The lifetime risk of a woman dying from pregnancy and childbirth related complications in Kenya is high, at 1 in 55. According to latest data by UNICEF, the maternal mortality ratio in Kenya is 488 per 100,000 live births is unacceptably high. Only approximately 44 per cent of births are assisted by a skilled health worker, mainly a nurse or a midwife. Skilled attendance and particularly the role of the midwife continues to be advanced as a global priority and effective intervention for safer motherhood.
The International Day of the Midwife, May 5th, is a day to celebrate the wonderful work midwives are doing around the world. I, Felogene Anumo, a Girls Globe Blogger had the opportunity to speak to Rachel Odoro who has over sixteen years of midwifery practice and is currently the Assistant Chief Nurse at Kenyatta National Hospital (KNH). She shares the highs and lows of her career and offers crucial perspectives on this year’s theme Midwives, Mothers and Families: Partners for Life!
What inspired you to be a midwife?
If a midwife has the passion for midwifery and is empathetic, all they require are the capabilities, skills and competencies and they can perform in the utmost. Delivering quality care for the mother and her family is what matters most.
I developed my passion while I was still young in my career as a community health worker. I really love the mother and the child and it saddens me that so many mothers are dying from mostly preventable maternal-child related causes. I believe that midwives and midwifery skills are very important for preventing maternal, neonatal deaths, stillbirths and birth related complications. My experience has taught me that in order to increase the survival rates during birth, midwives require adequate support, proper infrastructure and up-to-date training.
What makes you proud of being a midwife?
There is something special about providing care for a mother during the journey of pregnancy and childbirth. Being a midwife is not only about clinical skills but being empathetic, passionate, respectful, culturally sensitive to a woman’s needs during pregnancy. I recall some of my trying moments at Pumwani Maternity Hospital, one of the largest maternity hospitals in the country, where we would handle up to 100 mothers delivering within 24 hours. These numbers would go up during the nights when up to 60 mothers would deliver. Needless to say that midwives do not only deliver babies, they significantly contribute to women’s sexual and reproductive health, through the prevention of unwanted pregnancies, pre- and post-natal care and health education. Midwifery is also equally important for newborns during the critical first few weeks of life.
What change do midwives make in the community?
Midwives are essential in the healthcare workforce. A mother who is delivering a baby is not something that can wait. Well-trained, well-equipped, well-supported and regulated midwives working in communities are uniquely positioned to save so many lives in their communities. Most maternal deaths are preventable as the health-care solutions to prevent or manage birth-related complications are well known.
However, we have to overcome certain challenges in order to work better with communities. More specifically, strengthening interpersonal relationships with mothers by improving attitude and practices when they seek care and working with Traditional Birth Attendants (TBA) to avoid mismanagement of mother and child. Other factors that prevent women from seeking or receiving care during pregnancy or childbirth include poverty, distance to health unit, lack of information, inadequate services and cultural practices. To improve maternal health outcomes, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system.
The Lancet maternal health series highlights that we will require more than 18 million additional health workers to meet targets set out in the Sustainable Development Goals by 2030. The series further highlights that Kenya is among the countries that has some of the lowest densities of midwives and obstetricians (WHO recommended one skilled birth attendant for every 175 pregnancies). What kind of partnerships are vital to support the work that you do?
- Families – Women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. This support can be provided by families or the community. Community support groups are able to identify expectant mothers, share their experience and intervene for example by providing transport during emergencies. telecommunication, transport during emergencies etc. The midwife in this case needs to form strong partnerships with the community so that emergencies can be referred on time
- Governments – To improve transport and telecommunication infrastructure. These would include proper road networks to health units as well availability of ambulances. The devolved system of governance in Kenya has enabled health units to be built in remote areas but a lot more still remains to be done. There is still a lot of congestion in the labor wards as a result of the free provision of maternal and child health care by government but our role is to reassure them that they will receive the highest form of care.
- Non Governmental Organizations (NGOs) – NGOs can partner with midwives to build competency and ensure that they are well-trained and well-supported especially for midwives working in low-resource settings. I have benefited from several trainings including by PRONTO International . There is no one who doesn’t require training. If I don’t read my books and update myself on the latest practices, I will decay.
We conclude this interview with a powerful reflection by Cathy Moore (in Sisters Singing). To all the Midwives at the frontlines, making motherhood safe – we love you, we appreciate you and we cherish you. Happy International Day of the Midwife.
“…As we ready ourselves to accept new life into our hands,
Let us be reminded of our place in the dance of creation.
Let us be protectors of courage.
Let us be observers of beauty.
Let us be guardians of the passage.
Let us be witnesses to the unfolding…”