Giving birth is a significant life event that should aim for a healthy baby and mother. There are growing calls for women to give birth in their preferred birth positions. But this requires midwives to be trained in a way that enables them to respect the choices that women make. The Conversation Africa’s health editor Joy Wanja Muraya asked Lydia Mwanzia to explain why women have the right to make choices, and the important role played by midwives.
Every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable – including obstructed and protracted labour and one of its side-effects, obstetric fistula.
An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother’s pelvis is too small or the baby is too large.
In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour.
When I visit low- and middle-income countries like Ethiopia, Zambia, the Philippines, and Tanzania, I am always heartened by the number of mothers I see breastfeeding their babies. Breastfeeding for so many of these mothers is the best and most affordable way for them to nourish their babies. While every mother does not breastfeed to be sure, the sheer number of mothers I see breastfeeding at local clinics, while walking with their baby strapped to them or taking a break on a city bench, gives me hope.
From time to time I like to look back into history and share photos I find in the Library of Congress archives. I have done that previously with breastfeeding, newborn health, and tuberculosis. Today, I am sharing photographs I found of rural midwives in the south.
The sunny, steaming hot morning when I visited L’Hôpital Sainte-Thérèse in Hinche, Haiti, the maternity unit was overflowing with busy midwives checking charts and administering care, nurses-in-training in white and yellow uniforms obtaining requisite clinical hours, as well as a few obstetricians checking on patients. Of course, there were expectant mothers, mothers who had just given birth, and those who were being prepped to deliver their babies. Husbands and other family members milled about slowly, but deliberately, bringing food and water to their loved ones, or just sat on benches and waited.
In each of the maternity units – antenatal, postpartum, and labor and delivery – there was a bed for every woman. No expectant mother laid on the ground waiting for space. In fact, I even saw some empty beds. That is not always the case I was told. Some times of the month are busier than others, but each mother can be accommodated.
Some expectant mothers – many with swollen feet and ankles – walked around slowly outdoors in the sunlight angling for some type of momentary relief from the constant wave of contractions. Others laid in bed with worried eyes anticipating the incumbent pain they faced. When I visited labor and delivery, one mother’s screams were piercing and she wasn’t even pushing yet. Another woman was calm, smiled, and gave me a quick wave as I walked by despite her contractions. Midwives were attending to their care – calmly and respectfully.