Natural birthing centre

BEATRICE BINITA CARLA

The Natural Birthing Centre (NBC) is soon to be opened at Boudha, Kathmandu and forms part of the Community Hospital at Stupa Health Care Centre Co-operative Limited (SHCC). The ethos of the SHCC is to provide easily accessible and cost-effective, high quality care to the local community. The NBC is in an ideal position to fulfill this role where pregnant women are concerned. The Centre is now open for antenatal care and for the full range of community maternity services including home delivery.

The concept: Birthing Centers (BC) for natural birth became popular in the West over the past 20 years or so, as a response to the over-medicalisation of childbirth and the ever-increasing centralization of services into large, tertiary hospitals. The concept is based on the acknowledgement that for most healthy women, birth can be a normal life event requiring little if any medical intervention. In Nepal with its particular geography and its problems of access to modern health care, this concept seems even more relevant. In addition, we believe that the ethos and approach adopted by our Centre is more culturally appropriate than the care offered in most hospital settings. For example, we will respect the mother’s feelings and beliefs and will protect her dignity and privacy at all times. Intrusive procedures will be kept to the absolute minimum necessary in each individual case. We will support and encourage women in labor to do as they wish, and to give birth squatting or kneeling or in any other position they find comfortable. Relatives will be welcome to support the mother throughout labor and birth; we base this practice on the fact that the continuous presence of familiar persons has been shown to be directly correlated with improved outcomes.

The centre is very small at present and has a home-like appearance and atmosphere, providing a welcoming place where women will be able to relax. This kind of warm, non-clinical environment is known to have a positive effect on the course of labor and birth. Antenatal care is provided by the same midwives who will care for the woman in labor: knowing the midwife in advance has also been shown to reduce the anxiety and fear many women experience when they enter hospital. Research has demonstrated that the above factors are far more important in reducing the need for medical interventions than was previously thought.

Safety: Birth outcomes can never be entirely predictable and even in the most sophisticated hospitals, babies and mothers with life-threatening problems cannot always be saved. However, the statistics for existing BC around the world are excellent, and studies comparing BC outcomes with those achieved for women of similar low-risk status in traditional labor wards demonstrate consistently that BC are as safe as or even safer than large hospitals. It is thought that the reasons for this are to do with the fact that women who are relaxed and free from fear can labour better, requiring fewer interventions, whereas the frequent and even routine use of interventions common in most hospitals may actually create problems because most interventions carry some risks which may outweigh any benefits.

Midwives and doctors: Obstetricians are the experts for abnormal and complicated pregnancies and deliveries. Midwives are the experts for low-risk, normal pregnancies and births. Midwives are therefore best placed to provide total care for most women. They know how to recognise deviations from the norm, which is when they will refer to a doctor for advice and help. The World Health Organisation (WHO) has recommended that women should only be seen by an obstetrician in selected cases, not as a routine practice. This is because research from around the world has consistently demonstrated that low-risk women who are cared for by midwives achieve better outcomes and are more satisfied than those cared for by doctors.

At the NBC, all women will initially be seen by a midwife. They will have the option of seeing a doctor for their second visit (they will be accompanied by a midwife), and after that, the midwife will only refer the woman if she experiences problems. During labor, birth and following birth, women will be cared for exclusively by midwives, but a doctor will be on the premises or on call at all times for consultation should the need arise. For serious complications and emergencies which our community hospital may not be equipped for, we will have a referral system with hospitals in the vicinity.

Conclusion: We believe that our Centre will be:-

· A welcoming place whose culture is humanistic, holistic and culturally appropriate

· A place where pregnant women and their families will find information, counseling and support provided in a caring and compassionate manner

· A place for raising awareness about women’s human rights throughout the childbearing process

· A safe place for babies to be born

· An important resource which will bring substantial, long-term health gains for all women including those most at risk of poor health.

(The author is an independent midwife, NBC, SHCC, e-mail: stupa@healthnet.org.np )

Science communication for public understanding

BHARAT RAJ POUDEL

All good communication requires a fundamental understanding and appreciation of perceptions, values and needs those we are communicating with. If we tend to know about Science Communication, there will be basically three perceptions in this connection. Science communication deals with the task of making science a part of everyday life, accessible and exciting to young people and non-scientists, and bridging the gap between science and society. This is no trivial or easy task, but these are opportunities for science communication professionals and others to share their knowledge and ideas. Today we are focusing on science communication and its popularisation trend throughout the existing medias.

Edwin E.Slosson, editor of the first science writing syndicate in America, described his view on science journalism. "The public that we are trying to reach is in the cultural stage when three headed cows, siamese twins and bearded ladies draw the crowds to side shows." That is why, he explained, science is usually reported in short paragraphs ending - the fastest or the slowest, the hottest or the coldest, the biggest or the smallest, and in any case, the newest thing in the world. Today news about science often is featured in front-page articles - in stories about discoveries and news about health. Media attention focuses on science related policy, nature, issues such as environmental quality and public health. Controversies over biotechnology, AIDS therapies and the patenting of new life forms have become newsworthy.

We have history of a first publication relating science published in 1935 namely ‘Udhyog’ and the first journal was published by Nepal Medical Association (NMA) in 1962. In this regard, we can not forget Hem Bahadur Bista, a prominent media person, who has contributed in the publication of first science paper ‘Vigyan Prabidhim’ in 1983. Nepal Forum for Environmental Journalists – NEFEJ, started rewarding media persons working in the environment sectors. Some independent media houses like the Kantipur Publications Pvt. Ltd. have begun including science matter weekly on "The Kathmandu Post" namely "The Science Post". In Nepal at present, there are a number of science writers working for about 10-15 dailies. Some scientists are regularly contributing to the Medias. There are more than fifty professional societies in the field of science who are producing journals. Likewise, the Royal Nepal Academy of Science and Technology (RONAST) has produced about 30 science communicators and it has provided training opportunity with science writing for more than 100 media persons representing from different media houses, broadcasting agency and even fast growing small scales papers.

RONAST started popularising science through its medias like radio and television by organising weekly and fortnightly programs. To carry on further activities, RONAST has been working towards attaining the goal on public understanding of science namely "Science Learning Centre’ under the direct supervision of the Promotion Division. Radio programs, Audio visual programs, science feature service (Vigyan Lekhmala), Meet your Scientists (interaction of scientists with media persons) program, mobile science exhibition and its promotion activities, newsletters, issuing occasional papers, publication of proceedings as well as Nepal Journal of Science and Technology. Recognising science promoters and scientists is another key function of RONAST towards popularizing science.

The challenges in communicating science are not dissimilar for developing countries, indigenous groups and multicultural communities. The key challenges include:

- Cultural diversity between various groups -meaning there are issues with language, meaning and social traditions, values and much more.

- Coming to terms with positions of power – scientists are generally seen as having the power in relationships with communities; and journalists and "professional" are also seen as more powerful than individuals within communities.

- Establishing the role that science communication can play with such communities ("Science communication" is used here to cover the gamut of roles including science writing, science journalism, science promotion, science consultation, science engagement, science information exchange etc)

- Access issues – including access to information, access to electronic means of communication etc.

To make science communication better, government agencies, universities research/academies centers, scientific institutions and societies have to play key role. Similarly, the roles of scientist, private corporation and mass media should be integrated. Prof. Bryan Wynne at the University of Lancaster said "The communication from science to the public has been one way process in which scientists assumed that they could find answers say to the question of consequences of nuclear power or genetically modified agriculture, and then merely educate the public about the scientific determination of the issue".

Last but not least, make science a part of our life and let it be happened. Let science be most popularised in the future. Nepal is at pre-take off stage in the field of science communication, so we only see how science happens rather than to make it happened. Science promotion efforts made by every institution should be expanded in the circumstances ahead and science journalists/writers have to be recognised as per the contributions made either individually or institutionally. Attention should be paid towards more scientists to give them further exposure by the help of science communicators.

(The author is a science radio program producer at RONAST)

In Brief….

· A NASA study predicts that the Arctic Ocean will be completely devoid of summer ice before the 21st century has ended.

· Researchers at the information technology centre at Tokyo have calculated the value of phi to 1.2411 trillion places

· The known number of orangutan in the world has increased by about 10 percent, thanks to a newly discovered population in the forests of Borneo. Earlier, the orang-utan foundation international had reported that the orang-utan faces almost certain extinction within the next five to ten years if the current trend in illegal logging and forest loss continues in its rain forest habitat.

· IBM has created the smallest ever working silicon transistor that measures six nanometres only i.e at least ten times smaller than transistors currently in use.

· A laser beam has been used to guide nerve cells to grow in a particular direction. The technique might help damaged nerves to electronic implants, such as artificial retinas and prosthetic limbs.

· The teenage Mexican girl who underwent a second heart-lung transplant because of a mix-up on the first, suddenly developed irreversible brain damage hours after her latest surgery.

· A new theory and a revised interpretation of observations have bolstered the idea that Mars has more water than was thought and have encouraged speculation about the possibility of life on the planet.

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