Story by Wesley Kipng’enoh, Fundraising Content Manager
There’s nothing more precious in the labour ward to a mum and midwife than the first cry of a baby. That first cry, an old village adage says, is perhaps a realisation by the baby that they are further away from the creator.
But the cry is also, undoubtedly, an announcement of the miracle of life. Patricia has been a midwife and a nurse for over twenty years, and she never gets over the first piercing shriek of a newborn baby as she holds it in its fragility.
To her, it’s a notice of arrival by her tiny VIP guest as the lungs soak in the first gasp of air in what will be their home for a lifetime.
Labour Ward Emergencies
“When the mum is expecting, it’s like the midwife is expecting too; it’s like I am pregnant too,” she says. When there are delays to the birth, Patricia often feels anxious and paces in and out of the ward. “When it takes longer than we expected, it is an uneasy moment for both the mother and me as a midwife.”
At the labour ward, she attends to a newborn with a tag on one tiny hand. Like her uniform, the labour room is dressed in white linen with four beds tidily floating in the space. High-raised windows stare down at the emergency cupboard at the corner and a humming resuscitator at the end of the room. It’s quiet with a distant lingering tension, a betrayal-almost, that something remarkably powerful happens in the room.
As Patricia holds the baby girl, its tiny pink hand goes aloft from the wrapped bundle as if dreaming of cuddling. Her mum on the bed looks on with a faint smile and pride. The baby girl is only a few hours old. She suddenly makes a tiny squeal, disturbing the peace.
The most common emergency that Patricia and her colleagues deal with is childbirth complications such as baby asphyxia, lack of breathing and pre-eclampsia, or over bleeding of the mother at the delivery bed. Just hours earlier, the labour ward was in emergency mode when after delivery, the midwife discovered that the baby had a grunting respiration and could not breathe properly. The situation led to a chain of actions-what Patricia calls “the magic of midwives” as they worked together to support the baby to breathe normally. As she holds the baby, now stable, it’s a relief as the mum gets to go home, happy with her baby girl.
But the reality is that nearly 26,000 children die annually in Zambia before they can celebrate their fifth birthday. According to the World Health Organisation, “WHERE” a child is born, still determines the baby’s chances of survival within 24 hours after birth. A child born in sub-Saharan Africa is 10 times more likely to die in the first month than a child born in a high-income country.
This, the report infers, is because places like sub-Saharan Africa have systematic and structural challenges that limit the provision of maternal and child health care. A good example is that few women stay at the health centre for the recommended 24 hours for observation after delivery.
For Patricia, it is more than work that she reports to, it’s a calling to save lives and support women. She remembers how as a young girl, she would dance in an oversize nurse uniform she had borrowed from her aunt, who worked at the big hospital in a nearby town. She was just twelve when she visited the aunt at the hospital where she worked as a midwife. She admired how the white uniform fit the aunt perfectly and how the shoes matched her outfit.
Shortage of midwives
Now a senior health care worker at New Masala Health Centre in Ndola City in northern Zambia, she manages the maternity health unit. At one point, the small health centre handled over 400 births a month, delivering an average of twelve babies a night.
Serving over 54,000 people, midwives of the New Masala Clinic are always busy. This shortage leaves nurses like Patricia stretched as they struggle to attend to mothers. On many occasions, Patricia has juggled between several mothers on the verge of delivery at the labour ward. “There’s a time that you are all alone at the maternity wing, and you have ten mothers about to deliver,” Patricia observes.
“You will find that you want to deliver this woman; the others also want you. So immediately, the baby comes out, you put the baby on the mother’s abdomen, you go to the next one, you put the baby on the mother’s abdomen. You go to the next one until they all have their babies on the abdomen.”
A typical night for a midwife in a setting where resources are stretched to the limit.
Responding to high-risk pregnancies.
Being a midwife here involves handling different maternal and childcare cases at different stages. Maternity care from preconception to postnatal requires attention to support mothers throughout the journey, and training more healthcare workers like Patricia makes it possible to improve the survival and health of newborns.
Midwives do not just attend to births. They also provide antenatal and postnatal care and a range of sexual and reproductive health services, including family planning, detecting and treating sexually transmitted infections, and sexual and reproductive health services for adolescents, all while ensuring respectful care and upholding women’s rights.
For Patricia, the refresher training she received through the Closing the Gap project helps healthcare workers respond to emergencies by detecting pregnancy complications early enough and dealing with emergencies before they are referred to major hospital. She says high risks, such as blood pressure in pregnant mothers, are still among the silent killers for both mother and the baby and often lead to surprise pre-eclampsia on the delivery bed, especially for mothers who miss earlier prenatal appointments.
Patricia emphasises the need to have more midwives trained to handle these unforeseen risks/emergencies. But more important is having specialised health care workers to look after the population.
In Zambia, the ratio of nurses and midwives to patients stands at 1:1000, which limits the quality of care that mothers and children can receive with such high. In contrast, high-income countries like Netherlands, Sweden, Switzerland have over 12 nurses and midwives per every 1000 people. Other in this bracket like the US and Norway have over 15 nurses & midwives per every 1000.
A UNFPA report shows a shortage of nearly one million midwives globally, with the most severe shortage expected in low-income countries and Africa estimated to be 750,000.