By Lilian Nuwabaine

In all cultures, the midwife’s place is on the brink of life, where intense human emotions, fear, hope, belonging, triumph, and incredible physical power enable a new human being to emerge.

While the UK-Africa Health summit held at Royal College of General Practitioners, Euston from 18th to 19th March 2024 was organized, insightful and inspirational with global stakeholders, it was also an eye opener to me as a young Nurse-Midwife leader.

Amongst the countless stakeholders at the summit, I was privileged to meet Ms Wendy Olayiwola - the National Maternity Lead for Equality, National Health Service (NHS) England and NHS Improvement. I used this boundless opportunity to share about the status of Midwifery in Uganda. However, due to time limitations, we agreed to hold the discussion a few days later.

Noticing that I still had  few days in London, I had a keen interest in visiting some of the NHS trusts/hospitals around.

Ms Wendy took the initiative to link me to the Director of Nursing and Safeguarding North East London, Ms Marsha Jones. I was astound by this newsflash. It surely felt like a dream come true especially coming for a Nurse-Midwife with humble beginnings like me.

 I had always desired to attach sight to the sang beauty of midwifery care practiced in developed continents like Europe. Also, i sought to benchmark and make facsimile of the best practices in Europe and transfer them to my home country Uganda, for better outcomes for mothers and their babies.

Quote “All mothers deserve the best care there is”.

On the 20th March 2024, I paid a visit to Queen's Hospital, where I was warmly welcomed by Ms Lola Enifeni-a global health policy specialist and matron for the Labour ward. Here are some key things that I observed which caught my attention:

• On average, the hospital conducts 20-25 normal deliveries on a daily
• A shift runs for 7.5 hours
• Each shift consists of 13 registered midwives, 03 maternity support workers and 2 obstetricians.
• Each labouring woman is taken care of by one midwife, thus a ratio of 1:1
• Low risk women ie without complications deliver from the birth centres within the hospital, and experience a homey kind of environment, with only midwives
• The birth centres are spacious, tidy with water pools, birthing balls, delivery beds and stools, wireless CTG, Doppler and many others
• High risk mothers go straight to the Labour ward
• Data is entered electronically via intranet.
• Labour ward dashboard is updated on a daily and has a component of patients;’ experiences, hospital acquired infection, complaints, ward acquired pressure ulcers and medication on-top of the usual
• The hospital has emergency kits for managing emergency conditions like, severe preeclampsia and eclampsia, postpartum haemorrhage etc
• For each procedure or condition to be managed, one must follow the guidelines or protocols in place, short of that, one will need to justify why or even face legal implications. All protocols are available on intranet e.g. protocol for spontaneous vaginal delivery, breech delivery, twin delivery, shoulder dystocia, caesarean section, eclampsia, etc
• A maternal or neonatal death is barely heard of
• Common pregnancy complications in this hospital include hypertensive disorders e.g. preeclampsia and eclampsia
• Postpartum haemorrhage is a rare complication for mothers after delivery
• First line for management of 3rd stage of labour (use a mix of oxytocin and ergometrine) for non hypertensive women, 5IUs
• Labouring mothers are monitored using a doppler or wireless CTG to allow movements freely during labour
• They have a central monitoring point on top of the individual room monitoring for each mother. This helps the supervisors or experts to identify any unnoticed gaps during the labour monitoring process
• Minimum education level for a midwife is 3 years (without research). A bachelors’ in midwifery is 3years too but with research
• Emergency response teams are well set, and everyone undergoes mandatory training in this
• Patients are number one priority, and any concern from a patient is a big concern and must be highly critiqued
• Hospital has free WIFI accessible to everyone
• Mothers whose babies die after delivery are isolated, and put in a separate room and provided care
• Health workers such as midwives have good customer care
• Midwives have up to date knowledge, skills and always willing to share with others.
• Maternity care providers receive continuous professional development (CPDs) sessions every 03 months.
• Guidelines/protocols in use are updated every 03 years, however, whenever new developments or evidence emerge, the team is informed timely.
• Respectful Maternity care is paramount.
• Teamwork is key

With the above observations, I was so much challenged especially when i compared with our healthcare setting and care provided to our patients here in Uganda. I vowed to greatly contribute to better maternity care in Uganda.

I therefore recommend the government of Uganda to invest more in formal midwifery education/trainings, practice and workforce. Additionally, i recommend the Government of Uganda through the Ministry of Health and other relevant entities to ensure there is constant availability of supplies and equipment to enable all maternity care providers provide care with ease.

The author is; Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist & Heroes in Health Award Winning Midwife

Main entrance of Queen’s Hospital, Romford, London, United Kingdom

A view of Queen’s Hospital, Maternity Center, Romford, London, United Kingdom

One of the birth centers at Queen’s Hospital, Romford, London, United Kingdom for low risk women and normal deliveries

A snapshot of the labour ward dashboard at Queen’s Hospital, Romford, London, United Kingdom, which is updated on a daily

Lilian Nuwabaine-a Nurse-Midwife and Women’s Health Specialist meeting Ms Lola Enifeni-a global health policy specialist and matron for the Labour ward at Queen’s Hospital

Lilian Nuwabaine-a Nurse-Midwife and Women’s Health Specialist receiving donated training mannequins from Ms Wendy Olayiwola - the National Maternity Lead for Equality, National Health Service (NHS) England and NHS Improvement at NHS headquarters, London.