Three dedicated midwives and birth educators, Claire Eccleston, Jenny Blyth, and Stef Arvanitakis detail their recent outreach in Laos. It is the first time Send Hope Not Flowers has supported a maternal health project in Laos, and we hope it is the first of many. Here is Part 1 of an inspirational story.
After a lovely first couple of days together in Luang Prabang, Jen, Claire and I prepare all that we need by way of gifted supplies and teaching equipment and have been thoroughly nourished once again by the majesty of this beautiful city, its people and culture.
We meet with our beloved translator, Phonesavan and the members of the Red Cross who will be accompanying us for our trainings to come. The stress and burnout of these devoted health educators and trainers is palpable. It has been another trying year in Maternal Child Health in Luang Prabang Province, with numerous tragic deaths of mothers and babies and much grief and frustration felt in the exhaustive effort to bring change to highly culturally complex, disadvantaged and geographically remote circumstances.
After a couple of hours of travel through river valley countryside, we wove out way into the mountains of the district of Phonesay.
Surrounded by rolling hills, densely clad in banana, bamboo and frangipani, the heart of Phonesay district is a small township north east of Luang Prabang in Northern Laos.
It has been beautiful to be reunited with 15 of the women who had been present for our January Birthwork Training and to meet several new midwives and health workers from the district joining us for the first time.
The warmth and the sincerity of the greetings we received and the immediacy of the laughter and comfort we found with one another quickly helped to affirm the purpose of our being here and the value of our return visit.
We began with an exploration of the many uses of our hands as midwives, health workers and birthworkers – palpation, accessing baby’s position, baby’s size, keeping records, holding the pinnard to listen to the fetal heart, sharing self-care techniques with a mother, helping a mother to comfortably move, change positions and adjust herself, to gently massage the mother, to offer techniques to make more space for the baby and to offer emergency care.
We seek to impart three kindnesses:
To improve our own knowledge and to share what we know with our colleagues and the women we care for. When we keep learning and sharing the responsibility of our work is shared.
We must treat every woman in our care as though she is a cherished sister. Despite personal or societal prejudices our work is to care for pregnant, birthing and new mothers and babies and their job is the most important job in the world. They must be treated with the greatest of care. When we are kind, the mothers in our care will relax, and they will trust us and share honestly. When we are kind to the mothers in our care our kindness will be remembered even in dire circumstances. And equally important is the third kindness of being kind to self; to be able to do our jobs well we need to be nourished, hydrated and rested. When we look after ourselves we are better equipped to care for others. Don’t be afraid to ask for help.
Our afternoon was full to the brim with thorough teachings on emergency and more complex care, including postpartum haemorrhage, newborn resuscitation, shoulder dystocia and breach birth.
Despite the universally fear-provoking nature and breadth of these topics the day flowed with ease and comfort.
We interspersed our heavy discussion and learning with another mix of role-playing demonstrations, games and dancing.
We are so grateful to be here once again and so thrilled to have met our fundraising goal through a mix of our gofundme campaign, fundraising events, personal donations and a profoundly generous donation of $5000 from the charitable organisation Send Hope Not Flowers.
Our heartfelt thanks to all those who have given your support by way of funds, love and encouragement.
After a beautiful morning walk through the lively township, observing townsfolk tending to crops and animals, people washing in the river and children happily walking and riding to school our final day of Birthwork Training in Phonesay began with the confrontation of just how hard it truly is, in the instance of an emergency, to receive medical support or transfer a mother or baby from these more remote communities.
We discovered that for some communities while transportation is available it is not affordable for many community members and in some communities, transport it is simply not even available. District hospitals generally have a basic, tractor-like-ambulance but the inadequate quality of roads and hospital restrictions do not allow an ambulance to travel far out of the major towns. Many of the midwives and health worker present are working in isolation and they are a mother and baby’s only port of call in an emergency. Being in the presence of these courageous women and men began to feel even more humbling as the gravity of their circumstances further made its mark upon us.
Tomorrow we will travel several more hours into the mountains to acquaint ourselves further with the remote nature of village life for many Laotians, and how this impacts upon birth and maternal and child health.
Yesterday we covered infant resuscitation using the bag and mask but realised today how frequent it is that midwifes and health workers are without this simple piece of equipment. Because of the instance of communicable diseases, mouth-to-mouth resuscitation is not considered safe. We were able to show some methods that a colleague of Claire’s discovered when working in South Sudan using a pinnard or one’s hand on a scrolled position and breathing through either of these into a baby’s mouth
We explored the dynamics of pelvic anatomy and different ways to create more space and freedom from tension. We reintroduced the importance of kindness and gentle approaches that may help a mother feel safe and cared for.
We also re introduced the benefits and options of different active birth positions. Some women shared more opening about their concerns around deviating from the standard practice of lithotomy (back lying) position with legs in stirrups and how it has been hard for them to experiment with all of the options we shared in January but one woman proudly shared that she had been encouraging mothers to birth in positions of their choice and using our bodywork techniques and as a result more women were coming to her and feeling very happy with her care.
We covered different gentle methods for assisting to turn a baby in a challenging positions and different approaches to giving a vaginal examination that assist in enhancing dignity, respect and comfort for the mother.
At the end of the day we gave out bag and masks for resuscitation and ‘Days For Girls’ reusable cloth menstrual pad and undie kits made by volunteer women in Melbourne. https://www.daysforgirls.org/ supply menstrual pad kits for women in disadvantaged circumstances all over the world, helping to ensure that women are not limited by their cycles.
We finished our day with a reciprocal dance and song sharing including a labouring encouraging, hip spiralling and jiggling dance we had created last night accompanied by us singing Inanay! Very Funny!
We received many thanks and further affirmation of the unique nature of our training style and content – we were told that never before have trainers with approaches and methods like ours been to Laos and all our participants seemed again genuinely thankful for what we shared.
In such disadvantaged and complex circumstances it is hard to know is how significantly our input can be of service but we pray that even in the smallest of ways we are imparting some little jewels of knowledge, kindness and creativity that somewhere may be of value in times of need.
As the sun sets over the mountain village of Phontong in Northern Laos, boys play soccer in the field in front of our simple home for the night, our host arranges our sleeping mats on the floor, the frogs and night insects sing in a humming chorus, girls cartwheel, townsfolk return home with loads of freshly harvested rice, women squat at ground fires cooking dinner and people fill the village square for a frugal night market.
We wander through the village streets with Phonsavan (our translator) greeting the smiling people we pass ‘sabadii’; a boy with a monkey in pants, baby wearing women and children, children playing on a homemade single wheeled bike contraption and visit the poorest Buddhist Temple we have ever come upon.
In a largely animist village, the two local Buddhists monks and young novice have little daily alms on offer and little community support for their basic provisions and necessities of home and hearth. They live without running water or a bathroom, and the tumble down home that also serves as the village temple, was no more than a slapped together, draughty, wooden slat shed. This temple gong was a rusty old hanging wheel whose clang resounded through the town at sunset.
We found a local shop that sold plastic by the roll and were able to donate a long length to assist in making the house/ temple less draughty. The plastic and our other donations were received with the traditional reciprocation of prayer and blessings; woven saffron bracelet gifting and a water ritual offering blessings to our ancestors and our safe journeys home.
After winding higher and higher above the clouds, awed by breath taking mountainous views, we travelled for several hours on precarious dirt roads to come to Phontong.
Today we visited the local health and birthing centre, meeting new mothers, babies and pregnant women and travelled out to several villages for postnatal visits with the local midwives.
The hut of the new baby and mother was filled to the brim with family joyfully observing the postnatal visit that was given with much care and competence by the local midwife. When asked if we had any suggestions on improving the care we had observed our only suggestion was to consider being more actively inclusive of the extended family. Celebrating and acknowledging the good health of the mother and baby and emphasising the village it takes to keep a mother and a baby in good health. In this circumstance it felt that for now this particular mother and babe were receiving what they needed.
For these beautiful, warm-natured and gentle mountain folk, life is hard and while the land appears fertile and gardens and livestock thrive it is clearly a life of subsistence, simplicity and endurance. We were told that young women on average marry at 13, have their first child at 14 and have between 5-10 children before the age of 40. We were amazed by the numbers of babes in arms! While support with family planning is available, not everyone is choosing to take it up.
Claire visited the poorest village of the region, Vengjeulan while Jen and I rested, recovering from the nausea and wipe out of our windy travel.
In Vengjeulan she met with a mother and a very small 2-week-old baby, weighing only 2kg. While the baby appeared well, the mother was existing on a diet of rice and salt alone. This is commonplace postnatal diet for the mountain dwelling Khmu and Hmong communities; occurring through a mix of cultural reasons and poverty. This diet is a known cause of Beriberi; a condition resulting from vitamin B1, Thiamine deficiency and the cause of many cases of infant death in Laos each year. One egg a day is enough to prevent or cure the condition but for many reasons ensuring this has not been easy task. We have suggested that health care workers provide pregnant and breastfeeding women with eggs at each antenatal and postnatal visit.
In reviewing the Red Cross Competency Papers, Claire was able to find several points requiring amendment regarding safe and effective midwifery practice. It is also easy to see how the implementation of designated, suitable vehicles and a funded transport service for medical emergencies could also be of great value. While distance, proximity to medical assistance and the shocking conditions of the roads and impassable river crossings in wet season will always be points of major hindrance, having funded transport services and vehicles in each village could save lives in some situations.
We gave out baby clothes and blankets and more Days For Girls reusable menstrual pad kits to the village women but beyond this and our greetings of kindness and goodwill our offerings felt somewhat inadequate. The challenges of these remote circumstances are not easily remedied.
While our developed world and personal lives come with innumerable challenges and stresses of their own we are truly blessed by abundance and fortune of so many kinds. It is so easy to take what we have for granted.
We offered a little workshop at The Phontong Health Centre for the local doctors, midwives and health workers.
Gazing out over the village and into the misty mountains we covered a quick overview of Postpartum Haemorrhage, Manual Removal of the Placenta and Shoulder Dystocia, Infant Resuscitation, Pelvic Dynamics and Active Birth Positions.
For our last training in Phonsay Claire created a playful dance-like sequence of emergency care steps to make learning the different steps of emergency response easier. Once again this was received with much laughter and appreciation.
Having heard of the trepidation felt around encouraging women to birth in positions other than lithotomy (back lying) it felt valuable to demonstrate a variety of positional options in an actual birthing room and illustrate how creatively the narrow birthing bed and floor space could be used to safely support a mother to experiment with more open positions.
The recent arrival of western obstetric training and culture has worked hard to improve outcomes for mothers and babies but also seen the loss of traditional birthing practices and the introduction of questionable practices such as the routine use of narrow beds and stirrups in all birthing rooms. We have been told that there has also been a loss of approaches that support kindness and sensitivity and the exclusion of family in the birthing space.
Traditionally Laos women birthed in positions of their choice, often upright with the use of a hanging rope. Village women, birthing at home still do as they choose but birthing in a position other than on ones back is not common place elsewhere. We have been told that fear of being treated cruelty, made to birth on the bed and being separated from one’s family are some of the reasons that prevent women from seeking out midwifery support during their pregnancies and births.
It felt really exciting and far more realistic to be teaching positional options in an actual birthing room and illustrating how safe, achievable and anatomically valuable this was. We also made sure to include role played references to including a birthing woman’s mother or sister in the birth for extra support and many examples of tenderness, compassionate touch and kindness.
A few pregnant women joined us for this phase of the training and seemed inspired by the prospect of being free to move around as they chose. One woman shared a story of another village women who had recently experienced a long and challenging birth that she felt could have been made easier with the encouragement to try some different positions.
By end of our little workshop word of the funny western women, doing funny poses that resembled dogs and other animals must have circulated as quite a few towns folk had gathered finding much humour in what we were sharing!
We handed out our remaining midwifery supplies and left Pontong with a heart-warming farewell from our hosts and participants. We were gifted with three stunning, hand woven and dyed sins (traditional skirts) woven and embroidered by our lovely host, the beautiful women pictured below sitting at her loom.