I) Midwifery Care
Many Laotian people have been denied their wishes to deliver the babies at the hospital for midwifery care in their villages are more reliable. Thousands of babies, particularly in poverty-stricken villages of Lao PDR are being born by midwives care provision. Presently, midwives not only play a central role in prenatal care and health but help the country tackle sex trafficking problem, a modern form of slavery that exists throughout the world.
Midwives hold the power as the true spiritual leader in many local villages. They are the first one who serve the frontline of social, economic and environmental crises. A world of care that is independent from the main economy and the world society need to be investigated, especially when a service from “Male Midwives” is almost unheard of.
Midwifery care is a unique economic behavior, addressing basic right in providing midwives service, health and nursing. In the case of Laotian’s midwifery model of care and delivery, Buddhist philosophy, family and neighbors are the fundamental to survive the pregnancy and childbirth rather than an aid from the government. The intimate connection between birth attendances including midwives, mother, children, family members, relatives and neighbors ensure the success of healing.
Caring from all members within local society also promotes social and economic development through the promotion of female reproductive health in a unique way. Local health markets at the village level are guided by different values, that go beyond nursing service materials and physical frontier.
II) Teenage Pregnancy and Nursing Crises
Very recently, Lao PDR witnesses high rate of maternal death due to sex trafficking and ASEAN migration. Many young Laotian teenagers have crossed the border to work in service and entertainment sector of Thailand, mainly Karaoke shops and become the victims of sex trafficking. By different means of violence, threats, or debt bondage, they later engage in commercial sex and get pregnant. They are the teenagers less than 19 years of age.
While teenage pregnancy is increasing, midwives are inadequately prepared for better homebirth care. Midwifery was controversial in Lao PDR 23 years ago. Midwives have been ignored and play no role in the government policy, resulting in inadequate qualified midwives. An agreement to involve those midwives into government’s health policy due to increasing rate of maternal death came rather late. When midwifery is considered to be one of the best method to promote the growth of the country, less than 100 qualified midwives are still active. The service coverage of limited number of midwives to serve 6.2 million people is doubted. Midwives have to play an increasing role in solving maternal, newborn and child mortality problems.
There are many reasons why do people attach to midwifery care and in the case of Laotian villagers, it is difficult to change. Firstly, midwife is more familiar to the family, skillful and reliable. The midwifery care is blended in the routine lives of the people, in particular the wisdom of herbal plants. Herbal plants used during pregnancy of family members will be recorded for life for everybody highly involved in the delivery of babies in their family. There are more than 55 herbal plants used during the pregnancy during lying-in period. Apart from being a reproductive medicine specialist, midwives are also a herbalist, psychologist and teacher.
Midwives integrate knowledge and wisdom in servicing maternal care to ensure the survival of pregnant women and newborn. They promote the long-term well-being of women, babies, and family by offering advice and information on nutrition, supplementation, and breastfeeding. Quality of health after childbirth reflect the freedom. People familiar with the midwifery knowledge because it is based on Lao’s traditional disciplines (Heat Khong) and Buddhist principle as well as local believe.
The society accumulate the knowledge for long time for the survival in modern days. The knowledge rooted from Heat Knong of Laos are widely accepted for it is more reliable and trustable. The morality to attending birth rather taking exploitation, make the midwifery’s sufficiency economy is a science of humanity and philosophy.
Childbirth is very demanding. Women demand different forms of cares, including physical need, psychological need, cultural need. Spheres of life become differentiated from one another. The birth delivery at the hospital is viewed as common goods and can not response to every sphere of life.
Midwives help the pregnant women to deliver their babies (natural childbirth) at home which is the platform of lives and souls of parents, husband, relatives and neighbors. All of them play different roles as birth attendance, in particular the husband in the preparation through healing stage. His responsibilities lie in finding woods for using during lying-in period (Yoo Fai) once the pregnant has been notified. Husband also attend the delivery, handle placenta burial task, and take care of mother and newborn child during lying-in period.
The accumulation of woods for lying-in period aims to raise the responsibility consciousness and turn the husband to father. Fatherhood for Laotian starts at the time placenta is buried. People believe if the buried is taken under Bodhi Tree, the child will find a quick recovery. The hole must be wide and deep within 1arm length, enough for placenta and amniotic fluid under the cover of plastic sheet that was used during delivery period. Laotian emphasizes the importance of placenta’s buried tradition. Father must be concentrate; if the intention was lost or look around, the newborn will has a squint.
Childbirth is life agenda and opportunity to tighten the collective bonds and ensure the commitment with all members to share the responsibility of raising the child. Laotian considers it as an important transition to adopt the newborn as a child of everybody in the village.
IV) Natural vis-à-vis Hospital Childbirth
Natural birth delivery tests the physical strength of the pregnant women. Pain is considered to be part of life that everyone must overcome in order to achieve long-term well-being. The patience and calm (Athiwasana) is a method of eliminating defilements (Asawa or Kilesa). In particular, the profound moment of sharp pain during the delivery. It is a strategy to make people understand all things and beings (Dharm) should not be attached (Suppe dharma Nalung Abhiniwesai).
Many Laotian women are against an operative birth. This is because the birth canal operation stays outside the realm of Heat Khong tradition of Lao PDR. The treatment is considered as a threat led by unknown people. Subsequently, most of the people reject it with fear. According to Canthanom Manithip and et al. (2013) indicated the reasons that people do not want to deliver the newborn baby at the hospital because of the service quality. Many medical facilities in rural areas of Lao PDR are servicing people under the standard due to lacking of adequate equipment and the birth attendance are overloaded with many tasks. Their availability for the consultation is only for 5 minutes. In 2014, the government has lunched the maternal health policy to subsidy the childbirth at the hospital up to THB 4,000 – 5,000 per person including traveling costs.
V) Male Midwives
The appearance of male midwives at Non Patew village widening the frontier of maternal heath and a plural society that empower the people to live their economic lives beyond the limitation of social law.
All lives within Non Patew and neighboring villages depend on midwives. They are poor, lack of adequate income, living in a remote area outside the modern medical care coverage. Midwives could meet the effective demand of families and the whole community that lacks of medical cares. The notable midwife is Phoyai (it means grandfather) Chaem Nuphala, 68 years of age. He used to be the farmer, planter and daily worker before becoming a grandpa midwife. Phoyai Chaem inherited the maternal care knowledge from his grandmother who was an experienced village midwife. Accompanying grandmother to deliver the child gave an inspiration to him to be a midwife for humanity. It is considered to be an act of good deeds.
When grown up and married, he also provides a good care to his wife with food and herbal plants to ensure the healthy pregnancy and delivery of 13 children. He attended his daughters and all neighbors’ childbirth more than 100 live birth over decades with safe delivery. Due to the skills and proficiency, Phoyai Chaem has, therefore, gained trust from the people.
Laotian found no differences among male or female midwives because the practice is universal. It is based on Heat Khong and rituals (Khan ha) to pay a respect to Buddha, Dharma and Sangkha. The objective of sufficiency economy in the case of Laotian midwives is the protection of traditional rites and rituals. They believe that the society will be developed when a new life was born. Heat Khong is an important means to save all lives. Caring is not for purchasing but it is a matter of sharing the compassion. The medium of exchange is not money but it is the adoption of Khan Ha (5 respect) to practice human ethics or 5 precepts in the daily living.
In Buddhism, the appearance of Khan brings the emergence (Chart) or birth, starting inside the womb (Kuntuppa) since the fermentation. Khan comprises of 5 pillars including 1) physical body (Rupakhan) including earth, water, air and fire, 2) Vetana sanya 3) Sanya Khan 4) Sangkara Khan 5) Viyana Khan
The adoption of Khan is rituals of Laotian blended with the animism that a believe on spirit together with Buddhist rites. This is one of mechanism in sufficiency economy philosophy to strategy the idea for wisdom with insights into the Noble Truth. Buddhism emphasizes precepts (Sila), mindfulness (Samadhi) and wisdom (Panya) to eradicate the ignorance. The giving and receiving of Khan Ha has changed people to be more polite, giving a respect to the teacher who trained them can inspire them give the respect to others. The respect bring benefits to the people, i.e., healthy and beautiful skin, happiness and strength.
VI) Midwifery Practices
Midwives provide prenatal care and education to pregnant women from the start to childbirth. Processes of care include a private and traditional practice including prenatal care visits, physical examination, effective maternal care, and counseling services. Night time deliveries are attending. The collaboration of physicians and midwives generate the benefit to villagers. The physicians perform the life-saving care. It helps open the door for more access to most needed victims of sex trafficking and vulnerable women.
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