Birthing and the birthing transition in Thailand: Penny Haora and Streerut Thadakant examine current birthing issues in a country where midwifery is not yet an autonomous profession but maternal deaths have been reduced.

• Auteur: Haora, Penny
• Tenlastelegging: Clinical report

The processes and practices surrounding birthing in Thailand and the factors determining maternal health have changed considerably in recent decades. A significant contribution to the transition in birthing outcomes was the effectiveness of population control policies introduced in the 1960s. The total fertility rate was 1.7 in 2004 and the national contraceptive prevalence rate 79.2% in 2001. In 1998 there were around 850,000 live births and around 640,000 annually by 2003.

Historically, birth attendants called hmor tam yae dominated the care of Thai pregnant women. Most of them were women who had seen or experienced childbirth at least once before and thus they provided care from a basis of experiential knowledge. The delivery usually took place in or around the woman's home, and often involved the attendant physically supporting and encouraging the labouring woman, as well as providing immediate postnatal care to mother and baby. Postnatal food restrictions were common, and the practice of yue fai or 'staying by the fire' was prevalent in some areas. An auxiliary midwife training programme of 18 months duration was offered in parts of Thailand until the 1990s. However, these personnel became viewed as 'inferior' to the nurses formally trained in the higher education sector, where a higher entry requirement was also expected.

The World Health Organization (WHO) promotes the midwife as the lead carer for normal pregnancy and birth. However, at present, there is virtually no model of midwife-led care practised in Thailand, where instead, along with the hospitalisation and medicalisation of birthing, a model of obstetric nursing has been adopted.

In some parts of Thailand, institutional practices such as routine episiotomy, originally influenced by western countries but long since abandoned there, are still in regular use. Notions of 'woman-centred care' are yet to be adopted and women are denied intrapartum support from their partners or female relatives, in spite of this being the usual practice historically. The loss of these personal benefits seems to be regarded by women as little price to pay for the 'safety' afforded by the hospital and doctors, and the assurance of a 'healthy, happy and smart' baby. Such passivity seems to be reinforced by a 'system' and patriarchal society, where women have little input to political or high-level decision making.

Caesarean section rates in Thailand have been studied, and concern expressed regarding rates of up to 51.45% in the private hospitals in 1996, with a national average around 20% in that year. As in many contexts, the data demonstrate a public-private disparity. At the other end of the spectrum...