By : Syafiq Adman & Faiz Zahari

Specific Problem Midwife,or doctor?This topic still remain a silent

debate among woman,healthcare practitioners and in some case,among politicians.And recently,this had been widely discussed,due to inability to some traditional midwives to deal with complications during child delivery,such as hemmoraging, wrong medications given, adverse reaction given to medication during labor, heart attack, stroke, pulmonary embolism,blood clot and respiratory distress.

In one case,a woman complained during her labour. She told them she was having trouble breathing and they scoffed and said "duh you're in labor“.She died 15 minutes later.

Role of Traditional Midwives in Malaysia

•Child deliverer•Counselors.They prove mental support for the would-be mother.This is especially true in the 70s and 80s.However,this practice almost died out among traditional midwives,leading to rise in postpartum deppression•Nutritionists.Every midwife has their own cocktail of herbs,roots,plants, and (sometime) poison,which is called “jamu”.•Masseuses for mothers before, during and after childbirth.In fact,apart from occasional trade as housewives and shopkeepers,most are masseuses before they are midwives•Sometimes,abortionists.This still remain a popular choice among Malaysians,due to public stigma faced when visiting an abortion clinic,and expensive cost incurred•By law,as a liaison to the local doctor

Manifestation of problem• Amid rapid development in economy,infrastructure and

healthcare,there is still a lack of trust from pregnant woman in Malaysia to the modern healthcare system.

• In fact,almost 3 out of 10 woman testified that they would choose a traditional midwife over a modern one when they are expecting.

• This is especially true in rural areas,where ineffective government campaigns and lack of hospitals contribute to a gap in maternity healthcare.

• Traditional midwifes are required to register with MoH.However,influx of illegal immigrants from several countries led to birth of traditional midwives among them,who mostly are also illegal immigrant.This render the law ineffective

Location Most popular in rural areas both in

Peninsular and East Malaysia especially in Kedah,Kelantan,Pahang,Terengganu Sabah and Sarawak

Highly rampant among ingenious people,illegal immigrants and rural folks

Frequency The infant mortality rate(IMR) in Malaysia per

1000 live births fell from 76 per 1000 in 1957 to 45 in 1967, and maternal mortality rate(MMR) per 100 000 live births fell from 320 in 1957 to 168 in 1967. North Borneo reported an infant mortality of 74 per 1000 births in 1960.In 2010,IMR fell to 15.5 per 1000 live birth and MMR fell to 41.4 per 1000 live birth.

This is in conjuction with decline in usage of traditional midwives,from almost 10 out of 10 in 1947,8.3 out of 10 in 1957 to 3 out of 10 in 2007.

Infant mortality rate: total: 15.5 deaths/1,000 live births male: 17.92 deaths/1,000 live births female: 12.91 deaths/1,000 live births (2010 est.)

Definition: This entry gives the number of deaths of infants under one year old in a given year per 1,000 live births in the same year; included is the total death rate, and deaths by sex, male and female. This rate is often used as an indicator of the level of health in a country.

Factors•TRUST among woman to their local traditional midwife.•Lack of CONSCIOUSNESS toward antenatal,intrapartum and postpartum healthcare•It is understandable Malays are very much attached to their CULTURE even before birth in this instance. Here, women are seeking something beyond physical care, they appreciate the midwives' respect for their bodies and the families' spiritual connection with the unborn infant.•Retraction of government subsidy in healthcare make the traditional midwives a CHEAPER option•Most illegal immigrant choose traditional midwives out of FEAR to be caught and deported if they give birth in hospitals

Implications•High-risk pregnancy(too young,too old,too many) remains undetected•Imbalance diet and lack of nutrition among pregnant woman.Some of the “Jamu” was proven to contain excessive amount of iron, carcinogenic substances and traces of poison•Unsupervised practices led to unnecessary rituals which focused more on culture rather than maternal health•Complications during labour are not dealt appropriately•High risk of death when compared to birth delivery in hospital

Existing solution Campaigns by government to promote

conventional health care Track down illegal immigrant which leads to

dissolution of illegal immigrant traditional midwives Free educations for midwives under the Health

Care Act Union for traditional midwives promote safe

delivery and cooperation with hospitals and rural clinic

Promotion of maternal and child health care through primary health care activities and community awareness by WHO

Sources http://www.wpro.who.int/rph/reproductive_health/index.htm http://www.i-sis.org.uk/midwife.php http://apps.who.int/medicinedocs/es/d/Jh2943e/9.9.html http://www.who.int/bulletin/volumes/85/10/07-031007/en/index.h

tml http://www.bahasa-malaysia-simple-fun.com/malay-culture.html http://www.babycenter.com.my/pregnancy/asian-postnatal-practi

ces/malay-confinement/ http://areainfo.asafas.kyoto-u.ac.jp/english/activities/fsta/

15_kato/root.html http://www.pjnet.com.my/ftopict-7769.html http://www.mma.org.my/Portals/0/MED%20J%20MALAYSIA

%20VOL%2043%20NO%203%20DECEMBER%201988.pdf http://www.coronetbooks.com/books/new/bodi1194.html http://www.indexmundi.com/malaysia/infant_mortality_rate.html