WUNRN
Midwives Assisting Homebirths Face
Challenges in Rural Bangladesh
In
Bangladesh many women still die during child labour. Many of these deaths occur
at home. A trained midwife could prevent many of these deaths. In response,
countries in South Asia are now promoting the policy of homebirths supervised
by a trained midwife.
The Centre
for Health and Population Research, Dhaka, looked at the experiences of
midwives attending homebirths in the rural region of Matlab. In Bangladesh, 91
percent of births still take place at home and only 13 percent are assisted by
a doctor or midwife. In 1987, almost 20 years ago, a health initiative was
introduced in Matlab to allow midwives to attend women in the home.
Researchers
conducted interviews and group discussions with 13 midwives in Matlab in 2003
and 2004 to learn what difficulties they faced during their work. The study
found midwives experienced many problems conducting home deliveries. The
biggest challenges they faced were related to attitudes of the family members
who often wanted to maintain traditional childbirth practices. If a
complication arose during labour it could take hours or even days to persuade
the family to allow the mother to go to a hospital that offered care. Moreover,
childbirth was seen as dirty and whoever touched a woman giving birth was
viewed as impure. As a result the midwives did not receive the help and respect
they expected.
Other
difficulties confronting the midwives were:
Midwives
felt more comfortable working in a hospital environment. However in the
hospital the midwives behaviour was often reported to be inappropriate. Some
midwives shouted at and humiliated their patients for screaming during labour,
for taking too long to deliver or for refusing to show their genitals. The
midwives’ modern attitudes clashed with the traditional values of the families
both in the clinic, where the midwives felt more in control, and in the home,
where the families were dominant.
The
researchers suggest:
Even with
these improvements the midwives will face many obstacles during homebirths.
Governments should consider carefully whether a clinic or home-based approach
is the best option for ensuring skilled birthing care.
id21
Research Highlight: 3
April 2007