Midwives have faced a lot of backlash over maltreatment in the recent past, but are they just evil or taking the blame for a poor health system?
Midwives have faced a lot of backlash over maltreatment in the recent past, but are they just evil or taking the blame for a poor health system? Christopher Bendana finds out
Fatumah Nakakawa (not real name) has three children, whom she delivered from two hospitals in Kampala. However, she has no kind words for midwives.
Nakakawa gave birth to her first child from Mulago Hospital. She says she had to beg a midwife to attend to her. When Nakakawa realised the midwife was reluctant to help her, she offered her a bribe. The midwife relented and helped Nakakawa to deliver her baby.
Disgusted by the treatment she received at Mulago, Nakakawa opted to go to Naguru Hospital for her second and third children. She arrived at the hospital early in the morning.
She says she sought the services of a midwife, who only advised her to wait for her colleague, who was working on the day shift. The midwife Nakakawa found at the hospital had been on night duty.
“I pleaded with the midwife to help me because the contractions were so strong that I felt I was going to deliver in a few minutes. The midwife stood her ground that I had to wait for her colleague.”
However, Nakakawa says she kept feeling the urge to push the baby, so she quickly laid her kaveera (polythene bag) on the floor. “Three pushes later, my baby was born. I rushed to grab him because he could have easily slid off the slippery kaveera.”
With her baby cradled in her arms, Nakakawa says her only wish was that she had been allowed to come to the hospital with an attendant, who would have helped her since the midwife refused to do so.
This begs the question, are midwives evil or are they castigated even when the health system or the pregnant mother is to blame?
Rachael Nasongo, a midwifery instructor at Mulago School of Nursing and Midwifery, says before criticising midwives for the quality of services they offer, many mothers have to look inward first. “Many women go to the hospital late.
They usually book at eight months of the pregnancy or not all,” she says.
Why visit a midwife months before one’s due date?
Nasongo says expectant mothers should go for antenatal care as soon as they discover they are pregnant.
“That is when one misses her periods,” she emphasises.
Nasongo says at every antenatal visit, midwives give particular information and instructions to expectant mothers.
“At different visits, they are specific issues the midwife addresses,” Nasongo emphasises.
She says midwives educate mothers about the importance of visiting the hospital early in pregnancy.
During antenatal visits, midwives screen for medical conditions to prevent a pregnancy from becoming a high-risk one. Midwives screen for diseases like HIV/AIDS, malaria, high blood pressure and diabetes to ensure that pregnancy goes on smoothly.
At screening, midwives pay attention to a woman’s history, her age, number of children, kind of work and distance from health facility. “We examine an expectant mother from head to toe,” Nasongo boasts.
After screening, midwives treat the diseases they can manage and refer the patients to doctors for conditions they cannot manage. Midwives have to do this because many women die as a result of complications during pregnancy and childbirth. The major complications are severe bleeding, infections and obstructed labour.
Nassongo boasts that after they have educated the expectant mother, they also provide safe delivery and post-natal care.
According to the 2011 Uganda Demographic Health Survey report, Uganda’s maternal mortality ratio is 438 deaths per 100,000 live births.
However, despite all their efforts, one of the major challenges that midwives face is they are too few to cater for all the Ugandan mothers.
According to The State of the World’s Midwifery 2011 from the United Nations Population Fund, Uganda has seven midwives for every 1,000 live births and each midwife delivers about 300 babies in a year.
However, the World Health Organisation recommends that a midwife should deliver at least 175 babies each year.
How can midwives improve the delivery of their services?
An average of one million babies are born in Uganda every year. However, the Government and United Nations officials concede that while most mothers visit antenatal clinics during the first month of pregnancy, they opt to stay away at the moment of birth. Antenatal care for Ugandan women is over 70 %, but only 52% deliver in hospitals.
However, although Nakakawa appreciates all this, she does not agree with Nasongo’s argument of booking at the hospital before she is due to deliver.
“I cannot go to the hospital early. Where will I sleep? I am a single mother, who will take care of my other children?” she wonders.
Nakakawa represents a growing number of mothers, who loathe midwives, but perhaps are also ignorant of the services they can offer. In the past, midwives used to go to the communities to teach them about safe reproductive healthcare and matters pertaining to pregnancy.
Enid Mwebaza, the acting commissioner of health services and nursing, Ministry of Health, decries the fact that the role of the midwife has been relegated to the health facilities, yet it is critical, especially in secondary schools.
“Every school should have a midwife,” she argues. “They provide reproductive health services to adolescents, including issues of family planning.”
Mwebaza believes that if every school had a midwife to provide reproductive services, especially family planning information to the adolescents, they will make informed choices when they become pregnant as adults.
She calls for the revision of the role of the community midwife so that she supports the women who have not gone through the formal school system.
Mwebaza agrees with Nasongo that midwives can do a lot in educating expectant mothers such as teaching them about limiting the family size and nutrition during pregnancy.
She points out that a woman should have a maximum of five children. After five children, women are likely to suffer complications. The uterus may fail to contract, causing excessive bleeding and death. She says 25% of deaths in pregnant women are due to bleeding.
Mwebaza highlights some problems midwives encounter. She mentions expectant mothers who come too late due to delays at community level to make decision to visit a health facility. The other is the issue of mothers’ transport. Finally, she points to the general state of the health facilities, lack of equipment, and the poor working condition of the midwife.
“They are few midwives and they are poorly paid,” she argues. “Yet each expectant mother should at least be attended to by two midwives.”
Additional reporting by Andrew Masinde
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