This is a story about feeling respected and secure. It is a birth story about having a supportive partner and about loving your child unconditionally. In this episode Marianna shares her very positive and empowering story about giving birth despite it being prolonged and an infection complicating things.
“Oh my goodness you are so ugly. He looked so swollen!”
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.
This blog post was originally posted on Upworthy.com as part of a project with Girls’ Globe, Upworthy and Johnson & Johnson.
Claire Dion Fletcher was taking a class in Women’s Studies as part of her undergraduate program when she first realized she wanted to become a midwife.
She was writing a paper on the decline of midwifery and the medicalization of birth in Ontario, when she started thinking about whether or not midwifery was even practiced anymore. It didn’t take long before Claire found that the answer was ‘yes’ along with a lot more information on the subject from the Association of Ontario Midwives and the Ryerson Midwifery Education programme.
The more she read, the more confident she became about wanting to become a midwife herself. She had always been interested in health care, and especially women taking an active role in their health, so midwifery seemed like the perfect fit.
But it wasn’t just an academic interest — Claire also had a personal connection to health care and midwifery.
Claire is Potawatomi-Lenape, and she wanted to help Indigenous women like herself take an active role in their health care. She thinks that Indigenous women should have access to an Indigenous midwife if they want, because their Aboriginal identity is something that “cannot be replicated or taught”.
Despite the differences in experiences of Indigenous people, Claire explains that they share an ongoing experience of assimilation. Indigenous people also typically don’t have access to as comprehensive health care as other groups in Canada.
But one of the biggest challenges Indigenous people face is that “[they] have the poorest health outcomes compared to any other group in Canada”, Claire explains.
And there are studies to support Claire’s claim. In a report by the National Collaboration for Aboriginal Health, health indicators show a higher burden of disease or health disparities among Indigenous people than among non-Aboriginal Canadians. And there isn’t just a gap in health outcomes, there is also a gap in data which makes it more difficult to address the situation.
What’s more, women often get the shortest end of the proverbial stick, “due to the intersecting effects of colonization, race, sex and gender,” notes Claire.
This is why people like her are so important — Claire recognizes that there’s a lot about the state of maternal health that needs to change.
“Our families deserve Indigenous midwifery care that meets all their health needs, our people deserve access to health care in a place where they feel safe and respected, where they will be listened to and their concerns taken seriously.”
Thankfully, Claire found a way to actively work towards that change – she became a registered midwife who specifically caters to Indigenous women.
But she does much more than deliver babies.Claire holds several other positions that help propel her mission forward.
She sits on the core leadership of the National Aboriginal Council of Midwives, where she works on several projects to expand Indigenous midwifery and enhance midwifery education. She also supports increased access to culturally safe educational opportunities through her role as an Aboriginal student coordinator at the Ryerson Midwifery Education Program, which is also where she got her midwifery certificate.
And Claire’s constantly researching decolonized health care and Indigenous midwifery, too. One of her most interesting findings so far is the unique approach that Indigenous midwives bring to health care.
“Indigenous midwifery provides clinically excellent care that incorporates an Indigenous understanding of health and world view,” writes Claire.
Ultimately her mission is to recover Indigenous practices while trying to improve overall health and wellbeing of Indigenous people and fight against the ongoing impacts of colonization and assimilation.
And Claire and the National Aboriginal Council of Midwives share another important goal — to have at least one Aboriginal midwife in each Aboriginal community.
That’s why she lobbies for the expansion of Indigenous content in university programs and the growth of Indigenous midwifery in Ontario.
“I see all of these as a part of Indigenous midwifery and part of our responsibility as Indigenous midwives to serve our communities,” she notes.
Since she’s involved with so many projects, it’s impressive that Claire finds the energy to keep up her work, but the strength and resiliency of her Indigenous clients help her stay motivated.
And her goal for the future of Indigenous health care in Canada is a powerful motivator as well.
She wants to help build a health care system that is focused on the clients, in order to meet the needs of the people actually using the system. She also wants to make Indigenous midwifery is more accessible, and make it easier for Indigenous people to become midwives themselves.
To achieve this, she will keep lobbying for a fairer health care system and increased recognition for Indigenous midwifery. She hopes her research will also provide her with more tools to improve the situation and spread information about the most pressing issues associated with Indigenous health today.
There’s still a long way to go before we see the necessary changes in place, but with people like Claire in the mix, the chances are good that they’ll happen a lot sooner.
The World Health Organization (WHO) defines midwifery as the “care of women during pregnancy, labour, and the postpartum period, as well as care of the newborn”. However, the reasons midwives are needed and the ways in which they work around the world differ. The definition is universal, but the circumstances are not.
To celebrate this month’s observance of International Day of the Midwife, I had the honor of speaking with an incredible woman named Fancy. After fiddling with inevitable technical difficulties, we finally connected over Whatsapp.
A day in Fancy’s life begins with morning tea (sometimes coffee). She arrives at the Maina Clinic and checks her list of patients to visit that day – some at home and some at the center.
It was Fancy’s aunt, also a healthcare worker, who inspired her to become a midwife. Fancy knew as a child this was what she wanted to do. After two and a half years of education and internships, she felt prepared to join the workforce as a midwife.
Fancy has a passion for her work, and keeps always in mind the mantra ‘serve two lives’ – the mother and the baby. This is sometimes difficult when there are resources missing, like gloves, machinery, light, or doctors. Making sure clean water is available during birth is also a concern and a leading reason for birth-related complications in Uganda. Fancy tells me that helping mothers deliver is difficult during the night when the sunlight is gone if there is no electricity.
Fancy mostly provides care for young women and mothers – which makes sense since Uganda has one of the largest youth populations and highest adolescent fertility rates in the world. It is not uncommon for her to “see eighteen year olds with three children already”.
Before the call, I had researched Uganda’s legal status of abortion and contraception. Though abortion is legal in certain circumstances (such as a danger to the mother’s health), many healthcare workers and citizens default to recognizing it as illegal. Fancy told me that abortion is not legal, and that women still do get abortions but illegally and unsafely. She also shared insights into why she believes supporting the work done by local people in their own communities is a necessity for any development program.
Perhaps the loudest and clearest words of the entire call came toward the end of our time together when Fancy told me: “a good midwife should respect and treat all mothers equally – with no discrimination.”
Before our conversation ended, I spoke with the health center Executive Director, Moses. He said that midwives are taught to “be submissive” and simply accept their working conditions (like salary, rights, and status). This prevents midwives from speaking out about their struggles. If given the chance, Moses explained, midwives would voice their sadness about how mothers and babies they care for are sometimes failed by cycles of systemic failure – resources, doctoral care, education.
There is much the health AND finance ministries can and should do to improve things (and this includes international governments) – starting with empowering midwives to speak out and increase awareness of women’s health issues in all areas of Uganda.
Being Fancy in Uganda means having a passion for your work, an embedded resiliency, and the drive to continue serving women and girls in extremely vulnerable states. Midwifery is a difficult job, with many challenges. It requires knowledge, skill, passion, empathy, bravery, resourcefulness, multi-tasking, quick problem-solving, and grit.
Uganda, and the entire world, is fortunate to have people like Fancy – midwives who have chosen to use their hearts, minds, and skills for the terrifying and beautiful cycle of life.
To the midwife who brought my first baby to the world.
Despite the doctor’s miscommunication,
she guided the lioness in me through nature’s vulnerability
the miracle of life brought to me through her hands.
To the midwife in my family, my mentor, my friend.
In my darkest place, nipples sore and breasts ready to explode,
you support me to be myself, to listen to myself.
“Relax, breathe, it is going to be alright”
you always say the words I need to hear.
To the midwife who showed us our first picture of the baby inside,
her heart beating and legs kicking, reacting to the moves I make.
To the midwife who put her steady hands on my shoulder,
guiding me through inhales and exhales.
To the midwife who reassuringly investigated my scars,
creating the safe space needed to speak.
To the midwives who’ve spent hours listening,
my worries, my joys, my expectations, my fears.
Listening to my story.
To the midwives I’ve listened to,
in maternity wards and through podcasts
invaluable words of wisdom.
To the midwife who brought my second baby to the world,
my little one so content.
She kept the room calm, speaking only when necessary,
supporting me with actions through the unbearable.
My blood, my pain, my screams.
She let me lead, when I felt nothing like a leader.
She calmed the quick storm in me,
and gave us space to welcome new life.
To all of the above who’ve helped me become who I am today.
Thank you for being with me – with women everywhere.
In celebration of midwives worldwide, Kupona Foundation colleague, Dorcas – a midwife trainer at our sister organization, CCBRT – shares how her team is ensuring mothers and babies in the Dar es Salaam region survive and thrive.
Being a Midwife is Something Precious
“For the past 37 years, being a midwife has meant doing everything I can to save the lives of mothers and babies in Tanzania’s largest city, Dar es Salaam.
Tanzania has one of the highest maternal mortality rates in the world. Approximately 22 women die every day from mostly preventable complications in pregnancy or childbirth1. For the last 6 years, my team and I have worked to strengthen the quality of care provided in 23 health facilities in the Dar es Salaam region with the ultimate goal of seeing that mortality statistic reduced to zero.
As the Senior Midwife Trainer for CCBRT’s Maternal and Newborn Health Capacity Building Team, I train medical teams in all 23 of our partner facilities. I work to empower the maternal health teams already in those facilities with the mentoring, training and resources they need to save more lives. Last year, we learned maternal mortality had reduced by 40% in the Dar es Salaam region thanks to our efforts, partnerships, and the support of the Government of Tanzania.”
High Quality Maternal Health Care for Every Woman
“I divide my time between three regional hospitals, smaller dispensaries, and health centers. The volume of patients at each facility varies depending on the day, but the goal is the same: provide the best care possible to mothers and babies. And that’s why I’m here.
One of these facilities serves 70,000 people, and hosts monthly antenatal care clinics for over 700 pregnant women. CCBRT has supported this hospital since 2011. We began by performing an SBMR (Standards Based Management and Recognition)2 assessment to identify the facility’s quality of care. This facility scored 2% (perfection is a score of 100%). While staff were dedicated to helping mothers and babies, they did not have the equipment, tools, and skills to provide high-quality care to their patients.
We began by working with staff to collect data on current operations, find the gaps in equipment and skills, and identify the key issues. We then hosted training to address the root cause of the problem and teach the intervention needed to solve it.
In November 2015, the facility’s quality of care had improved to 87% on the SBMR assessment. I was so proud. In 2011, the facility delivered 406 babies. As the skills and confidence of their service providers increased, so did the number of babies they delivered. In 2015, the hardworking staff surpassed this goal and assisted with 1,386 deliveries, with zero maternal deaths.
When I go back to the facility, I see the entire team is busy attending to patients. The matron is managing her team efficiently, and it has been fantastic to witness her growth as a leader over the years. As soon as a new staff member joins the team, they receive an orientation of the SBMR tool so that they understand the metrics we use. I see staff members, once young and inexperienced, assisting in the labor ward, performing their tasks expertly and respectfully.
I always say, it’s a long journey. But in this long journey, you cannot go by yourself. You need to have people around you. Collaborate with them. Do things together, work together to serve one goal. I’m proud to say that this is what we do with our partner facilities, each and every day, on the CCBRT Capacity Building team.”
Kupona Foundation empowers people and communities in Tanzania by improving their access to quality healthcare. 100% of our resources are dedicated to the continuation and sustainable growth of our sister organization in Tanzania, CCBRT. Since 2009, Kupona has raised over $3 million to support treatment, training, capital projects and organizational development at CCBRT. In that time, CCBRT has provided over 75,000 life changing surgeries for correctable impairments, over 570,000 clinical consultations, and, through training and capacity building efforts, has supported the safe delivery of over 550,000 babies. Learn more at kuponfoundation.org.
Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
Measured by Standards-Based Management and Recognition (SBMR) assessments, developed by Jhpiego, an affiliate of Johns Hopkins University.
I have met both considerate and not so considerate midwives. Without a doubt, the majority have belonged to the first category, and to those who haven’t been as caring – I don’t blame you. I admire the work that you do, the long hours you spend in the delivery rooms, the paperwork you need to put up with. I admire all of it.
I have nothing but respect for midwives and I feel tremendously grateful to live in Sweden, a country where healthcare is equally accessible to all.Not once during my pregnancy nor the delivery did I feel fear, in fact I felt quite the opposite. I really did feel that I was in safe hands all the way through – from planning the pregnancy to the postpartum period.
I had quite an uncomplicated pregnancy and delivery, more or less, but I won’t deny that I was exhausted (to say the least) when our daughter was finally born.
The midwives made be feel so comfortable in the patient hotel right after delivery that I almost did not want to go home. Home – which is otherwise the only placeI want to be in times of exhaustion, insecurity or stress.
Knowing that they were right there, only a few footsteps away, gave me a strong sense of security. When my husband left the patient hotel for the first time, I recall the feelings of nervousness and insecurity that started to creep up on me. I was carrying our daughter in my arms when suddenly one of her legs turned completely blue. I panicked. I ran out in the hallway and screamed for help, and a midwife in her late 50s quickly came up to me: “You’re just holding her a little bit too tight, dear. Don’t you worry, she’s perfectly fine.” Her humble smile and reassuring stroke on my shoulder calmed me down in an instant.
On our second (and last) night in the hotel, the breastfeeding marathon was real. My breasts were crazy swollen, lumpy and aching and my daughter did not want to latch on properly. It was the middle of the night, I hadn’t slept for 48 hours and the tears seemed unstoppable. I felt inadequate for not being able to calm my daughter down when she screamed as if I was hurting her, while all I was trying my hardest to do was to please her.
This time, another midwife came to our room and, again, told me not to worry so much. “Let me hold her for you, and just try to relax for a moment. It’ll be alright, this is absolutely normal.” Then she helped me finding a comfortable position for breastfeeding while lying down, and put my daughter to my breast. The screaming party was finally over, and at last I felt as if I was able to breathe properly again.
Midwives provided me with their invaluable knowledge, skills and help, and I am forever thankful for the time they spent taking care of me and my family.
Obviously, we did eventually leave the patient hotel, but I’ll admit that I would’ve gladly stayed longer – in the safe hands of the midwives there.