September 30, 2003

Changing the way that doctors and midwives work

I am in Thailand at present, staying with my good friends Dr Tanit Habanananda and his wife Mel, who is one of our Graduate Diploma in CBE Supervisors (amongst other things!). The Habananandas are the driving force behind the Childbirth and Breastfeeding Foundation of Thailand which they set up to promote natural birth.

We have been discussing the slow progress towards changing the medicalised birth scene here. The doctors and nurses (there are no midwives as such) are often keen on the ideas and are willing attendees at lectures and workshops, but translating this into results in the maternity units just doesn’t seem to happen.

This situation is not unique to Thailand, as I pointed out to them. It is very hard to change the practice habits of professionals everywhere and this is a constant problem I have encountered everywhere. It seems to me that the only way that professionals will change is if they see natural births and then are able to be mentored as they try making changes themselves. Close observation of the new techniques followed by supervised practice might be the answer.

Here in Thailand, this approach may be reasonably easy to set up in the public system. Dr Habanananda is well known as a specialist and given his status and position, he can often “take over” a case for demonstration purposes. I have seen this happen, when he was able to step in and facilitate a birth in a teaching hospital. The woman was encouraged to adopt a comfortable position on the floor and very quickly gave birth to her baby, with a group of awe-struck nurses watching from the side.

This kind of demonstration brings the theory to life and enables care givers to see how it works. We discussed the possibility of setting up some intimate workshops for small groups of doctors and nurses that utilised this kind of demonstration, followed by a theory session to de-brief what they saw, then supervised practice with appropriate support and feedback.

There is a major hospital in Khon Kaen (a regional city in the north of Thailand) who are keen to implement change. They will be the first hospital to have the benefit o this approach and it will be interesting to see how it goes.

The Foundation has prepared a wonderful set of teaching notes and workbook exercises called the Better Babies Initiative and this will be used to lay the basic underpinning research evidence for changing the way birth is handled now. If this can be followed up with small group intensive training sessions using actual birthing women, there is a good chance that some of the techniques that have been discussed in theory can actually be translated into practice. I hope this works well for the Foundation, because without some tangible signs of progress, my good friends may just decide that 25 years of struggle is not worth it any more and that retirement is a better option. Thailand would be losing two of their greatest innovators, if this happens.

Posted by andrea at September 30, 2003 12:39 PM

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