In this episode, Gayle tells us about two very different births that took place over 20 years ago. I am, as always, amazed by how crystal clear this experience is for us – even many years later. The process and the feelings that are created are timeless and never go out of date.
“You can’t script a birth and you can’t script your life.”
The Positive Birth Story Podcast features empowering & positive stories about birth. Swedish midwife Åsa Holstein shares her in-depth knowledge of birth and speaks to brave women who share their personal stories. This is a podcast with women, for women about the super power that resides in all of us.
Find all episodes of The Positive Birth Story Podcast here.
The Save the Children and ICM Midwife for Life Award is an international recognition of exceptional midwives. Presented this morning at the ICM Congress by Patricia Erb, CEO of Save the Children Canada, the award seeks to recognise those who show great vision and leadership in midwifery. Two new winners were announced and I had the opportunity to speak with them about their achievements.
Amina Sultani, from Afghanistan, is a midwifery specialist for the Afghanistan Ministry of Public Health and Vice President of the Afghanistan Midwives Association.
Loveluck Mwasha, from Tanzania, who has beena steadfast advocate for, and a mentor to, midwives in Tanzania for many years. She’s the Vice President of the Tanzania Midwives Association and a midwifery teacher.
Girls’ Globe is at the 31st ICM Triennial Congress in Toronto, Canada. See all of the Girls’ Globe LIVE coverage here.
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…”
Midwifery is one of the world’s oldest professions and midwives have been ‘with woman’ (the literal translation for the word ‘midwife’) for thousands of generations. The work of skilled midwives is invaluable in ensuring the wellbeing of expectant mothers, new mothers and their newborns.
Throughout the years, midwifery as a profession has been subject to a plethora of misunderstandings, some as extreme as equating midwives with witchcraft. Even in the present day, at best, the role of the midwife is often misconceived as being simply about assisting births. Midwives around the world are undervalued. In the United States, laws prevent midwives from providing the full scope of care for which they are qualified. In the United Kingdom, midwives have recently been striking to get the pay increase they deserve. In parts of Asia, anecdotal evidence suggests that midwives are either wannabe doctors that failed to make the grade for medical school or poorly educated women who are unable to find any better work. In this year’s State of the World’s Midwifery (SoWMy) report, it was highlighted that in some of the poorest nations of the world, women seek medical rather than midwifery care because midwives are socially undervalued and receiving medical care gives a families a greater social status.
In the recent Lancet Series on Midwifery, midwives are hailed as “a core part of universal health coverage.” In addition, the SoWMy report highlighted the excellent value for money that midwives represent in primary health care.
Midwifery is “skilled, knowledgeable, and compassionate care for childbearing women, newborn infants, and families across the continuum throughout pre-pregnancy, pregnancy, birth, post partum, and the early weeks of life”. Midwifery includes family planning and the provision of reproductive health services. The services provided by midwives are best delivered not only in hospital settings but also in communities—midwifery is not a vertical service offered as a narrow segment of the health system. Midwifery services are a core part of universal health coverage. -The Lancet Midwifery Series
Ten reasons why well trained and skilled midwives are important:
Midwives care for women’s well being from pre-conception throughout pregnancy.
Midwives assist women in having a safe and positive birth.
Midwives promote normal birth.
Midwives ensure the wellbeing of mothers and their newborns in the postnatal period.
Midwives are trained to access appropriate medical assistance and perform emergency procedures where necessary.
Midwives play a vital role in promoting sexual and reproductive health of women.
Midwives advocate and empower women and mothers which in turn strengthens communities.
Midwives focus on health promotion and disease prevention, viewing pregnancy as a normal life event.
Midwives are a ‘best buy’ in primary health care.
Midwives are the cornerstone of primary health care.
Skilled, highly trained midwives who value compassion and dignity are integral to communities around the world. Not only do they provide essential life-saving care to women and newborns, but they provide care and support to women far beyond what can be captured by research and statistics and play a pivotal role in empowering women and thus communities.
It is time to give midwives the respect they deserve.
Last week, I wrote a post suggesting that the lives of mothers and babies in Afghanistan are showing signs of improvement. That was prior to the launch of the second State of the World’s Midwifery (SoWMy) report at the International Confederation of Midwives (ICM) 30th Triennial Congress. The report, coordinated by UNFPA, ICM and WHO but involving stakeholders from around the world, is a response to Millennium Development Goal 5 and provides an evidence base for the state of midwifery in 73 low- and middle-income countries.
Included in the report is a two-page country profile for each of the 73 ‘Countdown to 2015’ countries included in the report. The country profiles are data rich – the first half deals with ‘where are we now?’ and the second half looks at ‘what might 2030 look like?’.
Based on the available data, the report shows that:-
the maternal and newborn health workforce is able to meet 23% of the need in Afghanistan
this could decline to a shocking 8% by 2030 if the status quo remains
even if by 2030, the number of pregnancies were reduced by 20%, the number of midwife, nurse and physician graduates doubled, efficiency improved by 2% each year and attrition was halved in the next 5 years, the maternal and newborn health workforce is predicted to still only be able to meet 31% of the country’s need.
Anecdotal evidence from my experience living and working in Afghanistan suggests that a significant proportion of Afghan midwives have qualified in the past 5 years, are under the age of 25 and are as yet unmarried. In a few years’ time, those midwives will be married and be having their own children to care for, which may well mean for many of them, an end to work, thus negatively impacting attrition rates of the midwifery workforce.
Although this sounds rather bleak, it is important to remember that Afghanistan has just been through a period of decades of war and significant progress is being made. However, given the potential period of instability that the country may well be entering with the forthcoming elections and withdrawal of foreign troops, there will need to be an enormous and concerted effort on all levels to maintain the progress that has been made. It was truly wonderful to see Afghan midwife Sabera Turkmani receive the Dorethea Lang Leadership Award at the ICM Congress on the same day that the SoWMy 2014 report was launched.
Midwives in Afghanistan are also women and mothers, and find themselves facing the same pressures as the women for whom they are providing care. Girls need to be free to attend school in order to train as midwives, young women need to be free to work once qualified and midwives need to be free to travel to and from their place of work safely. That’s a lot of freedom needed for Afghan midwives in a country that has a history of oppressing the freedom of women.
Fundamentally, the state of midwifery in Afghanistan rests delicately with the freedom and security that the country will provide for women over the coming years.
The contractions have ended and the only sound is the cry of the newborn little baby lying on her mother’s belly. The room becomes calm and relaxed as the family exhales and begins to recover. After a few minutes the little baby starts searching for her mother’s breast, pecking her little head back and forth, smacking her lips and making her very first sucking movements with her mouth. Using her legs to push herself upwards, she slowly moves towards her mother’s chest, and with the help of her mother’s gentle hand, her mouth finally reaches the nipple.
The breasts are well prepared. The first milk, known as colostrum, starts to be produced in week 18 of the pregnancy. It doesn’t feel like the breasts contain any milk. It takes approximately three more days until the real milk flows into the breasts. But this first milk is perfectly suited for the little baby. The baby’s stomach and intestines have only known the amniotic fluid and is now slowly but surely getting used to breast milk. This first milk contains substances that help the intestines adapt to a life outside the uterus and brings vital nutrients that the baby needs to grow.
The new mother is now holding her baby in her arms. The baby lies looking up at her mother, seeing her for the first time. They look at each other for a moment. The distance between them is just as long as the newborn’s small eyes may be capable of seeing and being seen is extremely important for the little baby’s continued psychological development. After looking at her mother for a while, the baby starts to cautiously and tentatively suck on her mother’s nipple. Being close, skin to skin, enables both mother and child to relax even more, as oxytocin, the natural, well-being hormone, flows like currents in their bodies. Oxytocin causes the heart rate, blood pressure, body temperature and respiration to stabilize in their bodies and causes the production of breast milk. This hormone also causes the mother’s uterus to contract, preventing her to bleed too much.
After sucking for a while on the breast, the baby falls asleep, exhausted but satisfied with both the birth and the first meeting with her family. Colostrum contains enough energy so that the baby now can sleep for a day and the new parents can rest.
The above scenario may be recognized by some women, but not by others. The description has been used to demonstrate the awesomeness of our bodies, and particularly, a woman’s body.
A peaceful breastfeeding start increases the chances of successful breastfeeding in the future.
As a licensed nurse and midwife, I meet women who breastfeed every day. Some do it with ease. Some fight through each feeding in pain, with babies who do not want to suck or babies who don’t want to stop sucking. Some women struggle without enough breast milk, while other women have too much milk. I also meet women who have chosen to partly breastfeed, or who, for various reasons, have chosen not to breastfeed. What is common for all women I meet is the incredible love they carry and the strong desire to do the best they can for their child.
It is imperative that we, as health professionals, are aware that our knowledge and treatment can be critical to how a mother succeeds in breastfeeding.
Becoming a parent generates a wide range of emotions: love, fear, anxiety, joy, sadness, loneliness, togetherness, uncertainty, fatigue, giddiness, and more. To breastfeed or not to breastfeed is not always an easy choice and to get breastfeeding to work or to stop breastfeeding may require professional help. My wish is that new mothers and their families receive the help and support they need, and are able to make informed and empowered choices, leading to results that works best for both the mother, the child and the family. Breast milk contains the best nutrition a child can obtain during the first 6 months of its life, but what is just as important is having a mother who feels well, is present, strong and confident.
This is a guest blog post by Liza Henning, licensed Nurse and licensed Midwife. Liza works at the maternity hospital and the breastfeeding clinic in Malmö, Sweden.