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Women’s voices to be heard already before pregnancy

Published on 24.4.2020
Tampere University of Applied Sciences
4Steps 2.kuvaUniversity of Medicine and Pharmacyn (HCMC) konferenssiin Vietnamissa osallistui TAMKin partneriyliopistojen kätilötyön opettajia ja HCMC:n ja ympäristön sairaaloiden kätilöitä. Kuva: Anna-Mari Äimälä
The maternity and child mortality rate is still high in Asia. There is need for information on pregnancy, childbirth and post-natal care. The World Health Organization’s (WHO) aim is to stop preventable maternity and child deaths.

The 4Steps project coordinated by Tampere University of Applied Sciences promotes family-centred nursing practices in Vietnam and Cambodia in a way that respects mothers and children.

“Our aim is to give women the possibility to be heard before and during pregnancy as well as during and after childbirth. We want to help pregnant women and newborn babies,” tell Principal Lecturer Jouni Tuomi and Senior Lecturer Anna-Mari Äimälä from Tampere University of Applied Sciences.

The desired results can be reached by developing midwifery education. Midwives’ competence has an important role in preventing maternity and child deaths.

“We are now taking the model recommended by WHO to Asia. Based on international recommendations, trained midwives take care of women before and during pregnancy and during and after childbirth. Doctors treat complications. This is the cheapest, most effective and best system,” states Äimälä. 

WHO’s model emphasises the Full Scope Midwifery thinking. Pre-pregnancy advice, guidance and care have been added to the traditional maternity nursing.

Remote guidance for pregnant women

There are less antenatal appointments in Asian countries than in Finland and thus women need information for example by mobile phone between the appointments. Guidance tools are being developed in the project.

“We take mobile guidance to Asia because all have mobile phones,” says Tuomi. 

In February, the 4Steps team taught Asian midwifery teachers to use the Moodle learning environment. It would make remote teaching possible.

Midwifery education is also developed through curricula and updating of midwifery teachers’ academic and pedagogical skills and midwifery competence. The aim is to produce up-to-date education material for professionals and families.

The project takes the Nordic high-quality midwifery culture to the Asian environment. Attention is paid to the local conditions and mothers’ and children’s wellbeing. The project promotes care for newborn babies and aims at reducing maternity and child mortality, morbidity and disablement.

The cooperation partners of the 4Steps project are the University of Health Science and Health Science Institute of Royal Cambodian Armed Forces in Cambodia and Nam Dinh University of Nursing and the University of Medicine and Pharmacy at HCMC in Vietnam.

Research information and wise choices

Jouni Tuomi is in charge of Finnish and European sexual and reproductive health projects at Tampere University of Applied Sciences. The projects disseminate reliable research information on pregnancy and childbirth in a new way.

According to Anna-Mari Äimälä, the project applies the thought of the Finnish ViVa projects and sees childbirth as a natural event. The projects’ key idea is to promote normal childbirth: childbirth should be handled more naturally without excessive medicalisation. 

“Health care did not use to pay enough attention to the time before pregnancy. Fertility protection should already begin on health education lessons at school and continue in public health nurse’s appointments and family-planning clinics,” Äimälä hopes. 

According to Tuomi, risk births can be prevented because they can be affected long before the pregnancy or childbirth. 

The 4Steps project has created a databank for professionals. Some of the online materials are visual videos and animations and others are electronic books.

“Our aim is to promote normal childbirth around the world in such a way that all would have access to research information to support their choices before and during pregnancy as well as during and after childbirth,” Tuomi and Äimälä describe their projects during the past six years.


Further information:

Jouni Tuomi, Principal Lecturer, School of Health, Tampere University of Applied Sciences, jouni.tuomi [at], tel. 050 324 0173

Anna-Mari Äimälä, Senior Lecturer, School of Health, Tampere University of Applied Sciences, anna-mari.aimala [at], tel. 050 311 9759

Sexual and reproductive health projects:


Text: Arja Lundan

Main photo: Midwifery teachers from TAMK’s partner universities and midwives from HCMC and nearby hospitals participated in a conference of the University of Medicine and Pharmacy (HCMC) in Vietnam. Photo: Anna-Mari Äimälä