Celebrating the Work of Midwives

Midwives deliver babies — and they do much more. This slide show, created from photographs submitted by UNFPA Country Offices, shows midwives in action in more than 40 countries.

The world needs midwives more than ever

 
Chidbirth is perhaps the riskiest and most miraculous time in a woman’s life. And midwives are truly the unsung heroines of the challenge to reduce the risks women face in bringing forth life. Global Resource Spotlight: Investing

Now, armed with better skills and training, midwives are increasingly able to deal with life-threatening emergencies and are playing a critical role in making motherhood safer around the world. It is estimated that trained, well-equipped and supported midwives could save the lives of more than 200,000 women each year, and perhaps ten times that many infants.

But midwives do much more than deliver babies: Pregnancy, whether planned or unintended, is often a key entry-point into the health system. And midwives can provide a welcoming gateway. They often introduce women to the healthcare system and ensure that women and their babies receive a continuum of skilled care during pregnancy, childbirth, and in the important days and weeks after birth.

Midwives care for mothers before and after childbirth, they protect the health of newborns, they offer family planning counselling and supplies, they prevent mother-to-child transmission of HIV, and they know when to call for emergency help when complications arise.

Here are some stories about the lives, training, motivations and challenges of midwives who work with UNFPA to deliver for women.

A Multi-pronged Approach to Maternal Health in Lao PDR is Getting Results

SEPON HOSPITAL, Lao PDR — Twenty-five-year-old Xanya had twirled herself around her husband for comfort in the family tak-tak (an open-air cart attached to a motor by a long set of handlebars) along the 12 kilometres of rocky road from their home to the district hospital. He held her, hoping his body would absorb the continuous jolts. She had been in labor for more than ten hours. Read More

Rewarding the Heroic Work of Midwives in Afghanistan

KABUL — In mid-December, Maliha walked for five days to reach Faizabad, the capital of Badakhshan, in northeastern Afghanistan, to receive her award as best midwife in the province. She felt proud as she went onstage to be honoured for her work in her community health clinic. Though Maliha is just 25 years old, she is a local hero, having delivered hundreds of babies since graduating from the Community Midwives Education Programme six years ago. Read More

Bolivia: Training Midwives to Treat Indigenous Mothers with Respect

POCOATA, Bolivia — Bolivia has one of the highest rates of maternal death in the hemisphere, after Guyana and Haiti. The consequences have been devastating, particularly for some of the most vulnerable people in Bolivia – impoverished, rural indigenous women. Access to maternal care has been limited by inadequate infrastructure including medical facilities. Read More

Reaching Out to Minorities in Viet Nam with Midwives who Speak their Language

MA DU VILLAGE, Ninh Thuan Province, Viet Nam – After doing some chores on her small farm, Cha Ma Lea Thi Te puts down her farming equipment, washes her hands thoroughly, picks up a kit that includes supplies for an uncomplicated delivery and takes off to visit her clients. She is one of 49 graduates of the 18-month midwife training programme for ethnic minority women supported by UNFPA, the United Nations Population Fund, in three mountainous provinces. Read More

Midwives Deliver in Uzbekistan

TASHKENT, Uzbekistan — Nestling against his mother’s breast, the infant, barely two hours old, looked happy and contented. His mother, Ziyoda Karimova, was happy and contented as well. Mother and child were lying in a clean and well equipped birthing room at the Republican Centre for Obstetrics and Gynecology here in the capital.

With its modern birthing methods and state-of-the-art equipment, this center represents the very best of maternal health care in Uzbekistan. Read More

Heeding the Call: A Tunisian Midwife Becomes a Humanitarian Worker

CHOUCHA CAMP, Tunisia — As widespread unrest shook Libya in early March 2011, around 1,000 people per hour were crossing the border into Tunisia. Tents quickly sprung in the desert as refugee camps formed near small towns. While international organizations deployed staff and supplies to respond to the crisis, many Tunisians also rushed to the border to offer their skills to help refugees. Read More

Improving Midwifery Services in Tajikistan

DUSHANBE, Tajikistan — Tajikistan’s maternal mortality ratio is among the highest of the Eastern Europe and Central Asia region. Fifteen per cent of women giving birth in Tajikistan do so without a midwife or skilled birth attendant to assist. For every 100,000 live births, about 47.5 pregnant women die due to labour and delivery complications. Most of these deaths would be avoidable – if women had access to obstetric care. Read More

On the Front Lines of the Struggle to Save Mothers’ Lives

Voices of Midwives

Nester Moyo
Originally from Zimbabwe and now Senior Midwifery Adviser, International Confederation of Midwives, The Hague

Midwifery is practiced where the women are. That means that you will find midwives in areas that are remote, often with poor housing and security.

There are no incentives.

Our major thrust is to strengthen midwife associations in countries. We are convinced that midwives and midwife services are low-cost, effective and high impact, improving maternal and infant mortality. Midwife associations should be included at policy level discussions with the ministry of health to improve services to mothers and their children. We are convinced if we strengthen midwife associations, they can become the lynchpin pulling together all the other stakeholders in maternal and newborn health.

Nadia Van Camp
Trained as a nurse/midwife in Belgium, now works with Médecins Sans Frontières in Mozambique

There are midwife shortages even in Belgium. But I feel I can be more useful as a midwife in a developing country. You feel much more appreciated in the work that you do. We need to train birth attendants to more easily recognize symptoms [of complications]. There is a lack of human resources in Mozambique, and the training is not enough. It doesn’t take into account HIV — this is a big burden on the staff…If you have one in five infected (with HIV), one in five of health staff is infected as well. Maybe even more, because they are more at risk.

I would like to see salaries increase.

It will attract more people to the profession. If they go to a private business they get three times the salary. They are doing triple shifts. In hospital wards they are looking after 100 patients. It’s hard work for not a lot of salary. One of the particular problems is not international brain drain but internal: rural–urban and to the private sector.

Jeremiah Mainah
Nurse/midwife and treasurer of the National Nurses Association, Kenya

Midwifery encompasses the whole family.

You’re not dealing with one person but with three individuals — the parents and the child. Having a qualified midwife gives her (the mother) a better chance for herself and her newborn. A midwife is well-trained and doesn’t look at the pregnancyon its own. She sees the social economics of this family, what sort of food are they eating, where they live.

Nurses are the backbone of any health institution, but they have not been involved in forming policy or recognized for the work they do. We have seen a lot of brain drain in Kenya. Nurses have not been properly remunerated and suffer poor working conditions. So most of the nurses have been seeking greener pastures outside the country. I hope this forum opens up for discussion the issue of human resources for health at the country, regional and international level.

Ana De Lurdes Cala
Mid-level maternal and infant health nurse, Mozambique

I feel close to the mothers… I like to be close to life. (In Mozambique), there is a lack of health workers to cover the whole country. We can’t educate the women about their health care. Many women are still delivering outside of the hospital. The problem is the distance from the house to the hospital. They like to deliver to the community because they want to be near their family. But when there are complications they can’t resolve them if she’s in the house. So there is high maternal mortality. Infant mortality is also high. The government is doing training, but there needs to be more capacity building of existing staff. We need more nurses for all levels of maternal health.

Athaliah Bagoi
Treasurer of the Midwifery Society, Papua New Guinea

I saw it was important to be a midwife, because there were so many women who were having complications. I wanted to help other women. Most nurses after their graduation never go back for any formal training. Papua New Guinea has more than 800 languages and diverse culture, so there are cultural taboos. For example, in one culture a woman can bleed to death in front of a male midwife, because she doesn’t want to be seen by a man. Women do not come to the antenatal clinic, because they don’t want to be seen by a male officer.

When there are male officers, they don’t come for delivery.

Laila Ali Fadl
Nurse/midwife and government focal point for midwife training, Sudan

While I was a nurse I noticed that women die from simple things that can be treated like haemorrhage and obstructed labour. That is why I decided to be a midwife.

Midwife training started in Sudan in 1918, and the first midwifery school was established in 1921.But until now our coverage is less than 50 per cent. In Sudan, the challenge is that the midwife profession is not that attractive. Village midwives are not part of the health system. We need more village midwives. Due to conflicts and wars village midwives have been displaced. I would like to see that midwives in future have good training and skills and a clear career pathway. We need midwives to train midwives. We need midwifery leaders to build the capacity of midwives.

Enid Mwebaze
Nurse/Midwife, Uganda

After being a nurse for 10 years, I crossed over to midwifery, because it’s more rewarding. Someone is giving life, and that is my passion. There’s a lot of hope.

The shortage of manpower affects delivery.

You can’t hurry that process.

You need to be beside that person giving the encouragement and support that she really needs. Because the mothers are so many — this one is calling, that one is calling – sometimes you can’t offer that support, which frustrates. At the forum, I’m learning about scaling up and skilling up the health worker — increasing the numbers but also increasing their skills. We are now on top of the agenda, which makes me proud.

Grace Danda
Vice-President of the Zimbabwe Confederation of Midwives

I didn’t think nursing was complete without learning midwifery. You’re really doing the hands-on work. You’re bringing out life. In Zimbabwe, with hyper-inflation and the challenging economic situation, salaries are affected. Salaries are so low. The situation is also affecting working conditions. Hand-on resources — gloves, drugs, cotton, delivery packs — are insufficient.

Without resources, the midwives are demotivated, and they don’t want to work. They go to greener pastures where they can get those resources and work effectively — moving public to private, out of the country or rural to urban. There is a severe shortage of midwives when they move away. The patients are still the same number. Deliveries with skilled attendants have gone down, and with no one to continuously monitor pregnancies, maternal mortality goes up. With the declaration that is being issued, we hope for improved government support.

Midwives sorts thanks to Angela Walker

UNICEF, UNFPA – Chief, Advocacy and Partnerships, Regional Information…
Georgetown University
New Delhi India

BONUS: Angela Walker – Tackling the Taboo of Teen Pregnancy in Ghana