Midwives, emergency care key to reducing Cambodia’s maternal deaths

STUNG TRENG, Cambodia – Sixteen-year-old Hang Dèng travelled for an hour by boat to reach the health centre closest to her remote Cambodian village. She was in labour and suffering complications.

The health workers at the centre immediately recognized they could not handle the severity of Hang Dèng’s condition. They sent her to a referral hospital in north-eastern Stung Treng Province – a three-hour journey by ambulance.

It was nearly midnight when she arrived at the provincial referral hospital with her husband, Nan Sokhom, and her mother, Un No. Midwives there were waiting, ready to receive her.

By then, Ms. Hang Dèng’s feet, hands and face were swollen. She was experiencing convulsions, and there were signs of foetal distress. The hospital’s team immediately admitted her for an emergency Caesarean section.

Access to emergency care

As she waited outside the operating room, Ms. Un No, 39, explained that they had delayed bringing Ms. Hang Dèng to the health centre when she went into labour because the family could not afford proper care.

"Our family did not have enough money to prepare for the delivery, so when Hang Dèng went into a long labour, we left it until it was almost too late," she said.

According to the 2013 State of the World Population report, Cambodia has one of the highest maternal mortality ratios in the region. Most of the causes of maternal death are preventable, particularly when women receive antenatal care, are educated about pregnancy-related complications, and are able to deliver under the care of a skilled birth attendant – such as a midwife, nurse or doctor – who is able to refer patients to emergency services when necessary.

Impoverished, rural girls like Ms. Hang Dèng are more likely to become pregnant as adolescents, which increases the risk of complications and maternal death. Globally, 70,000 adolescent deaths occur every year from pregnancy and childbirth complications, according to the 2013 State of the World Population report, which also notes that most adolescent pregnancies take place within a marriage or union. Some 18 per cent of girls in Cambodia are married by age 18, according to the civil society partnership Girls Not Brides.

UNFPA, the UN Population Fund, supports a human-rights-based approach to sexual and reproductive health, including the provision of comprehensive sexuality education, universal access to reproductive health services, and access to safe delivery under skilled care. UNFPA also works to reduce the incidence of adolescent pregnancy and child marriage.

Skilled birth attendants save lives

In 2012, UNFPA donated two ambulances to remote Cambodian health centres. These ambulances are used to transport women with pregnancy complications to referral hospitals, ensuring that these deliveries are attended by professionals with appropriate training and equipment.

Because of their access to the referral hospital and skilled birth attendants, Ms. Hang Dèng and her baby survived. If there had been any further delay in reaching the hospital, both could have died.

Mr. Nan Sokhom, 21, said he was grateful for the help his wife and infant received from the hospital’s doctors and midwives.

"We are so lucky and blessed to have come to the referral hospital. The midwives took good care of my wife and baby,” he said.

The young couple shyly added that they would like to wait five or 10 years before having their next child, a plan they hope to accomplish with access to family planning services.