RRH: Perceptions and management of postpartum haemorrhage among remote communities in Lao PDR

11 January, 2020

Below are the citation and abstract of a new paper in Rural and Remote Health. Full text here: https://www.rrh.org.au/journal/article/5436

It's interesting that bleeding is seen as a normal and indeed necessary part of childbirth. As one discussant said: "We’re concerned that stopping bleeding, we believe that the bleeding blood is … blood that is bad, it’s a bad blood for the body to get this out. So, if we stop the bleeding, the bad blood will stay inside the body, so the body will be dirty, unhealthy." Traditional medicine can delay referral. Oral misoprostol is an acceptabl prevention strategy.

CITATION: Hose I, Durham J, Phengsavanh A, Sychareun V, Vongxay V, Xaysomphou D, Rickart K. Perceptions and management of postpartum haemorrhage among remote communities in Lao PDR. Rural and Remote Health 2020; 20: 5436. https://doi.org/10.22605/RRH5436

ABSTRACT:

Introduction: In Lao People’s Democratic Republic, despite a policy to provide free maternal health services in healthcare facilities, many rural women continue to deliver at home, without a skilled birth attendant. These women are at high risk of postpartum haemorrhage, the leading cause of maternal mortality in the country. While women in remote areas continue to be unable to access facility-based birthing, interventions to reduce postpartum haemorrhage are a priority. This requires an understanding of how women and their families recognise and manage postpartum haemorrhage in home births. The purpose of this study was to understand community perceptions and management of postpartum bleeding during home births in remote Lao communities.

Methods: Five focus group discussions with a total of 34 women and their support networks were conducted in five remote communities in Oudomxay, a province with high rates of maternal mortality...

Results: Women described postpartum bleeding as a normal, necessary cleansing process. Some women felt it was critical in order to expel ‘bad blood’ and restore the mother to good health. Participants were able to describe late symptoms of postpartum haemorrhage but did not describe any methods to accurately estimate the amount of blood loss that required intervention. Traditional remedies were the first courses of action, potentially delaying treatment at a healthcare facility. When asked about the acceptability of taking oral medication immediately following home births to prevent postpartum haemorrhage, most women felt it would be acceptable provided it would not stop normal bleeding, and its usage, benefits and side-effects were clearly explained.

Conclusion: While women continue to home birth in remote communities without skilled birth attendants, an informed understanding of traditional management of postpartum haemorrhage can assist in designing culturally responsive interventions. To support a reduction in morbidity and mortality from postpartum haemorrhage, tailored interventions are needed to raise awareness among women and their families to reduce delays in seeking health care. Women felt it would be acceptable to take oral medication to prevent postpartum haemorrhage. As such, community-based distribution of misoprostol that can be administered by lay people would provide an effective and acceptable prevention strategy. Other strategies should include promoting birthing plans, delivery by skilled birth attendants and early initiation of breastfeeding.

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Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org