International Day of the Midwife was on Sunday, 5 May. This day is an opportunity to recognise and celebrate the work of midwives contributing to the miracle of birth and for the myriad other things they do every day to contribute to the wellbeing of women and children around the world. At ISIS, we know first-hand that skilled midwives, with the equipment and support they need, can spell the difference between life and death for thousands of women, and many more infants, each year. This is becoming increasingly relevant as the 2015 deadline for reaching the Millennium Development Goals (MDGs) draws ever closer, and the need to improve maternal health still persists. We have invited one of the amazing Midwives from Kiwoko Hospital, Sister Corne, to share her thoughts on what it means to be a midwife in rural Uganda, and the challenges faced.
When I was a young woman, I observed four women in my community lose their babies during childbirth. Their pain and suffering was extreme, and it made me determined to do something to save as many women and babies as I could. So, I made a decision to become a midwife and I have had the great pleasure of working as a midwife at Kiwoko Hospital for the past 24 years.
Working in a rural setting has its challenges. Kiwoko Hospital is situated in an extremely large catchment area, and as such we have many patients. Oftentimes we feel quite overloaded, as there are few midwives and many patients. In a ward of 78 beds, we had 502 deliveries, of which 141 were caesarean sections in the last quarter (October to December 2012), these in the hands of only 24 midwives!
There are also challenges that stem from a lack of health education in the community. Across Uganda, 42% of births occur without a skilled healthcare professional present, and although advances are being made, there is more health education needed to help the community to see the benefits of giving birth with a skilled professional. Also, a large proportion of Nakaseke district are rural poor people, which is also a barrier for people to utilise health services.
Despite these challenges, I am proud to work as a midwife at Kiwoko Hospital. Reflecting on my role, I was reminded of one birth in particular that emphasised to me the importance of my role. A mother pregnant with twins had begun delivering at home, and tragically the first baby had died. She arrived at Kiwoko in labour with the second twin. The baby was in breech position and his heartbeat was quite weak. I summoned the Doctor, but he was delayed with another patient emergency. So, I quickly went over my training in my head about breech delivery manoeuvres and, despite some anxious moments, I managed to reposition the baby and deliver him on my own, just as the doctor was walking through the door. Sadly, however, as I looked down at the infant he showed no sign of life. I began to resuscitate the tiny baby boy as the doctor attended to the mother. Thankfully, the baby responded quickly, and as his breathing gradually improved. I let out a huge sigh of relief and gave thanks for knowing what to do in such a critical situation. The doctor thanked me for my work and from that day on called me ‘Senior’. I felt proud of this accomplishment.
Looking back on my long career, I can see just how important midwives are in preventing maternal and neonatal death. With their skills, midwives can do much more than just conduct deliveries. They can examine, diagnose and treat clients without a doctor, and make referrals when necessary. Midwives educate the community on a myriad of health issues, from breastfeeding, to antenatal and postnatal care. They are trained to resuscitate babies in complex situations, acting as the second givers of life to these infants. It is sometimes very stressful, waiting on the outcomes of labour, but it is also richly rewarding and fulfilling to make a difference in people’s lives on a daily basis.