Maternal and Child Health

Give & Take: Working with Local Nurses to Make Birth Safer in Laos

Photo Credit:
Lao nurses at a training. Photo Credit:

Written by Kristyn Zalota, Founder,

In my first Girls’ Globe post, I wrote of Laos’ high rates of infant and maternal mortality. While progress is being made, Laos is expected to fall short of Millennium Development Goals 4 and 5.  In 2014, Laos ranked 129th of 178 on Save the Children’s 2014 Mothers’ Index.

Knowing these bleak statistics, I started because I believe that no mom or baby should die from preventable causes.  In 2 years, we’ve provided 4,000 AYZH Clean Birth Kits containing hygienic birthing supplies that prevent infection to our local nurses in Southern Laos.  In partnership with the Yale School of Nursing, we have trained 110 nurses and staff in the use and distribution of the kits and the WHO’s Essentials of Newborn Care.

While the kits are important, education and training have made the difference between kits being used correctly or not.

We’ve made it clear to the nurses that the trainings are a two way street. We teach them. They teach us.  Open exchanges about the realities of birth in remote villages have led to innovative solutions to unsafe birth practices.

The two unsafe practices that we specifically target together are:

  1. Mothers birthing completely alone, due to a cultural blood taboo.
  2. The use of unclean items being used during birth.

These two practices are closely connected. Even if the mothers have Clean Birth Kits, it is very difficult for them to follow the steps needed to keep the birth hygienic once the labor begins and the baby is delivered. For example, imagine a mother alone in a remote area of Laos.  She has just given birth and is exhausted lying on the floor or outdoors on the ground.  She will not have access to running water, she will likely not have a prepared water basin nearby to wash her hands, and — even if she has water — she will be too exhausted to consult the picture instructions in the kit to remind her to wash her hands.  Given that this is not a traditional practice the instructions are a helpful reminder, but the tired mother is unlikely to take the step of hand washing before removing the sterile blade from its package, cutting and handling the umbilical cord.  Her dirty hands can contaminate the blade and cause an infection in the newborn.

AYZH Birthing Kit
AYZH Birthing Kit

At our last training in July 2014, the nurses told us that moms were using the kits but were still birthing alone, despite explicit instructions from the nurses at the time of kit distribution.

The conversation went something like this:

“The moms are still giving birth alone.  Potential helpers are afraid of the mother’s and baby’s blood,” said the nurses.
Silence. thought, “Uh-oh. This is a big problem.”
“So what can we do to encourage moms to have a partner?” ventured
Silence. Nurses thought about solutions for a while.
“What about gloves?” said one nurse.
“To protect the helper from touching the blood?” asked
“Yes. That might work. A barrier between the helper and the mother’s and baby’s blood.” said another nurse.

After more discussion, we decided to adjust the kits and give the gloves a try. We would continue to promote handwashing – the gloves would just address the cultural taboo.

It was a thrilling moment to find a solution together.  Within 3 months, the kits were updated to reflect the nurses’ recommendation.

Sharing knowledge has been incredibly important to moving our project from simply handing out life-saving supplies to the beginnings of a shift in birth practices.  We will continue to empower local nurses, who are essential partners in seeking practical, respectful ways to overcome harmful birth practices.

In March 2015, we are returning to Laos to train, listen, and learn.  Can you help? 

  1. Donate
  2. Join us for a Twitter Party #CleanBirth on Jan 29th from 1-2 EST 
  3. Take a selfie (alone or with family) with a handwritten sign: $5 Saves 2 Lives #CleanBirth and post on FB.

Thank you on behalf of mother and babies in Laos, and the nurses that care for them!

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Category: Maternal and Child Health
Tagged with: Family Planning    Maternal Health    Maternal Mortality    MDGs    Women