Mumbai Midwifery: An Interview with Lina Duncan

Originally posted on Maternal Matters.

View More: http://tinanandiphotography.pass.us/mumbaimidwivesportraits

Maternal Matters is so excited to feature British midwife and global citizen, Lina Duncan, who set up Mumbai Midwife – Justlink Health Services India Pvt Ltd, a private midwifery practice, in India. Thanks Lina for taking the time to be interviewed for Maternal Month – this will be insightful and inspiring for many!

 

 

1. Why and where did you train to be a midwife?

I “stumbled” into a school in El Paso, Texas whilst on travels, with blue hair and no set future plan. I joined the Primary Health Care course for third world settings, and towards the end, I decided to not jump into the next segment of the school and train as a midwife, would be like walking out of a five star restaurant after the appetiser!

2. What are you most passionate about as a midwife?

That’s easy – dignity and respect.

I have learnt something at every birth I attended and the more I learn, the more I realise the importance of keeping things as undisturbed as possible, and the importance that the woman feels safe.

3. You are a true global citizen – what has taken you around the world and how have you come to live and work in India?

I was born in Scotland and grew up and worked in the UK. I always liked an adventure and a challenge. Training under the National College of Midwifery in New Mexico was not in my life plan but I thoroughly enjoyed the learning experience. Our college fees ran clinics in slums in the Philippines so naturally, our practical learning application was there. That’s where I grew into a midwife and my heart expanded to the poor. I thought I would grow old in the Philippines and be a part of seeing generations of babies entering the world. Anyway, Asia was in my blood and I spent 5 years working on myself and learning new skills in Hong Kong before coming to India in 2007 with a small group of friends to set up a business here.

4. What is it like to work as a midwife in India?

In the beginning it was an adventure but a struggle also because there is no such midwifery model of care as there is in the UK and no system like the NHS! The poor access care through government hospital systems and still need to buy their vitamins in pregnancy, and medications for birth. The families who choose care with private doctors/ hospitals also need to struggle with a system that is very medically rooted – compulsory episiotomy for first time mothers, high cesarean rates etc. I took time to find doctors who would appreciate the benefits of having midwifery support for their clients. Then everyone is a winner! After 7 years my colleagues and I now have a venue we can access and a small team of doctors that can provide an option of midwife care alongside the doctor. Women and their families have said they felt safe, respected and were delighted with their experiences.

5. Midwives are not always viewed as highly trained and skilled professionals in India. Have you had to overcome others’ misconceptions and how have you done this?

I think in Asia there has been a concept that the doctor is like a god. This makes it difficult for the doctor to “perform” perfectly and for women it’s hard, because for the last decade at least there has been an expectation for the care provider to make the decisions and provide the care and take the flack when things don’t go as expected.

Now women are informed and want to be the decision makers so it’s a new era. I have found that being a midwife I have respect from the doctors and the families choosing to hire our services.

I have sought doctors who want to work like this and who then have the benefits of working as a team. I also have some friends who are still assisting women in the streets and slums. They are not as busy as they used to be because there is a push for all to birth in an institution. I like to hear their stories and learn from them also. They are skilled through their inherited skills and years of practice.

6. It is unusual for women in India to birth at home or in water. Why do women seek out your services?

Actually the home-birth rate for the country is still quite high but this is mostly rural numbers.

It’s only 2 -3 generations back that most low risk mothers did birth at home with traditionally trained midwives.

With internet access and a more medical approach to birth two things are happening; women are having unnecessary cesareans often which leads them on a path of Vaginal Birth After Cesarean (VBAC) and women are growing up not hearing of birth as an everyday event, rather as something to fear and even opt out of trying with an elective cesarean. Some cesarean rates in private hospitals are up to 90 or even 99%. So homebirth for women who choose the option and don’t have any complicated health issues for themselves of their baby, is a safe option, with a backup plan for medical help in case it is needed. Using water for labour and / or birth helps a lot with relieving discomfort. It can speed up the process, and I would say that the highest benefit is to create a safe place for the woman where she can calmly go through the birth process with little to no intervention and regular monitoring. It’s a method that gives dignity and respect in itself if used under a midwife model.

7. How do you find it working as a private midwife in a country with so much poverty?

Mumbai Woman
Photo credit: Elleen Delhi Flickr Creative Commons

With my training being mostly rooted in serving women and their families living in slums this is something I have a passion for. Starting a business and running it was a culture shock for me because in the Philippines we provided free care. I love both! In our spare time we have assisted quite a few families in accessing government care. We have provided something similar to a doula service – advocating for them, teaching them the system so they can access care independently in the future. We have supported local families through pregnancy issues, health complications in pregnancy such as TB, Malaria, Dengue, Typhoid, getting vaccinations for their babies, family planning, registering homebirths that happened too fast. Occasionally we have been able to be with some of them in labour and birth. In the same way, support and feeling safe, is just as important in the big private hospitals where intervention and cesarean rates are soaring.

I would love to train local staff with doula skills to provide support for each woman as I believe that when women feel safe and cared for, they enter parenting in a more loving and prepared manner. It can change society.

8. What is your dream for midwifery in India?

That everyone has access to Midwifery care – in the government hospitals, as well as the private. Midwifery model of care has so many benefits, including taking a large case load off doctors so they can manage the more complex women that require their expertise.

Skilled midwives can save lives and give safe and scientific based care in rural and urban settings.

I would like to see evidence based care such as NICE in the UK where they have changed the cord clamping protocols. Also not putting every woman on IV drips, limiting induction / augmentation for the cases that really need it etc.

9. How does your ideal day start?

After a few hours of sleep, a phone call for a birth, the excitement of a baby on the way.

Want to learn more?

Visit mumbaimidwife.com

Follow @MumbaiMidwife & #MaternalMonth

 

Cover Photo Credit: Shrinivas Sankaran, Flickr Creative Commons

A Mother’s Day Message from Two of the World’s Luckiest Mothers

Last year, two of us at Girls’ Globe lived through a major change in our lives: we became mothers. In September, Emma gave birth to a baby boy, followed by Julia’s baby girl who entered this world in November.

IMG_2234
Emma with baby Lucas – First moment on mama’s skin

There is no doubt that both of us are among the luckiest of mothers and our children among the luckiest of children. Having been pregnant and given birth in New York and Malmö, Sweden, we both had access to high quality, reliable health care throughout our pregnancies and during our labor. We had trained midwives, doctors and nurses to support and assist us; we had access to information and advice; we were able to prepare for our labor and for becoming mothers during our pregnancies, and our partners were able to partake on this journey, and supported us on each step along the way. We were never alone – we got to go through all the emotions that come with pregnancy, from the highest of highs to the scariest and darkest feelings and moments. We got to focus on being pregnant, on embracing the new life growing inside our bodies, and we got to enter labor knowing that no matter what lied ahead of us, we had trained and skilled birth attendants on our sides, ensuring that our babies got to arrive into this world safe and sound.

Celine
Baby Céline looking into Julia’s eyes for the first time

Now that we’ve been mothers for some months, our babies thrive and grow. They are healthy and safe, learning new skills every day, teaching us love we’ve never known before. Motherhood is never easy and simple, and neither of us has gotten this far with no challenges or difficulties – but we get through them, because we are not alone. We get through them with the help of our partners and families, friends and relatives – but also because we live in societies that have support structures that enable us and our children to thrive.

Not all mothers are as lucky as we are. Still, in today’s world, 800 women continue to lose their lives needlessly every day due to mostly preventable complications resulting from pregnancy and childbirth. Women around the world lack access to very basic sexual and reproductive healthcare services that would enable them to plan and space their pregnancies, and millions of women lack prenatal care and continue to give birth in dangerous circumstances, often without no support or help from skilled birth attendants. Women bring new life into this world literally in the dark – with no light, no clean water, no life saving medicine. Sometimes alone, often scared, risking their own lives to deliver their babies.

Not all children are as lucky as ours are. According to WHO, in 2013 around 74% of all under-five deaths – 4.6 million under five deaths – occurred within the first year of life. While the global infant mortality rate has shown notable decline, it remains unacceptably high in many countries and regions and progress has been uneven. Most of these deaths are caused by preterm complications, birth asphyxia, malaria, and diarrhea – conditions that could be prevented or treated, if mothers and babies had access to proper health care during pregnancy, in childbirth and during the postpartum period.

These problems aren’t only issues in poor countries, though maternal and infant mortality rates are of course higher in developing than developed countries. In the United States, thousands of low income women lack access to proper health care services and continue to receive sub-par care during their pregnancy and delivery. Over-medicalization of birth, and treating pregnancy and childbirth like illnesses is becoming a notable issue in many western countries, with soaring c-section and episiotomy rates and increase use of often unnecessary interventions during labor that can lead to long term consequences to both mothers and their babies. While in other parts of the world, mothers and babies continue to suffer grave consequences of not having enough medical services and medication available to them, in other parts women find themselves having to fight for their right to natural and unmedicated births and even face situations where their wishes about their own bodies are totally disregarded during pregnancy and labor.

We are lucky. Our babies are lucky. But this should not be a question about luck – or luxury. Access to safe pregnancy and labor, and proper healthcare and support to mothers and babies after labor, is a basic right – a right that is currently denied from millions of women and their children. Not dying in childbirth should not be about luck. Babies not dying before their first, or fifth, birthday should not be about luck. We have the tools and knowhow to keep mothers and babies safe – what is lacking is sufficient political will and resources. It’s time to step up the game, globally; it’s time to deliver on the promises and goals that have been made over and over and over again. It’s time to make sure all mothers and babies get to enjoy pregnancy, childbirth and childhood as we did.

Happy, healthy and safe Mother’s Day to all mothers around the world!

 

Women Inspire: Nozema Pul

This post is the second in a series of interviews from women and girls at the Georgetown Public Hospital Corporation (GPHC) in Georgetown, Guyana.

I’m here in Georgetown, Guyana to conduct interviews with inspiring women and girls and to listen to their stories. I recently met Nozema Pul, 41, in the GPHC maternity ward. Nozema was days, or possibly hours, away from giving birth. But being the shero that she is, she agreed to share with me her thoughts on motherhood, her dreams for her children, and advice for young girls.

What does being a mother mean to you?

A: Happiness. It means happiness.

How has your mother influenced your life?

A: My mother was a loving, caring and thoughtful mom. She taught me all about the good things in life. She raised me the right way, as a mother should. She gave me everything that she could afford in order to make me happy.

What do you wish for your children?

A: I wish for lots of happiness. I wish that they follow Christ and to have faith. I want them to be a good person and treat others as they want to be treated, not to be rude. I hope they are thoughtful and dedicated. But most of all, I want them to make the most out of life.

How did you first learn about reproductive and sexual health?

A: I was about 10 years old and I read about it in school.

Did you have easy access to family planning? What were the challenges?

A: No, access to family planning was not easy. I learned it from friends, family members, teachers, and others. I learned about contraception, condoms, and protecting oneself from sexually transmitted diseases, and not to have many children – especially one right after another. I learned that I needed to wait 6 to 7 weeks before planning the next pregnancy. It was challenging because I had to  learn much about family planning by myself. I had to learn how to find doctors by myself and what family planning and pregnancy entailed. I was scared.

What are the challenges you have faced as mother?

“I love making my children happy. I want to give them everything they deserve as my mother did for me.”

A: I had my first child at 17. It was very hard. I didn’t know how to raise a child, but I was living with my mother and she taught me how to be a good mom. I learned from her and how she brought me up.

How can we make sure all babies and mothers survive and thrive?

A: Mothers and pregnant women should go out and talk to the right people to get the correct advice for their children so they know how to love and care for their child when the time comes.

What is your favorite part of being a mother?

A: I love making my children happy. I want to give them everything they deserve as my mother did for me. I want to teach them kindness, how to treat people, and not to be rude.

What advice can you give to young girls about pregnancy?

A: Do not get pregnant early. Get educated, stay in school, and get a good job. Get your own home and everything you want. Get a degree so you can stand up for yourself. Don’t be a single parent because it is very hard.

No photos were permitted inside the maternity ward.

Maternal healthcare in Tanzania: Giving thanks for little victories

For those of us passionate about improving access to quality maternal healthcare, thinking about progress towards the MDGs can be disheartening. But this holiday season, as we celebrate Thanksgiving in the United States, we are reminding ourselves to be grateful for the little victories.

A long way to go

It’s a sobering fact that, despite encouraging steps in the right direction, we are very far from reaching our goals (1).

  • The global maternal mortality ratio has dropped by 45% between 1990 and 2013: far short of the 75% target.
  • The maternal mortality ratio in developing regions is 14 times higher than in developed regions.
  • 300,000 women worldwide died in 2013 due to pregnancy or childbirth related causes.
Image c/o Kupona Foundation
CCBRT/Daniel Hayduk/2014

Tanzania: The national context

Kupona Foundation is a non-profit committed to improving access to quality maternal healthcare in Tanzania. If I focus on the Tanzanian context, the picture is still bleak.

  • Every year, 8,000 women die as a result of childbirth or pregnancy related causes (2).
  • For every woman that dies, 20 more will develop an infection, injury or life changing disability (3).
  • There are still significant gaps in the technical skills and critical infrastructure required to enable teams on the ground to save lives.

We have just over 12 months to reduce Tanzania’s maternal mortality rate by 57%. It’s easy to be discouraged about if this is possible.

That’s not to say that the country isn’t pushing for change. Earlier this year, the President of Tanzania, Dr. Jakaya Mrisho Kikwete, launched the ‘Sharpened One Plan’. Inspired by the country’s laudable achievements in the reduction of child mortality, the plan is designed to accelerate progress towards improving maternal healthcare. In Kikwete’s words

We are still grappling with reducing maternal mortality…we still have a long way to go (4).
~President Dr. Jakaya Mrisho Kikwete

“The one person you save means something.”

It is easy to get lost in the statistics, but one of Comprehensive Community Based Rehabilitation in Tanzania’s (CCBRT) OB/GYNs recently reminded me of the need for perspective. Dr. Fatma Sulieman is one of several district mentors conducting on-the-job training and mentoring at maternity facilities across the region of Dar es Salaam, which has a population of over 4.3 million (5). Dr. Fatma is based at Temeke District Hospital, a facility managing approximately 2,000 deliveries each month with one of the highest maternal mortality rates in the region. (You can learn more about our comprehensive maternal and newborn healthcare program here).

At first, I used to get disappointed when I didn’t get the results I wanted immediately, but then I realized that the one person you save means something.
~Dr. Fatma Sulieman

Image c/o Kupona Foundation
CCBRT/Sala Lewis/2014

Little Victories

Dr. Fatma is right. As we come together this week and give thanks for what we appreciate most, I urge you all to recognize that change is happening.

By taking things one step at a time, Dr. Fatma has seen incredible results at Temeke. The facility reported zero maternal deaths for the month of September. This is remarkable. Thanks to the continued efforts of CCBRT and the Regional Health Management Team to train staff, improve infrastructure and distribute life-saving equipment to maternity facilities in the region of Dar es Salaam, every mother that gave birth at Temeke in the month of September survived. This is huge step forward, and a victory for the families of Dar es Salaam.

We need to step back and celebrate every individual life saved. Step back, and give thanks for the little victories.

Image c/o Kupona Foundation
CCBRT/Mark Tuschman/2014

Of course, not every month is going to be as successful as September. Thousands of women and their babies are still dying in Tanzania every year. We need to build upon this year’s successes and continue to enable the teams on the ground to improve skills of healthcare providers, ensure that they have access to the facilities and the equipment they need to do their job, and decongest health facilities so that they have the time and space to attend to every patient. We need to step back and celebrate every individual life saved, and give thanks for the little victories.

Written by Abbey Kocan
Executive Director, Kupona Foundation

Share this post on social media and remind your followers to give thanks for #littlevictories.

Follow us on Twitter: @KuponaFdn & @CCBRTTanzania

Footnotes:

  1. The Millennium Development Goals Report 2014’, United Nations’
  2.  Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
  3. Nanda, Geeta, Kimberly Switlich and Elizabeth Lule, Accelerating progress towards Achieving the MDG to Improve Maternal Health: A Collection of promising Approaches, World Bank, Washington D.C., April 2005, p4.
  4. Putting Mothers of Tanzania First, UNFPA Tanzania, UNFPA.org. August 8, 2014.
  5. Tanzania National Bureau of Statistics Online Census Database, November 2014