the others were born at home, it should be alright. It wasn’t. Thanks to the midwife and health staff I’m here today.”
Both Nang Khe and Nang Thein Yi managed to reach the health facilities on time. Unfortunately not all mothers and children are as lucky as them. In order to reduce maternal and neonatal deaths, UNICEF encourages mothers to go to a health facility and Government to find solutions to reduce out of pocket expenses for transport and medical expenses related to delivery. Probably, the lives of the Nang Thein Yi’s previous two children, who died during birth at home, could have been saved if she had planned to deliver at a health facility.

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