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In working with midwives around the world, Tembi Mugore dispenses more than just clinical advice.
Olga Richardson—Ritchie, as we fondly called her—was my supervisor and mentor when I was a newly qualified midwife. And she taught by example.She reminded us over and over that compassion and empathy are two of the most important characteristics of being a midwife. Always assess, monitor, anticipate, and plan for what a woman will need during her pregnancy and labor, she said, by seeing each situation through her eyes.
The experience of childbirth makes a big difference in whether women seek care during future pregnancies.
As a practicing midwife and technical advisor on global health programs, I have met midwives throughout Africa, Southeast Asia, and beyond in very low-resource settings and challenging circumstances, working hard every day to ensure women and newborns receive the high-quality care they deserve.
I want to share some of our stories because midwives can greatly reduce morbidity and mortality of women and newborns, and because the experience of childbirth makes a big difference in whether women seek skilled birth attendants for future pregnancies, delivery, and postpartum care.
In East Africa, I came across Jane.* She was the only midwife at her rural health center, and was on call 24/7. On this particular morning, her shift had started at 3:00 AM. Five hours later, she had already assisted two normal deliveries, was preparing to transfer a woman to the hospital due to complications, had two additional women in labor, and was preparing to provide antenatal care. In between, she had decontaminated and sterilized the few delivery instruments she had and cleaned the delivery room. Jane exuded so much confidence and professionalism and had an infectious smile despite what must have been great fatigue. Ritchie would have approved.
Imagine being the only midwife or person with midwifery skills in such a setting.
Does Jane even know that May 5 is International Day of the Midwife?
There are many Janes all over the world. They are unsung heroes—my heroes—who should be celebrated every day. I often ask myself whether Jane even knows that May 5 is International Day of the Midwife. And if she does, what difference does it make to her world?Then there is Ann, one of the many midwives I’ve seen shine during a near-death experience. A vivid memory of her is etched in my mind: there she was, steady, with no obvious panic, providing emergency care to a woman who was bleeding immediately after giving birth. Quickly and efficiently, Ann called out instructions to us while she manually applied compression to the woman’s uterus.To Ann and many like her, this is, unfortunately, a fairly common occurrence—she is used to it and has acquired the skills and experience to know exactly what to do, despite the paucity of resources.
In my travels I’ve also come across Mary, a well-trained midwife who had been practicing for years as well as working in teaching hospitals. Mary shouted at women. Her abuse could be heard all the way from the entrance to the clinic. She would not allow any male partner into the antenatal clinic, let alone the delivery room.
I have seen fear on women’s faces when a midwife like Mary is on duty—they are afraid to ask questions, to speak, or to return for antenatal visits.I know firsthand how traumatic such an experience can be. When I had to have a caesarian section, the doctor booked the procedure for 8:00 AM. At 8:30, he called from the operating room to find out what the delay was. A midwife quickly told me to get on the trolley, and on the way to the operating room pushed the trolley so hard I almost fell head-first.My crime was that I was a private patient who was paying this doctor who’d had the cheek to ask the midwives why I was late getting to the operating room. I would never go to that hospital again. And for quite some time, I was afraid of midwives, despite being one myself.
I know firsthand how traumatic an abusive experience can be.
I have heard stories from many women who have been abused and vow, as I did, never to return to a particular health facility. For many in rural areas, this might be the only facility and the alternative is home delivery with an unskilled birth attendant.
While abusive midwives can tarnish the reputation of our entire profession, they are a minority. And we must not shy away from talking about abuse or make excuses for mistreatment. As a midwife, I am resolved to talk about this issue openly and advocate for change.
The International Day of the Midwife gives us the opportunity to stand up as a reputable, compassionate profession that strives for excellence, and to address issues such as staff shortages, low salaries, and poor working conditions around the world
.It’s an opportunity to call for more mentors and supervisors like Ritchie who look at every situation from the client’s perspective and model empathy, good interpersonal relationships, and understanding.
It’s an opportunity to make almost every antenatal, childbirth, and postpartum care experience a positive one and boost women’s confidence in seeking skilled birth attendance.
This is how we will make a lasting impact on preventable maternal and newborn mortality.
The world needs more midwives like my heroes, Jane and Ann, if we are to achieve the World Health Organization’s vision of a world where every pregnant woman and newborn receives high-quality care throughout pregnancy, childbirth, and the postnatal period. Midwives can also help us achieve the goals of the Global Strategy for Women and Children.
The world needs more midwives like my heroes, Jane and Ann.
But the world must support every Jane and Ann with greater resources and better working environments. Those who succumb to the pressures of this difficult job and become negligent or abusive need just as much help, so that they can become the midwives they aspire to be.
So as I work with midwives around the world I dispense more than just clinical advice. I show them how to help a mother breathe through a contraction, to make sure a woman in labor is covered and not lying there naked on a delivery bed that is separated from other clients by only a thin curtain, to talk to a client and her family respectfully.Because I am a midwife and this is what I do.
*All names (except for Ritchie’s) have been changed for privacy.
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