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Midwifery care in Thailand

Following a terrific few days in Japan, I have headed to Bangkok, to do some work for the Childbirth and Breastfeeding Foundation of Thailand. A one-day workshop had been planned as an update on the Active Birth theme and a group of midwives from a number of hospitals and universities came to share their ideas.

There was also a group of midwives frm Vietnam - they were undertaking studies at the College of Nursing and attended with their Tutor. I was pleased I could present the program in English as having to translate into both Thai and Vietnamese would have slowed us down considerably.

It seems that active birth concepts are still slow to be adopted in Thailand. The maternity care system here is dominated by the obstetricians and the midwives (nurses) work completely under their control. There is no real understanding of midwifery as a separate profession as all nurses have six months of obstetric care as part of their basic training. Some do go on to specialise in birth, and would be regarded as midwives anywhere else, although they too have to stand aside for the doctor to manage the birth itself.

There is also no separate organisation for midwives, and it is impossible for “foreign” midwives to work in Thailand. This is such a shame, as Bangkok has a large expat community, including a number of midwives, who could readily provide some on-the-job training and guidance for local staff. I met a midwife from Norway, with many years of experience facilitating home births in her country, who has been totally frustrated in her efforts to use her skills in Bangkok. She mainly works offering support to women pre and postnatally with occasional opportunities to support women in labour. She told me that she has recently had a breakthrough when supporting one woman in a hospital. The obstetrician ws prepared to stand and watch her manage the labour. He was astonished at the ease of the birth and the calm way that the midwife carried out her care. He was very impressed and although there are legal difficulties for her to continue working in this way, she is hoping that some kind of informal “arrangement” can be made with this open-minded man. At least he has seen how birth can happen safely and simply in a midwifery environment. Perhaps he will become a rare convert to the idea that with birth, “less is more”.

As with other medicalised countries, the main stumbling blocks to achieving change are habit (old habits die hard), money (doctors are paid for what they do), territory (they are not willing to have anyone invade their patch) and lack of experience. This last issue is a major problem because unless a doctor has actually witnessed alternative ways of managing labour, it is almost impossible for them to imagine how it can be done, especially their own role. Seeing really is believing when it comes to implementing new ideas.

Without skilled midwives to demonstrate alternative approaches, it makes stimulating change very difficult. The Foundation is planning another round of workshops facilitated by Dr Tanit and Melanie Habanananda (the leaders in natural childbirth in Thailand) and they hope to recruit some others to join their training team. A lot of work is needed to reduce the caesarean birth rate which is now hovering around 70% in the private hospitals.

The workshop was fun and productive. We covered the usual material and discussed local issues. This workshop may become a regular feature on the Foundation’s calendar, to underscore the work they are doing themselves. Many of you will recognise these activities, illustrated below:

Posted by andrea at December 17, 2006 01:00 PM