Sterilization of Women by Nurse-Midwives in Thailand

Abstract

As a result of trails aimed at evaluating the performance of postpartum tubal ligation by trained nurse-midwives the Thai Cabinet has approved the use of such personnel for postpartum sterilization under medical supervision. This program scheduled to be implemented in 1985 is expected to help meet the great demand for female sterilization. Over 150000 female sterilizations were performed in the country in 1980. Trainees will be nurse-midwives 25-35 years of age who have been working as operating room assistants for at least 1 year and are willing to serve in provincial hospitals for at least 2 years after completion of their training. In a 1979 pilot study the performance of 5 nurse-midwives who had been trained for 12 weeks to perform postpartum tubal ligation by minilaparotomy incision under local anesthesia was compared to that of 3 physicians. Although nurse-midwives averaged 18 minutes of operating time/procedure compared to 12 minutes for physicians postoperative morbidity was similar in the 2 groups. Next a large-scale field study was conducted to assess the performance of nurse-midwives in this area under normal conditions in maternal and child health centers. Provincial hospitals successfully operated on 3549 women in a 1-year period obtaining results that compared well with those of physicians. 3457 (97.4%) of sterilization acceptors reported full satisfaction with the nurse-midwives and indicated they would recommend tubal ligation to their friends. Physicians in the 18 participating hospitals in this field trial were surveyed about their attitudes toward the nurse-midwife training program. In general obstetrician-gynecologists who played a major role in the program expressed a higher level of satisfaction with it than other physicians. Physicians noted that the nurse-midwife program will free doctors to perform other tasks.