Rwanda: What We Need to Address the Plight of Midwives

Photo: Dennis Agaba/The New Times

Nurse Esperance Mujawamariya takes care of her patient.

analysisBy Sharon Kantengwa

Stories about midwives usually invoke bad memories for many that have been in the labour ward. But there is also another side of midwives that we rarely get to know. It is a story that brings a smile on expecting mothers. Take for example, the story of Ruth, a mother of one and marketing executive in Kigali.

“The midwife who attended to me was kind and always had a smile on her face every time she entered the delivery room. Being a first time mum, I was worried because of the many horrifying stories I’d heard about midwives. This lady was nothing like that,” says the 31-year-old who requested to be referred to as just Ruth.

The humility and love with which the midwife handled Ruth is a contrast of the beliefs and perceptions about midwives, generally.

Josette Umucyo is a midwife at Muhima District Hospital, and is in charge of the labour ward. With nine years of experience, she has lost count of the number of deliveries conducted. Despite her hands-on experience, helping a woman to deliver is always a lifesaving moment for her and her team that requires them to give their all.

“We take the delivery process as a moment between life and death. Even though it is a joint effort with the mother, we have a bigger hand in this. That is why I put all my mind and energy into it, to ensure that the delivery is successful,” she says.

The plight of the unsung heroes

Despite this life saving role, the work of midwives is sometimes not made any easier.

As Umucyo ushers me into her office, we pass through the labour ward where I catch a glimpse of women waiting for their turn to deliver their babies. Some are all by themselves,calling out in agony because of the painful contractions.

“It’s natural for women to get labour pains but we assist them and teach them ways to reduce the pain and control the anxiety that they may have. We show them how to remain comfortable during those contractions,” Umucyo explains to me.

I did not see any men in the ward and when I inquire why the men aren’t present, Umucyo says, “Sometimes, the men want to experience the moment but they are not given the opportunity because of the limited space in the ward.”

In one of the rooms, four women are waiting to deliver. The midwives who have already conducted nine deliveries have to attend to these too.

The hospital has an estimated 25 deliveries a day, with each shift having only five midwives to attend to all the cases.

“We have only 20 midwives in the labour ward in this hospital and we conduct around 25 deliveries each day,which means that we are supposed to be 70 according to the number of deliveries we conduct each day. Professionally, two midwives are supposed to attend to one mother,” Umucyo says.

Josephine Murekezi, the president of the Rwanda Association of Midwives, says that this poses a threat to the mothers because a midwife is supposed to help the mother from the time of her first antenatal visit to when she gives birth, which does not happen because of the limited number of midwives.

Shortage of midwives?

Andre Gitembagara, the president of the Rwanda Nurses and Midwives Union, reveals that from the required 4,000 midwives, only 1,700 are registered with the council of nurses and midwives and are licensed to practice. Even with the limited number, not all the licensed midwives are in practice.

“We need more midwives, especially in health centres because that is the first point of contact for the mothers. Many of them are in referral, provincial and a few in district hospitals, yet we have 461 health centres,” he says.

Because of the limited number, he further reveals that most of those assisting in deliveries are not actually qualified midwives.

“In many health centres, especially rural areas, we have nurses who will deliver one or two mothers and yet they have to attend to other patients, and that is a big workload. This is why sometimes the A2 nurses (associate nurses) come in to help, yet they are not fully trained,” he says.

Gitembagara adds, “We also have a shortage of nurses yet they also assist the midwives. Some have since joined other business ventures while others are in other educational domains perhaps because of the working conditions. The number of those in practice is pint-sized compared to what we need.”

Murekezi blames this on the little motivation for the midwives in terms of salary and workload.

“This is a profession where we get the same salary, regardless of the experience. There is no promotion yet it is a tiring job,” she says.

She notes that it is a big challenge and a daunting situation especially when the community health workers mobilise expectant mothers to deliver in the hospital and there are not enough midwives there to attend to them,” she says.

What keeps them going?

Despite the challenge, the few that the country has still cling on to their roles and seem passionate about their work. But what keeps them going to serve with a smile?

“I always try my best to focus on the mother and ensure that I help save her life. When I have successful deliveries, I congratulate myself. If my motivation was derived from the salary that I receive, I wouldn’t be here,” Umucyo says.

“I meet a number of mothers regularly who show me the babies I helped them deliver and it gives me joy and a sense of fulfilment. That is my salary,” Umucyo explains.

“When midwives assist in giving birth to a baby successfully, they are happy. This is what motivates us. The ethics we teach also make the midwives passionate. But it becomes worse when they have done something wrong because it is not expected of them,” Murekezi explains.

Prima Uwase, a mother of two, reveals that she has always dreaded delivering her babies from public hospitals because of the ‘unfriendly’ nature some people presume the midwives have.

She prefers having her deliveries done in private hospitals where she is assured of complete attention.

For Umucyo, this is no surprise to her because this should be expected of in the health centres.

“Midwives are said to be rude which is true in some cases. However, due to our overwhelming work we cannot perform to our best capability. We are most times required to alternate our roles to the most vital and urgent ones,” she says.

What needs to be done to solve the problem?

Gitembagara reveals that the country has eight training schools for midwives, which are enough, but the problem lies in retaining them to keep in practice.

As such, he explains that more favourable incentives should be provided to the midwives, especially those working in rural areas.

“The government is doing what needs to be done because we have had progress over the years. However, it should give continuous professional education to those who are already in service as we train the new ones,” Murekezi says.

She explains that the association helps in giving continuous professional development by teaching midwives more professional ways of helping the mother and the new born. It also unites them under cooperatives to save.

While some countries train ‘nurse-midwives’, Gitembagara says that Rwanda plans to adapt to this kind of training in 2020.

“We are harmonising the East African training and we need to train a holistic nurse-midwife where a graduate can be able to provide both nursing and midwifery services.

“This, however, is a long term solution. The mid-term solution is to increase the number of midwives in each health centre with the average deliveries per health centre in mind,” he says.

What it takes to be a midwife

“It just requires the will and the qualification,” Murekezi says.

“We take on those who have passed with two principle passes in Biology and Chemistry in their senior six exams.

“The first year of study in midwifery involves anatomy and physiology combined as a must, and thereafter, they can go for midwifery classes.”

Why should midwives be celebrated?

Every new mother needs at least one person to help her and the baby, to provide proper care for the newborn and also help the mother with day-to-day activities during the days right after birth. Midwives have taken training and acquired the skills to efficiently look after the baby and therefore deserve to be celebrated.

Rebekah Talitha, pharmacist

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My first experience was okay with many of the midwives being good to me, assisting me right from antenatal with a few others making some unpleasant remarks about my delivery. All the same, I’m glad they came to my rescue in those tough times.

Blessing Kyshe, businesswoman

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The delivery of a baby happens in a space of time where the mother’s life is at stake. The midwives are responsible for this procedure and because they save lives, they should be celebrated. Their profession will be an inspiration to many.

Doreen Umutesi, online marketer

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In as much as these midwives derive their joy from saving the new born baby and the mother, they deal with the anxiety of mothers and give tough love where necessary. With their tiring work, I feel they are not being acknowledged enough. Simple gratitude from the parents and the government can motivate them.

Rita Mbabazi, businesswoman

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Rwanda: What We Need to Address the Plight of Midwives

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Posted by on May 18 2017. Filed under Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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