Midwives need support from all quarters to achieve better outcomes

Thursday 4 May 2017




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I was once asked which verse of Psalm 23, The Lord is my Shepherd, made the most meaning to my life. Verse 4, I quickly replied: Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me.

I said this because I had just had my third baby, and the realization that there is a very thin line between life and death when giving birth struck me even more than it had before. And the earthly person in whose hands my life had lain, at that particular moment, was the midwife who had assisted me to deliver. I remember the young lady, who was monitoring me, asking her colleague to stand guard at the door of the delivery room where I was, and monitor me, while she attended to another mother. And while her colleague was standing guard, my baby decided to make his entrance, so the ‘guard’ had no choice but to deliver him.

Whenever I have given birth, I have wanted to send a ‘thank you’ card to the midwives and, as was the case with my last child, the doctor, who have helped me deliver. Without their due attention, I am not sure whether and how my babies and I would have survived.

While numerous complaints are heaped on them because of things that go wrong in health facilities, we need to acknowledge that a lot of the time midwives go out of their way to ensure that mothers and newborns survive. I know midwives who have wept along with mothers at the deaths of babies they fought so hard to save. Midwives whose tears flow freely when they recall a mother who bled to death as they waited for blood. A midwife who will first bathe a lone mother who comes in the night, having left her three young children and disabled husband at home, because she has failed to give birth on her own this time round. A midwife who will improvise and place a premature baby in a box as it is transported to a private health facility to be put in an incubator while she tends to its teenage mother. A midwife who won’t break off when she is due till she is sure the asphyxiated babies she delivered can breathe on their own. A midwife who will refuse to leave her job in a government facility for one that promises to pay three times her salary, just because she is worried about who will care for the poor mothers who seek services at her health facility. The list is endless.

Watching uniformed midwives from all over the country proudly marching at the commemoration of the International Day of the Midwife last year in Arua, I could feel my heart swell at their obvious pride in the profession, challenges notwithstanding. This Friday I will watch them again in Fort Portal, and I’m sure the feeling will be the same.

Of course all this is not to say that midwives don’t make errors, or that the actions of some do not result in preventable deaths of mothers and newborn babies. No. But as we commemorate midwives’ day, let us applaud the thousands who do a great job, and note that midwives need support to be able to carry out their job well. Support in the form of training, mentorship and supervision, equipment, better working conditions and fair workload.

The third of the Sustainable Development Goals, which is on health, spells out specific targets on reducing the deaths of mothers and newborns. For mothers,  we should have reduced the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, while we aim to reduce neonatal mortality to at least as low as 12 per 1,000 live births. In Uganda, we are currently at 438 maternal deaths per 100,000 live births and about 23 neonatal deaths per 1,000 live births. These rates need to go down by more than half by 2030.

Midwives cannot meet these targets on their own. There is need for concerted efforts from all spheres – Government, civil society, professional councils, midwives themselves and development partners – to achieve better outcomes for mothers and newborns.

Blog by Sylvia Nabanoba

Communications Manager