Safe Arrivals: Responding to the Local Context in a Training Program for Birth Attendants in Cambodia

The World Health Organization (WHO) recommends that every woman should have a skilled birth attendant (SBA) attend her birth; however, until this ideal is met, traditional birth attendants (TBA) continue to provide care to women, particularly in rural areas of countries such as Cambodia. The lack of congruence between an ideal and reality has caused difficulty for policy makers and governments. In 2007, The 2h Project, an Australian-based, nongovernment organization in partnership with a local Cambodian organization, “Smile of World,” commenced the “Safe Arrivals” project, providing annual training for SBAs and TBAs in the rural provinces of Cambodia. Following implementation of this project, feedback was collected through a questionnaire undertaken by interviews with participants. This was part of a quality assurance process to further develop training in line with WHO recommendations and to consider the cultural context and respond to local knowledge. Over a 2-year period, 240 birth attendants were interviewed regarding their role and practice. Specifically, through the responses to the questionnaires, several cultural practices were identified that have informed training focus and resource development. More broadly, it was evident that TBAs remain a valuable resource for women, acknowledging their social and cultural role in childbirth

Safe Arrivals: Responding to the Local Context in a Training Program for Birth Attendants in Cambodia

The World Health Organization (WHO) recommends that every woman should have a skilled birth attendant (SBA) attend her birth; however, until this ideal is met, traditional birth attendants (TBA) continue to provide care to women, particularly in rural areas of countries such as Cambodia. The lack of congruence between an ideal and reality has caused difficulty for policy makers and governments. In 2007, The 2h Project, an Australian-based, nongovernment organization in partnership with a local Cambodian organization, “Smile of World,” commenced the “Safe Arrivals” project, providing annual training for SBAs and TBAs in the rural provinces of Cambodia. Following implementation of this project, feedback was collected through a questionnaire undertaken by interviews with participants. This was part of a quality assurance process to further develop training in line with WHO recommendations and to consider the cultural context and respond to local knowledge. Over a 2-year period, 240 birth attendants were interviewed regarding their role and practice. Specifically, through the responses to the questionnaires, several cultural practices were identified that have informed training focus and resource development. More broadly, it was evident that TBAs remain a valuable resource for women, acknowledging their social and cultural role in childbirth

Nausea and vomiting in pregnancy: Blooming or bloomin’ awful? A review of the literature

BackgroundNausea and vomiting in pregnancy (NVP) is a normal, commonly experienced affliction of early pregnancy. Despite this, its impact on women's lives is not necessarily minimal. For some women, the implications of NVP are substantial with multi-faceted effects, hindering their ability to maintain usual life activities, and particularly their ability to work. In an effort to understand the effect of NVP, several researchers have developed NVP measurement tools, which enable an understanding of NVP's effect on quality of life (QOL).ProblemThis paper seeks to provide a review of the literature to explore the impact of NVP on women's quality of life, particularly their ability to maintain social and professional commitments.MethodMedline, CINAHL, PsychINFO, Ebsco, Science Direct, Health Source, Academic Search Premiere, Cochrane databases were extensively searched using Boolean operators with various combinations of relevant terms: nausea, vomiting, pregnancy, emesis, quality of life, QOL, NVPQOL, PUQE, SF-12, SF-36 and limited to those published from 1999 onwards. Papers were scrutinised to include those discussing the impact of normal NVP on women's lives, particularly their QOL with careful exclusion of those addressing hyperemesis gravidarum (HG).FindingsNVP has a significant effect on women's QOL and therefore their ability to maintain day-to-day activities as well as work capacity. This has implications for the woman, her partner, her family and her employers.ConclusionIt is important that all maternity care workers consider the impact of NVP on the woman's QOL and that care is given not to minimise this experience. Further research is warranted which considers ways in which women can best manage this experience in relation to social and professional commitments. Given the authors were able to identify only one Australian study in this area, published in 2000 and utilising non-NVP specific QOL measurement tools, there exists scope for additional local studies using NVP-specific QOL tools to determine the impact of QOL for Australian women and therefore Australian society

Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour

BackgroundApproximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of ‘normal’ labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context.AimTo examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth.MethodsEthnography, underpinned by a critical medical anthropology methodology.ResultsThese findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence.ConclusionsAs we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a ‘risky’ practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more ‘dangerous’ option

Critical Medical Anthropology in Midwifery Research: A Framework for Ethnographic Analysis

In this article, we discuss the use of critical medical anthropology (CMA) as a theoretical framework for research in the maternity care setting. With reference to the doctoral research of the first author, we argue for the relevance of using CMA for research into the maternity care setting, particularly as it relates to midwifery. We then give an overview of an existing analytic model within CMA that we adapted for looking specifically at childbirth practices and which was then used in both analyzing the data and structuring the thesis. There is often no clear guide to the analysis or writing up of data in ethnographic research; we therefore offer this Critical analytic model of childbirth practices for other researchers conducting ethnographic research into childbirth or maternity care

Paradox of the institution: findings from a hospital labour ward ethnography

BackgroundInterest in the influence of culture on birth practices is on the rise, and with it comes a sense of urgency to implement practices that aid the normalisation and humanisation of birth. This groundswell is occurring despite a broader cultural milieu of escalating technology-use and medicalisation of birth across the globe. Against this background, rates of epidural analgesia use by women in labour are increasing, despite the risk of side effects. Socio-cultural norms and beliefs are likely to influence pain relief choices but there is currently scant research on this topic.MethodsThis study was undertaken to gain insight into the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour. The study had an ethnographic approach within a theoretical framework of Critical Medical Anthropology (CMA), Foucauldian and feminist theory. Given the nature of ethnographic research, it was assumed that using the subject of epidural analgesia to gain insight into Western birth practices could illuminate broader cultural ideals and that the epidural itself may not remain the focus of the research.ResultsFindings from the study showed how institutional surveillance, symbolised by the Journey Board led to an institutional momentum that in its attempt to keep women safe actually introduced new areas of risk, a situation which we named the Paradox of the institution.ConclusionsThese findings, showing a risk/safety paradox at the centre of institutionalised birth, add a qualitative dimension to the growing number of quantitative studies asserting that acute medical settings can be detrimental to normal birth practices and outcomes