Mothers dying needlessly due to lack of proper health support

Lotus birth has become an emerging trend in Vietnam. It is the practice of leaving the umbilical cord uncut after childbirth so that the baby is left attached to the placenta until the cord naturally separates at the umbilicus, usually 3-10 days after birth.

The WHO does not support the idea of Lotus birth. Instead we recommend delayed cord clamping, performed approximately one to three minutes after birth, for all babies, which prevents anemia, and in smaller babies, brain hemorrhages and necrotizing enterocolitis, a common problem where parts of the gut die. Early umbilical cord clamping, performed less than one minute after birth, is not recommended unless the newborn is not breathing and needs to be moved immediately for resuscitation.

Pregnancy, childbirth and the postnatal period are memorable events in a woman’s life. Most of these occur without complications for women and their babies. Some women might want a "natural birth" and prefer to rely on their bodies to give birth to their baby without the aid of medical intervention. However, some messages about the “Natural Childbirth Movement” may put the mother and her baby at risk.

One such message is that no health staff are needed during pregnancy and delivery. If a pregnant woman doesn’t go to health care facilities for antenatal care, she may not get the correct information on appropriate nutrition nor have assessed maternal and fetal growth, well-being and presence of risks that may lead to a bad outcome, such as hypertension and diabetes. If a woman delivers alone, it is dangerous because any “normal” delivery can suddenly deteriorate into an emergency. Having a skilled birth attendant is VERY IMPORTANT, regardless of the place of delivery, to identify the first signs of danger, provide first stabilizing treatments and refer to an appropriate health facility for emergency obstetric care. During the first hours after birth, health professionals need to closely monitor the mother and her baby to detect signs of illness and to manage them accordingly.

Also, to recommend not getting vaccinated puts mother and baby at risk of getting common and often deadly diseases such as maternal and neonatal tetanus and later in life, liver cirrhosis and liver cancer from Hepatitis B. The benefit of all vaccinations promoted by the Ministry of Health far exceeds the infinitesimal risk from them.

Saving Vietnamese mothers’ lives

Vietnam has been acknowledged to have achieved great improvements of its maternal and child health programs, including significant reductions of maternal and newborn deaths. The Maternal Mortality Estimation Inter-Agency Group estimated that the maternal mortality ratio in Vietnam reduced more than 60 percent between 1990 and 2015 – from 139 maternal death per 100,000 live births in 1990 to 54 in 2015. Still, complications can happen, and the disparities between rural/mountainous areas and urban/flat areas are enormous. A new initiative by the WHO called Early Essential New Born Care (EENC) has provided a healthy start for millions of newborns. At the core of EENC is a protected and prolonged skin-to-skin cuddle between mother and baby, which helps babies to become pink, warm and healthy. Skin-to-skin contact also helps stabilize the baby's circulatory system and breathing and promotes early and exclusively breast feeding, one of the most lifesaving things we can give to babies.

The WHO envisions a world where every pregnant woman and newborn receives quality care throughout the pregnancy, childbirth and the postnatal period.

How can we save mothers’ lives?

Globally, approximately 140 million births occur every year. Every day (in 2015), about 830 women, or 216 per 100,000 live births, died due to complications during pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The primary causes of death are hemorrhage, hypertension, infections and indirect causes. In September 2015, heads of states of the United Nations adopted the 2030 Agenda for Sustainable Development and agreed to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

Positive pregnancy experience, access to antenatal care during pregnancy and birth in a safe environment with skilled birth attendants are lifesaving during pregnancy and childbirth. Recently, the World Health Organization released updated recommendations on ANC and intrapartum care for a positive pregnancy and childbirth experience. These include evidence-based recommendations on what care is needed during pregnancy, labor and immediately after childbirth for the woman and her baby, including respectful care and good communication between women and health providers and allowing women to make decisions about their pain management, labor and birth positions and push when they have the natural urge.

*Dr Kidong Park is the World Health Organization representative in Vietnam.