Celebrating Midwives & Partnerships that Matter

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 IMG-20170503-WA0003International 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?

  1. 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
  2. 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.
  3. 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…”

Who Says I’m a Bad Mother?

Women may often be described as goddess-like, but perfect we are not. When my daughters were born I was ill-prepared and scared, and I momentarily felt like I lost a sense of myself.

Don’t get me wrong – my little miracles were precious to me from the first hint that I was pregnant, but it was a major life change. Sharing these mixed emotions seemed to perplex people, as though I should have been ever-joyous, selfless and nurturing, even despite sleep deprivation and my body being transformed beyond recognition.

I was a working mother who also attended school but I wanted to ensure the girls were my first priority. I made sure I was home most days after they were dismissed from school. We spent our afternoons doing homework, laughing and talking as they eagerly told stories of their day. Each night, I was thankful that I was able to read to them, pray with them and tuck them in. And as soon as they dozed off, I cracked my schoolbooks open.

Everyone familiar with my dreadful schedule would wonder, “You’re so hard working and brave. How do you do it?” I didn’t think I was either of those things. I just knew I wanted to show my children what determination looked like and how love felt.

The girls quickly moved into their teenage years, which brought on some unexpected challenges. I suppose that’s the art of being a teenager, doing the unexpected. And this is when everything shifted. I was no longer seen as hard working or brave.

Instead, people began to insinuate that maybe I had done something wrong. No one seemed to consider the neurological and hormonal changes all teenagers go through. No one seemed to remember how hard it was to navigate friendships and relationships in high school.

Well, maybe if I were around more, they’d hint, maybe if I didn’t go to school. Maybe I should have been a stay-at-home mother. Maybe I should have been more attentive, they’d imply, maybe more emotional. Some wondered whether I should have allowed the girls to have more freedom, while others said maybe I shouldn’t have allowed them to have so much. And slowly over time, I too began to question my abilities as a mother.

I also wondered why people judged me so harshly. Yet, in my heart, I knew the reason why. Society has developed an unattainable definition of the role of mothers: all sacrificial, never tiring, never stopping and relentlessly giving. We are supposed to raise our children perfectly, to get them through their many milestones seamlessly and to maintain composure gracefully, all the while pretending that none of this is detrimental to our own well-being.

There were times I locked myself in my bathroom and wept until my brown face turned a shade of deep red, wondering what I could’ve done to turn things around. I considered quitting school or sleeping less to get more done. Guilt rippled through my body, leaving knots in my stomach and tightly wound blood vessels throbbing in my temples.

Despite all of this, I knew that teenage hormones are powerful, that raising children isn’t linear, and that despite sometimes succumbing to guilt, everything wasn’t my fault. It wasn’t my fault that my children sometimes had a hard time in class or that boys were sometimes crass and girls were sometimes mean. It wasn’t my fault that they sometimes felt depressed, as heartbreaking as it was to witness.

My responsibility was to be there to help them when they fell, and sometimes even to catch them when I knew the fall would be too hard. It was my responsibility to listen, to love and to share my wisdom. And knowing this reassures me that although I’ve made mistakes, every imperfect thing in their lives was not due to my inadequacies, and things happen even despite my attempts to protect them. Being a mother is not about perfection. In fact, it is an imperfect art and a glorious blessing.

The Power and Influence of Mothers-in-Law in Lesotho

We have all heard the stories of ‘monsters-in-law’ when a group of women get talking about their husbands’ mothers. Some women are blessed with mothers-in-law who treat them as respected family members, while others struggle with finding balance between two of the most important women in a man’s life.

In Lesotho (southern Africa), this same dichotomy exists, but the ‘monsters-in-law’ are creating consequences far more severe than whose lasagna is preferred, or who will host Christmas dinner.

When we think about achieving gender equity, many of us assume that men are holding girls and women back through patriarchal norms. But mothers-in-law are women – and they have traditionally been one of the greatest hindrances to empowering women in Lesotho.

When a man and woman get married in Lesotho, it is traditional for the newlywed couple to live with the husband’s family for six months with no contact with the brides’ family. If she fails to meet her mother-in-law’s expectations, she will often be mocked and sometimes even abused. For many young women who enter into marriage with low self-esteem due to poverty, trauma and limited education, being verbally, emotionally, or physically abused by an older woman can give them the lowest sense of worth imaginable.

Mothers-in-law in Lesotho hold a tremendous amount of power that can be transferred to empower their daughters-in-law, or to abuse them. On the abusive end of the spectrum, the following are three of the most overt examples:

  1. Naming rights: Mothers-in-law can significantly change the identity of their daughters-in-law. When a girl gets married, her mother-in-law has the right, under customary law, to rename her anything she wants. Mothers-in-law who do not approve of their new daughter-in-law may give her a rude name that will make her feel ashamed to leave home. Mothers-in-law also get to name the couples’ first child, and the new mother’s identity is changed once again as she takes on the name ‘Ma-child’s name’.
  2. Doubt: Daughters-in-law live in scrutiny over every action they take; if they wear something that makes them look beautiful when they go to town, their mother-in-law might assume they are meeting another man. This level of mistrust manifests itself in relationships beyond mother-in-law and daughter-in-law, often leading to the wife being abused for something that her mother-in-law fabricated or exaggerated.
  3. Abuse: The way a mother raises her son plays a significant role in the extent to which a man respects and values women. For some mothers, they are so tragically accustomed to violence that they actually encourage their sons to perpetuate this deeply harmful behaviour. When mothers are threatened by their daughters-in-law, in terms of influence, money, or opportunity, some mothers-in-law will go as far as to instruct their son to ‘put the wife in her place’.

While there are no official statistics on the prevalence of mother-in-law conflict in Lesotho, it is clear that the issue is very common. There are at least as many women who share stories of conflict with their mothers-in-law as there are women who have been embraced by their mothers-in-law.

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Photo credit: Help Lesotho

 

So, why are so many mothers-in-law limiting the freedom and confidence of their daughters-in-law? It’s certainly not that all mothers-in-law are inherently bad women. In fact, it’s not even all that difficult to understand things from the ‘monster-in-law’ perspective. If you were receiving financial support from your son, which would be typical in Lesotho where the majority of families live in poverty, and suddenly that support ended, you might also let feelings of jealousy and desperation affect your behaviour.

Perhaps the biggest reason for daughter-in-law mistreatment is the normalcy of it. Teliso Nchabeng, a Program Officer with Help Lesotho, explains that mothers-in-law face a high degree of peer pressure. Teliso says, “other mothers in law treat their daughter in laws poorly, so it’s like ‘keeping up with the neighbours’ to also follow suit”. Much of this mentality comes from mothers-in-law treating their daughters-in-law the way they were treated by their own mothers-in-law.

Mothers-in-law have the potential to significantly change the power dynamics within families at many levels – and if they use their influence for good – thereby foregoing the years of mistreatment and abuse – we will see daughters-in-law with stronger marriages, healthier children, and higher confidence fueled by the respect of their husbands and family members. ‘Monsters-in-law’ will be a myth of the past, or at least relegated to discussions about what colour of shirt the husband/son should wear for the family photo.

Cover photo credit: Help Lesotho

Postpartum Depression: the Danger of ‘Bad Mother’ Stigma

I felt so trapped, like I had a made a huge mistake in having my child.

It’s heart-wrenching to imagine any mother having to say these words about her own child merely days after giving birth. But while interviewing Serena*, a young, resilient, postpartum depression (PPD) survivor last year, I was taken by surprise by this phrase.

Serena’s story about her struggles as a mother suffering from PPD were poignant. From difficulties getting out bed and taking care of herself, to a severe emotional disconnection from her own child and family, Serena suffered for weeks after giving birth to her first child. She felt unsupported and, after hearing accounts of mothers who were enjoying motherhood, she soon labeled herself a “bad mom” which caused her depression to deepen further.

It was not until she found a support group with other women going through similar struggles that she regained her strength and spirits. In the peer group, she found solace in knowing she wasn’t alone and that she was not indeed, a bad mother. The women who Serena interacted with in the group shared and learned techniques for overcoming their PPD and Serena benefitted and ultimately gained her life back. She no longer labels herself a “bad mom” and feels free to express some of the real difficulties she faced while transitioning into motherhood.

Serena’s experience is more common than you might imagine. 1 in 7 women are said to suffer from symptoms of PPD – depression that occurs after childbirth. Unlike Serena, however, only 15% of them ever get care. This leaves millions of women without treatment or support for a disorder that cripples them and plagues their lives. While talking to Serena, I often found myself wondering about how much more manageable PPD would have been for her had she been able to express her emotions and feelings. But due to the fear of being stigmatized for what seem like “unusual thoughts”, Serena suffered in silence for weeks.

The problem with this stigma is that it originates very early on. I can distinctly recall being taught that motherhood is a blessing. With media, social networks and familial conversations, I, along with countless other women, grew up with a narrative that portrays motherhood as a natural bonding process. Rarely, until recently, did I consider the pressures associated with not being able to fill the expectations of being a “good” mother. Not until I talked to Serena a few months ago did I realize how the stereotypes lead to a stigmatization, which makes PPD, other postpartum mood disorders and often even the everyday tasks of motherhood difficult to talk about.

As I conversed with more mothers who had suffered from postpartum mood disorders, each one of their experiences cut deeper than the last. Every woman mentioned having to bottle up her emotions and recalled blaming her own self. Instead of acknowledging their likely genetic predispositions or the imbalance of hormones as the real causes, they pointed fingers at their own characters, which worsened their condition.

As a society, it is time for us to reduce the stigma and turn the narrative of constant perfect motherhood around, so that women can feel unafraid to talk about the very real disorders that affect their lives. So that, on an even broader level, we can liberate women and free them from the chains of unrealistic standards. This is a goal that we can all partake in. We can read up on PPD, share our knowledge with others, and often simply offer a listening ear to mothers who need it. Most importantly, we can donate to organizations who are already making strides in a positive direction (Postpartum Progress, Postpartum Support International).

Being a mom is not easy and it’s time we portray this reality. Going forward, my hope is that our combined efforts can raise awareness and bring PPD to the forefront of care. Implementing simple steps can provide an outlet for every woman to open up and share her pain, so that she does not have to suffer for as long as Serena did.

*name has been changed for confidentiality purposes

Photo Credit: Bridget Coila, Flickr

The Arduous Process of Getting Pregnant: Infertility and IVF

Whenever I’m feeling a bit down, or if I struggle to fall asleep in the night, I tend to go back to the time when my husband Jakob and I decided that we wanted to have a baby. So far, this is the sunshine story of my life.

While trying to wrap my head around the fact that Donald Trump has been elected President of the (not so) United States, I’ve been finding it hard to come up with ideas for an inspiring post. Sadly and unfortunately, this sorry excuse for a man has been occupying my mind and for a brief moment, I feel like I need to go to my “happy place” to be able to combat my somewhat darker thoughts, and to regain energy.

We had been together for about a year and a half when Jakob was diagnosed with testicular cancer. I vividly remember everything from that doctor’s appointment in February 2013 – the look on the doctor’s face while doing the ultrasound screening, and that moment when Jakob and I looked at each other before any words were even spoken. We knew. And then we cried. And Jakob’s main concern was: “Will we be able to have kids?”

The following weeks were exhausting and scary – to say the least. First there was surgery, then radiotherapy, followed by chemotherapy. We were aware of the positive prognosis of the particular cancer that Jakob had – today more than 95% of all patients in Sweden are cured. This was some sort of a relief. However, emotions overtook rationality. And even though we’d been informed of artificial reproduction techniques, it was tough knowing that the likelihood of Jakob getting his fertility back was close to zero.

After the surgery and prior to the rest of the treatment, “we” saved sperm in a sperm bank in the hospital, for future reproduction attempts. We had more than enough already, but Jakob stubbornly went back not only once, but twice, to fill up the pantry. Both of us so desperately wanted to have children.

About a year later, we decided that we wanted to begin the “child-making-process”. I didn’t expect it to be easy, or free of complications. And it wasn’t.

At that time, I hadn’t had my period since I began taking birth control pills – about seven years earlier, and at this point I had been off contraceptives for over a year. I always felt uncomfortable with not having my period, but I was told by several gynecologists that it was “normal”. Normal? What about that is normal?

So, the first thing that needed to happen was for my menstrual cycle to return – naturally or artificially. The first didn’t happen, and after a few months of unsuccessful lifestyle adjustments, I went back to my gynecologist and told her that I had done my research and had my own theory for my menstrual absence. I told her I suspected that I suffered from PCOS (polycystic ovary syndrome) – a syndrome generally characterized by the presence of cysts on the ovaries and irregular ovulation and menstruation, resulting in infertility – and therefore would need artificial progesterone to get my cycle back. She laughed at me and told me that I had no “classic” PCOS symptoms (obesity, acne, excess body hair etc.), and that I should give it a little more time.

And so I went home, waited a few more weeks and then went back – still with no period in sight. When I finally got the progesterone pill, my much-awaited period came back.

Followed were countless doctor’s appointments at the hospital in Malmö, where it was confirmed that I did have cysts on my ovaries. So, with Jakob being infertile and me having no ovulation, IVF was our only hope – meaning, my eggs and Jakob’s sperm combined in a laboratory. To make a long (and painful) story short: on the second round of IVF treatment I was finally pregnant with our gorgeous daughter.

In hindsight, this is the most mentally and physically arduous – and at the same time most rewarding and luminous – experience of my life. And I would do it a million times over.

In my opinion, becoming pregnant, pregnancy itself and parenthood is too often glorified in our societies. I can only encourage those who experience any sort of difficulty to dare to speak about it and ask for help and support in your community. It is worthwhile.

And oh – don’t let Trump get you down. He’s not worthwhile.

Traveling to Malaysia & the Global Breastfeeding Partners Forum

I was invited to represent Girls’ Globe at World Alliance for Breastfeeding Action‘s (WABA)Global Breastfeeding Partners Forum (GBPF) in Penang, Malaysia, on quite short notice. To me, this meant that I didn’t have the time to get nervous, nor to actually realize that I was going to the other side of the world with my husband and 8-month-old daughter.

When the airplane lifted towards the cloudy sky in Copenhagen it all suddenly hit me, and my heart skipped a beat. I was going to attend a breastfeeding conference with people from all over the world, many of whom have been in the game for longer than I have even existed. I was going to represent this fantastic organization that I had only even been aware of for no more than two months or so. I was going to take part in a plenary session in front of all of these knowledgeable people. What on earth was I getting myself into? What was I going to say?

We arrived in Penang quite late in the evening, two days before the forum was going to begin. My daughter had spent hours at my breast, or sleeping in my arms more or less the entire flight (somehow she couldn’t settle with daddy at that particular time). I felt as if I had been hit by a truck. Oh, how I longed to get a good night’s sleep in a proper bed. And my gut feeling (which most often is a good friend of mine) told me that I actually would.

I was wrong. The littlest one in our family decided not to fall asleep, but to have a breastfeeding party until around 3 am. Then we all finally collapsed into a deep, jet lagged sleep.

I woke up 7 hours later, still feeling quite heavy-headed but somewhat rested. And it hit me again – that feeling of nervousness and insecurity. However, this time I decided to turn my emotions around and I told myself that I can only do my best, and doing so is going to be sufficient.

The main objective of the GBPF was to refine the elements of two global campaigns that WABA is currently working on: the Warm Chain of Support and the Empowering Parents Campaign. The Warm Chain of Support is an extension of the Baby-friendly hospital initiative (BFHI) and it attempts to provide a consistent pattern of care and support for the mother and child within and across the community and health care system, throughout pregnancy, labor, post-labor and up to 1000 days after the child is born.

The Empowering Parents Campaign focuses on increasing the supply of gender equitable social protection to facilitate for parents and caregivers to integrate caring work – including breastfeeding – and work. In other words: to make sure that every man and woman is eligible to adequate parental leave and has appropriate support at their workplaces.

By bringing together all sorts of breastfeeding advocates – researchers, lactation consultants, professors, midwives, doulas, paediatricians, journalists, bloggers and so on – the desired outcome was to get insights into how the above mentioned campaigns can be revised and improved.

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The plenary discussion I was invited to take part in was called “The Next Generation”. When preparing for the plenary, I had the pleasure to collaborate with several young leaders from all over the world. Our team represented the younger generation at the forum, and we were to give our “youth perspective” on the campaigns. I shared my personal experiences of being a young mother and student in Sweden, and Girls’ Globe’s mission to raise the voices of young women worldwide. 

The take home messages that we, as panelists, wanted to disseminate to the audience was that for us to be able to take action on all levels of decision-making, we first and foremost need to be invited into the discussions. We need to be involved and trusted, and feel that we hold the power in our hands, so that our potential energy can be developed into future success.

Even though all of us in the youth panel use social and digital media in several different ways and to different extents, they are still our common denominators. These platforms are the common denominators for billions of people around the world, on all levels of society – which is why we must use these platforms for action.

Our plenary was the final one of the forum, and when we closed the discussion my initial feeling was relief. I had made it without fainting, without losing my words, without falling asleep in the middle of a sentence. I actually felt as if I had made an impact in one way or another.

I left Malaysia and the GBPF feeling grateful to WABA for hosting this vibrant forum, and  encouraged to continue the ever so important breastfeeding advocacy. I feel uplifted by the collaboration between the generations of advocates, empowered and inspired by all the eloquent participants and most of all – appreciated for what I do for not only my own daughter, but also what I intend to do for every child on the planet.

I will always strive to change and improve social norms and attitudes to promote and foster environments that support and value mothers, fathers, children and breastfeeding.

Stay tuned for much more on breastfeeding from Girls’ Globe, and you can read all our posts on the subject here