Midwives-ensuring safe deliveries despite COVID-19

7 September 2020

Daengmala Inthiphone and Nandee Xayaxane are two passionate midwives in Lao PDR. Daengmala was born and raised in the hill at Datjeung District, Sekong province, and is currently working at Thadaeng District Hospital. She belongs to the Talieng ethnic group. Nandee Xayaxane is from Sekong Province in the south.  They both share the love and care for mothers and babies. Daengmala is senior and well experienced, while Nandee is still a junior midwife and feels she needs more exchange and continuous capacity building to gain confidence.


In her work, Daengmala has always come up with plans to promote and persuade the community about maternal care. She engages and seeks support from community leaders like the Village chiefs, who often support her.  Together with the chief, she visits the villagers to provide and promote family planning, encouraging mothers to get antenatal care, which is free of charge at the nearest health center or to visit the hospital if necessary for the complicated deliveries. Daengmala does this so that couples give up going to deliver into the wood. This practice is still common and very risky. At the hospital, Daengmala ensures that mothers receive an after birth kit for them and the newborn baby.


“There was a mother who delivered in the forest, went back home to lay by the fire while she was still bleeding, she passed away after she was sent to the hospital,” said Daengmala. She added: “I work hard so that this kind of cultural belief ends. It is my duty to redouble efforts of education and awareness to sensitize women and their husbands on existing services.” 



@UNFPA Photos, Ms.Nandee Xayaxane

However, Daengmala and Nandee cannot communicate with all patients. In Sekong alone, there are 8 ethnic groups, each with their own language. Traditional differences are also an issue with some people holding on to misconceptions such as medical visits bring bad luck to the baby.  Traveling can be another struggle for both of us and the community. Many live in remote areas without roads. Sometimes, we must go when mothers are at risk during delivery” said Nandee.


As midwives, Nandee and Daengmala are aware and worried about the high rates of maternal and child mortality in Laos, especially since COVID-19. The lockdown and fears impacted the number of visits and made follow up challenging. Their teams had to come up with solutions to make services accessible such as using outreach for Antenatal care and mobilize community-based education UNFPA is piloting telemedicine modalities to address COVID-19 realities.  Recent data shows that antenatal care coverage in Lao has dropped due to COVID-19 and an increase in unplanned births, as well as maternal deaths, is projected. Nandee and Daengmala recognise the need to support the community, to inform husbands and families on the importance of sexual and reproductive health rights especially: hygiene, contraception, preparation for pregnancy, care during and after birth.


“As a midwife, it is my responsibility to educate mothers on their rights and healthy behaviors, especially Family Planning, explaining the advantages of birth spacing for them and their families. In addition to providing information on existing methods of contraception, I encourage mothers to visit the hospital for antenatal care, so we can plan ahead when it is time for delivery. The ultimate goal for the successful antenatal care is the wellbeing of mother and infant not only on physical plan but also psychological too.” says Nandee.


In Lao PDR, UNFPA supports the Ministry of Health through multiple modalities and partnerships to achieve the ICPD25 commitments made by Lao PDR.  This work is supported by partners including Luxemburg Aid and Development, Korea Foundation for International Healthcare (KOFIH), the Korean International Cooperation Agency (KOICA). The partnerships contribute to flagship UNFPA interventions: i) making sexual and reproductive health services universally accessible and available, ii) building capacities of midwives based on international training standards, with a focus on inclusion of midwives from ethnic groups for deployment in relevant communities. iv) Youth-friendly Communication, counselling, and services that is gender-sensitive and facilitates informed choices,


“I’m proud of my skills in midwifery, that mothers can trust us in taking care of them during pregnancy. Also, I’m proud that I’m able to save the mother and infant lives by providing them safe maternal care.” Daengmala, a midwife.


Quality midwifery care reduces maternal and newborn mortality and stillbirth rates by over 80%. Quality midwifery care improves breastfeeding rates and psychosocial outcomes, and reduces the use of interventions, in particular cesarean sections. It costs USD 3000 approximately, to train a midwife in Lao PDR to complete a 3-year curriculum.



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