Midwives and Mothers
What is a midwife?
"According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):
A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant." [25]
The Midwife-Mother Relationship
During my semester in Uganda, I observed six deliveries as well as four caesarian sections. Every normal delivery I observed was done by a midwife. In fact, midwives and the delivering mothers themselves were the only people that I ever saw present at deliveries. Upon interviewing 100 expectant Ugandan women about whom had assisted with their previous deliveries, I found that 100% of previous normal deliveries performed in hospitals were done by midwives.
Midwives were in-charge of every step of the delivery process, from antenatal care and checkups to postnatal care, such as vaccinations. It is for these reasons that I have determined that midwives play an absolutely crucial role in the implementation of maternal healthcare in Uganda. It should also be noted that by midwives, I am referring to the occupation in Uganda which is held by women who have received formal training of some sort, and are of the same status level as nurses in Western cultures. They are primarily involved with maternal healthcare and the child-birth process at health establishments.
I spoke with a midwife in Uganda in order to determine what the typical training consisted of before a midwife was certified. I discovered that midwives undergo four years of clinical training and two years as a “junior” assistant midwife before becoming a certified midwife. This training appears adequate, as the maternal and infant mortality rates in hospitals are much lower than Uganda’s national average maternal and newborn mortality rates. Therefore, there exists a potential difference between the quality of maternal health care mothers receive in the hospital compared to the care they receive in their own homes. As a solution to this issue, Anderson and Bauwens conclude that, “[If] some people want home birth, then part of the funds available for health care should be directed to providing services to them.” [26] These funds could be used to train TBAs to reach the same skill level as midwives or to allocate more midwives to home-settings. It is likely that many women in the future will choose to deliver at home for various reasons and these deliveries could be made more successful with skilled persons present.
While this solution has been recognized, it has not been effective for reasons concerning cultural barriers. In order to adequately train TBAs, a culturally-sensitive approach must be taken during this process. Sheila Cominsky, Ph.D. says that,
“Official medical personnel often believe that increasing the midwives’ knowledge and practice of western medicine would be an important factor in…raising the level of maternal and child health. Consequently, they are attempting to change childbirth practices in many parts of the world... However, such programs are often carried out without concern or knowledge of existing practices, their rationale, and their relationships to other aspects of the culture; with the result that they are not as effective as they otherwise might be.” [27]
Comisky asserts that, “The attempt to make such training more compatible with the sociocultural framework of the midwives and their clients would also made for more effective health care.” [28] I agree with Comisky’s ideas but also wonder how health care professionals can be made more culturally aware in their teaching practices. Involving local anthropologists may be one key to connecting better with cultures and teaching them proper maternal health care techniques.
"According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):
A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant." [25]
The Midwife-Mother Relationship
During my semester in Uganda, I observed six deliveries as well as four caesarian sections. Every normal delivery I observed was done by a midwife. In fact, midwives and the delivering mothers themselves were the only people that I ever saw present at deliveries. Upon interviewing 100 expectant Ugandan women about whom had assisted with their previous deliveries, I found that 100% of previous normal deliveries performed in hospitals were done by midwives.
Midwives were in-charge of every step of the delivery process, from antenatal care and checkups to postnatal care, such as vaccinations. It is for these reasons that I have determined that midwives play an absolutely crucial role in the implementation of maternal healthcare in Uganda. It should also be noted that by midwives, I am referring to the occupation in Uganda which is held by women who have received formal training of some sort, and are of the same status level as nurses in Western cultures. They are primarily involved with maternal healthcare and the child-birth process at health establishments.
I spoke with a midwife in Uganda in order to determine what the typical training consisted of before a midwife was certified. I discovered that midwives undergo four years of clinical training and two years as a “junior” assistant midwife before becoming a certified midwife. This training appears adequate, as the maternal and infant mortality rates in hospitals are much lower than Uganda’s national average maternal and newborn mortality rates. Therefore, there exists a potential difference between the quality of maternal health care mothers receive in the hospital compared to the care they receive in their own homes. As a solution to this issue, Anderson and Bauwens conclude that, “[If] some people want home birth, then part of the funds available for health care should be directed to providing services to them.” [26] These funds could be used to train TBAs to reach the same skill level as midwives or to allocate more midwives to home-settings. It is likely that many women in the future will choose to deliver at home for various reasons and these deliveries could be made more successful with skilled persons present.
While this solution has been recognized, it has not been effective for reasons concerning cultural barriers. In order to adequately train TBAs, a culturally-sensitive approach must be taken during this process. Sheila Cominsky, Ph.D. says that,
“Official medical personnel often believe that increasing the midwives’ knowledge and practice of western medicine would be an important factor in…raising the level of maternal and child health. Consequently, they are attempting to change childbirth practices in many parts of the world... However, such programs are often carried out without concern or knowledge of existing practices, their rationale, and their relationships to other aspects of the culture; with the result that they are not as effective as they otherwise might be.” [27]
Comisky asserts that, “The attempt to make such training more compatible with the sociocultural framework of the midwives and their clients would also made for more effective health care.” [28] I agree with Comisky’s ideas but also wonder how health care professionals can be made more culturally aware in their teaching practices. Involving local anthropologists may be one key to connecting better with cultures and teaching them proper maternal health care techniques.