Midwives’ work explained in a short film

Watch the midwives work explained in this short film, thanks to  The Royal College of Midwives. Amazing,  what we do. Enjoy

A call for ‘nursing voice’ at the World Health Organization

 Geneva, Switzerland; Valletta Malta, 7 May 2011 – Expressing extreme  concern at the lack of nursing policy presence within the World Health Organization (WHO) structures, an emergency resolution* was passed by the governing body of the International Council of Nurses (ICN) at its biennial meeting held in Valetta, Malta. The official representatives of ICN’s member national nurses associations voted unanimously to demand that the WHO  Director General empower and finance nursing leadership positions throughout  the organization. “At this time of health system redesign aiming to enable access and cost-efficiency, it doesn’t make sense for WHO to advocate for nurses to fully participate in the health care team at the clinical level, yet exclude them from playing their full role at the policy table,” declared ICN President Rosemary Bryant. “As we move to discussion of the Resolution on Nursing and Midwifery at the upcoming World Health Assembly, we urge member states to add their weight to the call on Dr Chan to remedy the appalling lack of nursing leadership positions throughout WHO structures, including at headquarters and in the regional offices, beginning with reestablishment of the post of WHO Chief Nurse Scientist.”

This action by the nursing leaders is commendable and was long overdue. To read more click here

Monica Onyango

voicesofmidwives@gmail.com

Six Hours, Five Babies to Catch

On this international day of midwives, I have chosen to reflect on an experience I had in 2010 while working with midwives at The New Nyanza Provincial General Hospital in Kisumu City, Kenya

This write up is based on a trip I made to my home country of Kenya in September 2010. As I usually try to do on these visits, I took part in a few nursing and health-related programs while I was there. I spent two memorable days of volunteer work at the labor ward (delivery unit) at the Nyanza Provincial General Hospital (NPGH), Kisumu. .

My first visit to the unit was on an afternoon shift which ran from 1 to 7:30 p.m. As soon as I stepped into the unit, I realized that I would be more than just an extra pair of hands. There were only two nurse midwives on duty during the shift.  The shift was relatively busy but ended up well. On this day, the head nurse asked me to help in the delivery room where one of the nurse midwives was stationed. After receiving report from the morning nurses, we got to work. We took over the care of two patients who were just about to deliver. I started to look at the notes on one of the women, and, lo and behold, as she began to push, it was a breech presentation — every midwife’s nightmare. For some reason, I had not realized that everybody who was standing around me at the time was a student. One of them screamed: “Sister, this patient is ready to push and it is a breech. Put on gloves quickly.” I put on gloves. In any case, the woman was ready, the perineum was bulging and somebody (me) had to catch the baby. The baby was small and, before we knew it, the legs had come out and they were hanging. I just had to deliver the hands (very carefully so they didn’t fracture) and the head. There were no complications and the baby came out and gave a loud yell with the first breath of outside air! Phew, I sweated a little. What an experience! In the next two hours I conducted one other delivery and was also involved with routine patient care.

The joy of that first day did not last long. What happened the next morning left me stunned.  I reported to the unit by 7:30 a.m. when the morning shift began. The most important case was that of a woman who had twin pregnancies and had delivered the first twin at a health center. She had been referred to the hospital because the second twin had died in utero and was lying across the mother’s uterus (transverse lie), with one arm hanging out (arm prolapse). She urgently needed a Caesarian section. She was taken within one hour of our arrival to the labor ward, which was very impressive.

That morning there were just two qualified nurses in the unit (including  me). So I decided to take over the instruction of students as they examined and monitored the women in labor. This meant that they examined the women and I confirmed their findings. We had completed one examination, when a patient came into the labor unit ready to deliver. The student who was taking care of her told me to put on gloves (students cannot conduct deliveries alone). So I helped with the delivery, while at the same time attempting to give students an educational experience by demonstrating every step in the process.

I completed the first delivery, including the active management of the third stage of labor (delivery of the placenta, the examination of the woman for tears, bleeding, etc). After we cleaned the patient, but before we could take her to the room, another patient was brought in, ready to deliver. Again, I was told to wear gloves. After all, the other sister was busy elsewhere. The second delivery was somewhat difficult because the mother was delivering for the first time and the baby’s head was a little big. I needed to support her perineum very well to avoid her getting a tear. I was unlucky and she got a nick, which was stitched. The baby came out alright and cried immediately. I finished with her, cleaned her, and was told yet another patient was ready to deliver.

This third patient was also a young girl having her first baby. She was very tight and had to get an episiotomy– and the baby came out. Please note that this was baby number three! The routine of baby catching continued until 1:30 p.m. Over the course of the shift, I delivered six healthy babies (one mother got episiotomy, one a small tear); examined all six placentas, ensuring they were all normal and nothing was retained in any of the women’s uterus; and made sure all notes were well written.

By 1:30 I could not have conducted even one more delivery. I was thoroughly exhausted. I had not moved out of that small room, not taken a drop of water, and not gone to the bathroom. At 1:45 pm the sister in charge thanked me so much for being there–how would she have managed alone? She offered me tea; but I had to leave because I was supposed to be at my daughter’s school at 2 p.m. I thanked her and told her I had to run. As I rushed out of the labor ward, I wondered how the midwives work there on a daily basis and stay sane. I also wonder now, when we talk about the shortage of nurses in developing countries, do we really understand the magnitude of this shortage? Do these nurses ever have a minute to reflect on what they do? How are they expected to provide quality care under these circumstances? But I was too tired at the time to reflect too much on this experience. I shelved it for another day and went to my daughter’s school. There really is never a dull moment for a midwife in Africa.

Nonetheless I salute the midwives at the NNPGH for your patience. The skill you displayed at the bedside was amazing. I am sure nobody understands how you do it. A tribute to each one of you on this International Day of Midwives. Keep up the good work.

Monica Onyango

voicesofmidwives@gmail.com

A Midwifery Song by Afghan Midwives

The Afghanistan Midwives Association are preparing for  their 7th annual congress. Over 500 midwives from all 34 provinces of Afghanistan are expected to attend. In preparation for this conference, they have written an inspiring midwifery song:

 Your presence (midwives) is an answer to our prayers.

You save our lives.

You struggle honestly and faithfully

to prevent our silent death.

You (mothers) were not alone, you were never without us.

We (midwives) were with you, always praising your name.

Mothers! You are waiting for midwives in Bamyan,

Paktika and Helmand, in Nangarhar, Badakhshan

Farah and Gardiz, in Faryab, Nooristan, Moqor

and distant villages of Ghor, Badghis and Laghman.

You (mothers) were not alone, you were never without us.

We (midwives) were with you, always praising your name.

You (midwives) are the sun shining on our homes,

your kindness makes our life warm

in Herat, Samangan and Urozgan, Logar, Kuduz,

Kunar and Kabul, in Kapisa and Panjshir.

You (mothers) were not alone, you were never without us.

We (midwives) were with you, always praising your name.

Mothers in Sar-e-pul, Zabul and Parwan pray for us

as we save mothers in Wardak, Kandahar and Farah.

Don’t wait anymore in Daykondi, Takhar and Jawzjan

Keep a smile on your face always in Khost, Nimroz, Balkh and

Baghlan.

You (mothers) were not alone, you were never without us.

We (midwives) were with you, always praising your name

This song was translated by Meghann McNiff, a consultant for Afghanistan Midwives Association. Email: mcniffadventures@yahoo.com

To learn more about the Afghanistan Midwives Association, click here to visit their  website

A Virtual International Day for the Midwife

I have learned of a free online conference that aims to cater for midwives, students and anyone interested in birth. It starts 12pm 5th May (New Zealand) and runs for 24 hours. The topics will include: discussion about how midwives respond to international disasters;  eLearning and student midwives; The Postmodern Midwife; and baby-led introduction to solids.  To access the conference click here.

I am interested on the involvement of midwives during disasters. I am looking forward to taking part in this conference.

Monica

Email: voicesofmidwives@gmail.com

Who Can Write? by Nechama Wildanah

In the early morning hours I come home from a long home birth, a healthy baby, a safe passage, and all I want is sleep.  I’m hungry, and I can barely pour my bowl of cereal without spilling milk.  I eat as quickly as I can, and I crawl into bed.  Twenty-seven hours.  Twenty-seven hours of monitoring and supporting, whispering that it will be ok, nodding my head, thinking about safety and never breaking a woman’s gaze as she does the work of becoming a mother.  Twenty-seven hours receiving a new baby, watching over everyone’s health, cleaning blood off a brand new scalp, bringing baby to breast, smiling with my eyes always vigilant.  At the end of this night, sleep never seemed so good, and my bed is a heaven.  I wake up as the sun is setting, having slept through the whole day, and I take out my journal and write this story.

I can write because I do at most 5 home births like this a month.  I consider this a busy home birth practice in Boston, in the United States, where there is so much infrastructure supporting my work, where I live down the street from my mother and my grandmother, whose house I go to for a real meal after this day spent sleeping.  I can write because after my long birth, I am not getting up for another one, not sleeping a few hours and waking up to a long line of women waiting for their prenatal visit.  I can write because if I cancel a prenatal visit to sleep, I know my client will still have access to health care.  I am not the only health care my clients have, so I can write.  I can spend the day writing if I want.

There were times in my life when I couldn’t write after every birth.  When I worked in a birth center on the U.S./Mexico border, and we had days with nine births in a row, and barely time to run to the restroom during a 24 hour shift, I couldn’t write at the end of those days.  My midwife friends in Haiti who go from birth to clinic to birth and joke that midwives never sleep do not write at the end of their endless days. My midwife friend in Guatemala single-handedly cares for the health care needs of three villages, spending endless days on the bus traveling down dusty roads to care for every woman who needs her; she does not write at the end of her long day, because she knows that if she sits down to write, she will fall asleep with her pen in hand, and her pen is a precious resource she uses to record all the births in all her villages, and all the deaths.

As a midwife myself, I know what it takes to write.  I know the feeling of staying up way too many hours to ensure the safety of mother and baby, only to sleep a few hours and do it again.  I know what it is to be running in 5 different directions at once, each direction a potential matter of life and death.  I know what it is to wish there was more of me, that I could somehow divide myself between everything that needs me without giving anything less than my all, knowing that even my all is never enough. I know what it is to feel that if I let myself sit down, I will sleep forever and to want so badly to sit down anyways, and to then have a woman walk in pushing with sky-high blood pressure at that very minute.  And while I am sure it is humanly possible to write at the end of that day, because I know that midwives have, I know that I need a different kind of day to write.  For me, it takes a break, time when no one is pushing, when my practice is slow, when no one needs me, when I can go the restroom without an ear out for that yell that lets you know the baby will be here very, very soon and that always seems to occur the second I close the restroom door.

Writing takes time, and writing takes support.  Writing my stories is something I can do now that my practice as a midwife is cushy and soft, now that the women I serve have other access to health care, now that I live down the street from my mother and grandmother who feed me.  Writing means no one is waiting for me to measure her belly or weigh her baby, and that I have the time to find words.  And knowing this makes me concerned about the midwifery stories that are reaching the world.  I am not the only midwife, and easier jobs like mine are not the only kind of midwifery.  I worry that telling the stories of only the midwives who have time to write paints an unbalanced picture, leaves out the midwifery stories that most need to be told.  Writing is a function of privilege, but midwifery means caring for every woman, everywhere.  I challenge us to honor the diversity of what it means to be a midwife, to make sure that the stories of the midwives too tired and overworked to write also make it into our collective story of what it is to be a midwife.  I challenge us to paint an inclusive picture of midwifery, to keep space for the stories that aren’t being written, because the midwife knows that if she sits down, she will fall asleep, and that the second her eyes close, someone will walk into her clinic, ready to push out a baby, and the midwife will need to be vigilant once again. And however we practice, this story belongs to all of us midwives, if we can make room to listen.

Nechama Wildanah is a midwife in  Boston, Massachusetts. Email:motherrootmidwifery@gmail.com .

Web Page: www.motherrootmidwifery.com

Why ‘another’ blog for midwives?

By now you may already know that I come from Kenya. For years I have wanted to hear more voices of nurses and nurse midwives in the discussions around health issues and  health care systems. I am mostly concerned by the lack of voices from developing countries especially Africa. There are numerous blogs about midwives and midwifery out there. I have so far only seen ONE blog from an African midwife (South Africa).

I have chosen to focus on nurse-midwives with this blog because the world has realized that midwives are essential in maintaining and improving the health of mothers and babies. Interestingly, a majority of people and individuals who discuss the role of midwives and midwifery are not midwives or nurses. While there is nothing wrong with other people/professions discussing the role of midwives, time has come for us midwives to share our experiences. We know the crucial role midwives are playing especially in the periphery of the health care systems around the world and more so in developing countries.

I am hoping to receive and post stories by midwives from around the world. I will also write my stories as I travel and also strive to interview midwives so that we get to hear their successes and challenges.

I am also a co-author of a book in progress, Midwives: Stories of Triumph. The other co-author is Nechama Wildanah, a midwife from Boston Massachusetts. We are just beginning work on this book. It will be a collection of stories from midwives around the world. If you are interested in learning more about the book and the possibility of contributing a chapter, send an email to: midwivestories@gmail.com.

…and please, contribute a short midwifery story for this blog!

Monica Onyango