Respecting Choice in Childbirth: Preferred Delivery Positions Among Ethnic Minorities in Vietnam
In recent decades, Vietnam has had remarkable success in improving maternal health, with the maternal mortality ratio declining 64% between 1990 and 2013. While this decline is impressive, the national figures obscure the persistent health inequalities that exist between the Kinh ethnic majority and Vietnam’s 53 ethnic minority groups. Ethnic minority women are far more likely to deliver without the assistance of a skilled birth attendant (SBA) and face significantly higher rates of maternal mortality.
For Vietnam’s ethnic minorities, their cultural preferences and traditions surrounding childbirth are often portrayed as obstacles to the uptake of maternal health services. One cultural preference that is viewed as a barrier to receiving maternal health care is the use of traditional birthing positions. During facility-based delivery, women in Vietnam (as in many countries) are expected to lie on their backs, in the supine position, to deliver their children. The supine position allows the attending health care professional to have a better, unobstructed view of the birth.
Providing women-centered care
The optimal position for labor and delivery from a medical perspective has been studied extensively. While there are slight advantages and disadvantages to both supine and non-supine positions, the evidence does not support the routine use of the supine position. In fact, the World Health Organization (WHO) identified the routine use of the supine position as a practice that should be eliminated.
In 2016, WHO released “Standards for Improving Quality of Maternal and Newborn Care in Health Facilities,” which recommends that health professionals encourage women to “adopt the position of their choice during labor.” Despite these recommendations, many countries and health facilities around the world continue to dictate the routine use of the supine position for childbirth. In Vietnam, the National Standard Guidelines on Reproductive Health were recently updated in an effort to improve quality of care. However, these new guidelines continue to prescribe that women lie on their backs on a delivery table during childbirth.
Mandating the supine position constitutes a failure to provide a person-centered approach to maternal care as it prioritizes convenience for the SBA over the comfort of women giving birth. For some of Vietnam’s ethnic minority groups, this policy can also be culturally insensitive. A preference for traditional non-supine birth positions has been well-documented among several of Vietnam’s ethnic minority groups.
Respecting women’s preferences
In northern Vietnam, research among Thai and H’mong women highlighted the importance of traditional non-supine delivery positions. H’mong women described delivering in a sitting or squatting position, aided by the use of a low birth stool. Traditionally during labor and delivery, Thai women maintain a kneeling position while grasping a strong woven cloth – called a pieu – that is suspended from the ceiling.
In the South Central Coastal region, research among the H’re and Bana groups found that women unanimously preferred to deliver in their traditional non-supine positions, which were considered more convenient and comfortable. In addition to their own experiences during labor and delivery, women expressed a belief that giving birth in the traditional position makes the infant stronger.
Preferences and traditions around the time of delivery are diverse among ethnic minority groups in Vietnam. Some customs require more ingenuity or resources—for example, those that involve the use of fire. However, there are many customs that can be adapted relatively easily to ensure culturally sensitive facility delivery, including traditions surrounding placenta burial, male involvement at birth and religious practices.
Providing high quality care requires utilizing evidence-based policies that respect the cultural practices, preferences and needs of ethnic minorities. Positioning cultural preferences as a barrier to overcome represents a continuation of assimilation policies directed towards ethnic minorities. If, instead, the challenges of providing culturally sensitive maternal health services are viewed as the barrier, then the responsibility is shifted towards the health sector to provide higher quality, respectful and patient-centered maternity care.
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