February 28, 2004

Book launch in Bangkok

The Thai edition of “Preparing for Birth” was launched yesterday at a press conference arranged by the Childbirth and Breastfeeding Foundation of Thailand. There were a small group of journalists present and they were very keen to explore the concepts of natural birth and what was happening in Thailand as well as Australia. Most press conferences that I have been involved with last only a short time, but these people kept us talking for 3 hours! I was rather exhausted by the end, as I was jet lagged and it was way past my biological bed time by the time we finished.

None of the journalists had given birth themselves and they were very interested to learn more about it. At one point we showed them a video (one of the Dutch videos) so they would be able to see what we were describing. Two of the young women literally peeped between their fingers, scared they would see a lot of blood. The staff at the hotel we were using were all lined out outside the room watching in avid fascination!

We were asked how this kind of birth could become more available in Thailand and what would be needed. It was very tempting to say “get rid of the obstetricians!” because here all births are conducted by doctors as there are only obstetric nurses and no midwives. Up to now, the main thrust of the Foundation’s work has been aimed at convincing the doctors and nurses to try new approaches and there have been some success (although only in a few places). The use of water for labour and birth has been so successful in the birth centre at the Samitivej Hospital in Bangkok that their rates for caesareans, forceps, epidurals and pethidine have dropped dramatically. Those women able to afford private health care and who choose this progressive unit have a very good chance of a normal, uncomplicated birth.

For the vast majority of women who use the public system, the picture is not so good. Women labour alone, in communal labour rooms and give birth in lithotomy strirrups, having had a shave and enema before the inevitable episiotomy. Caesarean rates are high, and women frequently request elective surgery so their baby can be born on an auspicious day, such as the King’s Birthday, or an important date on the Chinese calendar. Bringing change to this system will be very difficult, for without midwives to catch the babies, the system must use doctors, who are keen to maintain things as they are - they know no other way of delivering babies.

The availability of “Preparing for Birth” in Thai is the first step in making information about alternatives available to women. It is being sold in bookshops across the country and early indications are that sales are brisk.

I feel sure that once women start to learn of other options they will want more ideas and support. We’ve been discussing how the Foundation might set up prenatal classes to facilitate further educational opportunities for women. It will mean training leaders and devising a program that can be rolled out in major centres. Fortunately there are several graduates of our Graduate Diploma in Childbirth Education in Thailand, and these women can form the core trainers for the new educators.

One stumbling block will be that these new educators are most unlikely to have ever seen or experienced a natural birth, so ways will have to be found to expose them to this approach so they can confidently explain the options to the women in their classes. One way to achieve this might be to adopt the “follow through” system that the Australian B Mid students use to gain their experience. For these educators, it might mean teaming up with pregnant women and following them through their pregnancy care, birth and postnatal weeks. Observing natural births will be the problem, but if a way can be found for educators to team with women using the Samitivej Hospital’s birth centre, they would very likely witness natural births, including many in water. If Thai women know of other ways of giving birth it will encourage the doctors to experiment and provide them with better learning opportunities as well. It’s a plan......

Posted by andrea at February 28, 2004 07:14 PM