Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

efer to the baby’s willingness to be delivered or not, resulting in prolonged and difficult, orunproblematic labour.For an unproblematic birth at home, a woman may or may not call a TBA to assist. Many informantsused the term ‘trained TBA’ (dukun terlatih) to distinguish those TBAs provided with training andresourced during the Indonesian period from those TBAs who have never been trained. Several saidthat TBAs are able to determine an incorrect (antenatal) position of a baby mentioned as ‘lyingwrong’ (toba salah), and re-position or turn (fila) the baby manually by ‘holding and pushing’ (dudukaer) or, during labour, by ‘holding the sides of the stomach and pushing down to correct’ (kaer husikabun sorin dudu tun no halo los) (see Box 9).A few informants (and several government health providers) mentioned infection resulting from theTBA cutting and tying the umbilical cord.Informants described various actions taken within the household in the event of difficult birth. Theseincluded applying hot compresses, giving hot water to drink, elevating the woman’s legs by tyingthem up with cord to reduce bleeding, giving traditional medicine (e.g. certain leaves kneaded(dulas) into a ball and applied to the stomach), providing a bottle into which the woman could exhaleor blow, and suspending a rope from the ceiling by which the woman could support herself. (Manyof these household-level actions are probably taken also for births considered to be unproblematic.)A TBA may be called to assist a difficult birth when the labour takes place during the night, when thehealth facility is far and there is no transport, or when the road to the health facility is cut by floodingduring the wet season. Difficulties mentioned for which a TBA could not assist, and for whichexhaustive efforts were then taken, sometimes unsuccessfully, by family members to call a midwifeto the house or transport the woman to a health facility included haemorrhage, baby’s arm or legfirst, long labour, retained placenta, woman has no energy to push, and excessively large baby. Helpwas also sought from midwives if waters broke early or labour began prematurely. One married manobserved that, in the context of a difficult birth, the doctors (i.e. health workers) “know what isinside, we can only see outside”. 13Informants mentioned almost 30 forms of difficult birth, with the most common being retainedplacenta, baby’s arm or leg delivers first, long labour, position of baby, twins and stillbirth. Otherdifficulties included those related to the mother (first birth, very young mother, old mother) andthose occurring in the pregnancy (e.g. spontaneous miscarriage, premature labour or early ruptureof membranes, anaemia and heart-condition). Problems arising during delivery included blue baby,mother breathless (iis la to'o) and/or too weak to push, excessively large baby and/or large head,arms and legs of woman without strength (mamar), placenta delivers first, or ‘white blood’ (raanmutin)—fainting or light-headedness or swelling to the eyes believed to result from the womanbecoming cold after delivery and white blood rising to the head. Raan mutin is usually treated with ahot compress or warmed palm wine/tuak to drink. Problems following delivery included infection asa result of cutting and tying the umbilical cord, postpartum haemorrhage, and malaria in thenewborn.Several advantages of calling a midwife to assist a difficult labour, or delivering in a health facility,were mentioned. It was said that a health provider (unlike a TBA) could advise the right time to13 ‘Tamba inan isin rua ne’e ita hare deit husi liur maibe laran ne’e ita la hatene lolos doctor sira mak hatene nebe lori ba ihadoctor sira hodi koko’ (Married man, FGD, Manututu).38Timor-Leste Health Care Seeking Behaviour Study | 2009