________________

It’s 10:22 am (May 4, 2024), Okoth Jackeline Akech, a midwife at Atiak Health Centre IV, is attending to a mother who gave birth at 4:00 am to a bouncing baby boy in Amuru district.

On top of attending to this mother, she also has five other new mothers in the postnatal ward who are waiting for her care.

Okoth is a night-duty midwife, but she’s most of the time forced to work both shifts because of the shortage of midwives at the hospital, where there are only two serving a population of more than 100,000 in Amuru district.

“We are only two midwives, but today I am working both day and night shifts because my colleague lost someone. I have to attend to outpatient expecting mothers. I also have six mothers in the post-natal ward. We also have those that come in for antenatal.” Okoth explains.

Okoth Jackline Akech says that as a midwife, she advocates for a natural birth through exercise, eating well, and reducing carbon dioxide and emissions. Photo by Godiver Asege

“The mother who has given birth has a caesarean from her previous delivery, so today it was almost impossible to have a vaginal birth and I was alone. I thank God that I did it even though it was tiresome,” she adds.

With 14 years of experience, Okoth recalls the best experience of her career.

“In my entire career, I have had not less than 5000 deliveries because in a month I could have 100 deliveries, especially at Kaladima and Olinga health centres, which had many mothers.

But on April 14, 2020, at around midnight at Otweze Health Centre III, I received five mothers who came in as if they had planned. They were all already in labour pains and were ready to give birth. I was alone at the ward; they didn’t have anything for preparation, like baby clothes or anything. In most cases, we used to run out of gloves, but I was lucky they were available,” she notes.

“We didn’t have enough beds, so four of them gave birth on the floor. I remember using a lot of speed to change gloves. When I was attending to one, I saw one mother when everything was out on the floor. The placenta was just out, so I hurried and cut it open. The baby was fine but needed oxygen.

I was happy to save all five mothers because even this baby was referred to a health centre IV and he got oxygen,” she narrates.

Okoth says besides that, she always gets happy when she delivers a mother well.

“One day a mother came and she was on the verge of dying; she had not had antenatal, and because of a complication because the uterus had ruptured and the baby had died, she was also going to die too. Even though I failed to save her baby, I am happy that whenever I meet her in our field work and she testifies about me saving her life,” Okoth explains.

Just like Okoth, all midwives in Uganda have a big work load. She, however, calls this a calling from God. 

She says in most cases, besides a big work load, they lack enough essential necessities like gloves that are used by midwives during the delivery process.

Okoth says International Midwives Day explains their role in humanity, even though many people don’t respect them like other doctors.

This year’s theme is “Midwives: a vital climate solution”. Okoth says that as a midwife, she advocates for a natural birth through exercise, eating well, and reducing carbon dioxide and emissions.

She also says many expecting mothers in Amuru do not come for antenatal care during the rainy or sunny seasons, but whenever they go to the field to look for them, they also advise them to plant trees.

“We support sustained practice. In this, consider a midwife to practice who not only provides parental and child care but also educates the expectant parents about the eco-friendly options. The eco-friendly options offered by the offered by the midwife might encourage the use of cloth diapers.

You know, sometimes buying the pads or the cotton wool is very expensive for them. We teach them; we go to the community and teach them how to make these diapers and the padding so that they rewash. And as they rewash, it avoids waste disposal," Okoth explains.

Other midwives speak out

Apio Mary Gorret, the best-chosen midwife from Pallisa Health Centre IV, says the joy of seeing both the mother and child happy and alive is every nurse’s happiness.

With just a three years’ experience in the labour ward, Apiyo normally has over 20 deliveries a day and around 380 monthly.

Apio Mary Gorret, the best-chosen midwife from Pallisa Health Centre IV, says the joy of seeing both the mother and child happy and alive is every nurse’s happiness. Photo by Godiver Asege

She, however, says that as much as sensitisation has been done, many mothers do not come to the hospital for antenatal care, and they end up going for them.

“We always go to them if they don’t come to us but in most cases, we find a problem of the long distances but also the bad weather; when its very hot its hard to move and when its a rainy season its also hard to move so there’s the need to work on the climate change by planting more trees,” Apio explains.

She however credits UNFPA for the continuous training that has enabled her and other midwives to be up to the required standard. She says they provide them with both financial and other necessities.

Beatrice Akello, the head nurse of the Gulu Regional Referral Hospital, has been a midwife since 1992. She says midwives have contributed a lot, especially in the Sustainable Development Goals, do health education to the mothers about their nutrition by telling them the type of food they should eat.

Midwives matching in commemoration of International Day of the Midwife that was celebrated in Gulu District on 5th May 2024. Photo by Godiver Asege

She also however decries the understaffing of midwives especially at Gulu Regional Referral Hospital where she supervises.

“We have been talking about the reduction of maternal and child health mortality rates from 336 per 1,000 live births to 189 per 1,000 live births but we only have three midwives in antenatal, three attending to all that big population that we have. At least on a weekly basis, we receive from about 200 mothers every week,” she says.

Akello says the hospital has a total of 36 midwives who work in different shifts and different days. Akello highlights that at times the post-natal ward is left with only two midwives who always overwhelmed by the number.

More investment in midwives

Juliana Lunguzi, the programme coordinator-sexual reproductive health at United Nations Fund for Population (UNFPA) called upon government to invest more in midwives especially through recruitment, salary enhancement and improving their working standards like providing necessities like gloves.

“To us at UNFPA, we have three core mandates. We want to make sure that we have zero maternal deaths when women are pregnant. We have unmet need for family planning. And we also want to ensure that we have zero gender-based violence.

And you can see that in all these three transformative results for us to achieve our goals at the centre of providing the services is the midwife. That's why in our work at UNFPA, we value the work of midwives,” Lunguzi explains.

Retired midwives posing for a photo with other government officials. This was during the celebration of the International Day of the Midwife in Gulu on 5th May 2024. Photo by Godiver Asege

She appreciated the government of Uganda and the Swedish embassy who have tirelessly worked to bring the mother to child mortality rate down.

During the International Day of the Midwife celebrations held in Gulu district on May 5, 2024, at the boma grounds, midwives highlighted that they work seven hours a day, six days a week, and have a higher-than-normal workload.

The patient-midwife ratio in Uganda is 7.2, and 5:1 for the bed-midwife ratio.

Midwives in 2023 reported a 20% workload excess due to a five-person staff gap.

Midwives in Uganda experience high levels of stress, with workload being one of the most common stressors. Other stressors include: patients and their families, problems with supervisors, conflict with physicians, and treatment uncertainties.