If Only There Could be More Midwives Like Miriam.
Nurse Midwives make a BIG difference.
When I arrived at Nabwendo community based hospital in rural, central Uganda (Mityana district) Miriam was still smiling after a long morning (it was only about half nine).
Already that morning, before some people even have their breakfast, she’d safely delivered two breech babies.
Miriam told me one mother had arrived with a leg and an arm of her baby dangling out of her. The pain she must have been in travelling several kilometres to arrive at the hospital doesn’t bear thinking about.
Luckily, the other woman was able to arrive making use of one of the motorbike ambulances Interact’s Closing the Gaps project has provided.
Miriam told me that if they had arrived at a government health facility rather than hers (which is privately run by our partner UPMB with help from organisations like Interact Worldwide) with no trained midwife on duty in the early hours; the mothers’ and babies’ may not have been so lucky.
In all cases, prevention is better than cure. Good quality ante-natal care during pregnancy can pick up and identify a potential breech birth ahead of labour and, a skilled midwife can use physical manipulation and massage to turn the baby around for an easier birth.
The critical points here are skilled and experienced midwives and decent ante-natal care.
Things, which here in the UK are rightly taken for granted in all but the most exceptional circumstances, but that in Uganda, and other developing countries are still far from universal.
The solutions are simple but currently inaccessible because of distance, cost (to developing countries limited health systems, or individual families), or cultural barriers like those which prevent many Ugandan women (see below).
Quality of care is critical, and in this clinic it was clearly present. Women patients in the clinic were all happy with the way they had been treated; sadly this is not always the case.
I have heard horror stories of how women have been shouted at and in extreme cases even beaten during labour for making too much noise. It appears that many woman fear being labelled as ‘weak’ if they go to health facilities to deliver their baby. There is a certain level of social stigma associated with having ‘help’ when giving birth.
The quality of care at Miriam’s clinic is due, in no small part to her leadership.
Not only does she deliver babies herself she is also currently mentoring two young nurses fresh from midwifery school to pass on her wealth of experience accumulated over 25 years of being a midwife.
Her leadership was acknowledged publicly by the local government official in attendance who praised Miriam and her team for contributing to a reduction in maternal and neonatal deaths in the sub-county.
There were 1,009 total deliveries in this one small health centre in the first three years of Closing the Gaps. Maternal deaths less than 1% over the three year period. Far less than the national average.
However, Miriam is quite rightly ambitious and interested in her own learning and development; consequently she is leaving the health centre in Mityana for further study in 2 months.
Hopefully by then the skills she will have passed onto her junior midwives will endure and the fact that UPMB has planned for the transition is testament to the wider support she and other nurse midwives are receiving through Closing the Gaps.
We need to get the government of Uganda to increase the quota of midwives to health facilities in Uganda.
Not just to government health facilities but for not for profit hospitals outside the government system and private ones too.
The reality is 30% of Ugandans use services from these providers and not the government health facilities.
By making a donation to Interact Worldwide today, you can help push for nurses and midwives in developing countries so they’re trained and valued. Not cosseted but supported; so that their skills and numbers can continue to reduce the number of vulnerable women and children dying needlessly from preventable causes during pregnancy and childbirth.