Rekindling a love of midwifery

By Zeenath Uddin on 14 May 2014 Midwifery Global midwifery Uganda

I was losing the passion for midwifery in the UK because of the bureaucracy and box-ticking, so I volunteered to travel to Uganda for four weeks to rekindle my love for the profession.

Maternal and infant mortality is high in Uganda. For every woman who dies, at least 20 more suffer injury, infection or disability. A massive 90% of the complications that lead to their deaths are avoidable, which is unacceptable.

During the Global Midwifery Twinning Project (GMTP), the Royal College of Midwives partnered with the Uganda Private Midwives’ Association from 2012-2015. The aim of the project was to build capacity, to improve quality of care and to also improve maternal and newborn outcomes, thus contributing to achieving the Millennium Development Goals. 

My assigned role was to work with four different private midwifery clinics, training trainers in emergency life-saving skills for mothers and babies. I was very well prepared for the trip, as I had been given the objectives before I left.

I knew I had to be versatile, as people have different learning styles, so I took leaflets, posters, CDs, presentations, workbooks, a doll, a mask and a mini pelvis. I would encourage the midwives to consider a change of positions for women in labour other than the supine position. I also introduced massage in labour as a form of pain relief, taught examination of the newborn and the updated theory and practice of resuscitation of the newborn. I found it a continuous battle to implement changes that are seen as basic knowledge to us in the UK.

It was very challenging when extremely sick women were referred to the government hospital knowing there could be many days of waiting; whereas no delay in treatment would occur if they were able to afford care. Paying for health care means that poorer people are inevitably going to suffer.

Illiteracy and lack of education accompanies the increasing rate of maternal mortality. Gender inequality remains rife in Uganda, where women continue to have a low status. Many women choose to deliver alone at home as this is seen to be a potential way to ‘elevate’ their social status.

It was apparent to me that midwives need to educate and empower women and girls about maternal health issues. Also, skilled community-based birth attendants need to be trained to increase maternal health coverage in and to remote areas. There are high rates of unsafe abortions and corruption appears to be a major problem in the country.

Since returning to the UK, I have a renewed appreciation for the NHS, despite the current frustrating changes and lack of appreciation for clients’ minor complaints. The trip has also given me a real interest in global maternal health and if given the opportunity, I would love to return and do my master's dissertation or a project in Uganda.

Mothers are dying every day all over the world and being part of the GMTP has inspired me to set up a charity to help these women and change this.

The best way to reduce maternal mortality and morbidity rates is to support the enhancement of good midwifery care and education during the antenatal period, which will inevitably follow through to the intrapartum and postnatal period. Additional information for contraception, family planning and access to legal and safe abortions will have a dramatic impact on maternal health too.

There were many places in Uganda where maternal health education is completely overlooked – this needs to change. I would also like to see more focus on education for younger children, particularly girls, as this is the key to a better future. Every mother counts and health care should be a human right to all. Every woman should be able to give birth safely and be treated with dignity and respect.

Those who live in high-income countries with good medical access have high expectations for good quality, compassionate midwifery care. The question is, how can we ever achieve sustainable development for all if we continue to turn a blind eye to these women who need our help during the most vulnerable time of their lives?

This is not making a difference to one person’s life. If a mother or baby doesn’t survive, it will affect everyone – the family unit and the community. A mother who has health has hope; and a mother who has hope has everything.

One day in Uganda

At the beginning of each placement, I would develop a structure for learning with the midwives – this was dependent on how busy they were. We utilised every quiet moment. We did a lot of simulation training and I found that everyone was very enthusiastic and passionate to learn, which was very encouraging.

During my second week, I received an email from one of the midwives to whom I had taught the newborn resuscitation. She wrote:

"Thank you so much for everything you taught us. A baby was born very flat and it wasn’t breathing; it was blue and needed full resuscitation. We went through all the steps you had taught us and then he survived."

Prior to this, if a baby had required resuscitation, the midwives would have turned it upside down, smacked its bottom and hoped for the best. I felt extremely humbled by her response and pleased to have been a part of changing the attitudes and behaviours of the midwives, so they were able to save one baby’s outlook. I hope that together, with input from other GMTP volunteers, we, as a team, are able to continue to contribute and aim to make childbirth in Uganda safer for mothers and their babies.

Zeenath Uddin - Masters Student, King's College London