The day a woman gives birth can be one of the most dangerous days of her life. The statistics are unacceptable – particularly because they tell a tale of inequity. The lifetime risk of death from a pregnancy-related cause worldwide is 1 in 4,000 women, but in East Africa, it is 1 in11 women. That means that one in 11 women face the very real prospect of losing her life due to a pregnancy. Most causes of maternal deaths are preventable, however, and studies show mortality rates decrease dramatically when a woman is attended by a skilled provider in childbirth.
The United Nations Population Fund leads a collaboration which produces the State of the World’s Midwifery report. Effective midwifery education programs are needed in order to train midwives to provide safe, respectful care and reduce maternal mortality. However, midwifery education programs are too often hampered by the lack of resources, student exposure to unsafe practices, and limited faculty oversight in the clinical practice environment.
To improve student learning, empower local midwives, and strengthen maternity care, Linda Robinson, a Volunteer Nurse-Midwifery Educator working in Malawi, has developed a novel solution in collaboration with her colleagues: a midwifery ward staffed by local qualified midwives and supported by midwifery faculty and students. Working with Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi and Kamuzu Central College of Nursing (KCN), students will receive training and mentorship. As a result, congestion in the traditional medical ward will be alleviated. Midwifery faculty from KCN will be responsible for staffing weekly shifts to supervise and mentor students to supplement the care provided by QECH staff midwives rotating through the ward.
With this model, the goal is to improve the student experience by strengthening the link between the theory taught in the classroom and clinical experience. By augmenting the supervision and training that students receive from hospital midwives, who are often overworked by the high number of patients, care for mothers will improve.
Frere Hospital in East London, South Africa has also implemented this model to tackle the overcrowding in their maternity ward. Implementing an on-site, midwife-led ward resulted in improved outcomes for women giving birth. After reviewing the hospital’s routinely collected data, this new model may have contributed to a lower number of maternal and perinatal deaths. Multiple studies have shown that midwifery led wards have great potential to improve the quality of care provided to mothers and their babies.
With funding from Seed Global Health, three faculty from Kamuzu College of Nursing in Blantyre, Malawi visited Frere to learn their process of implementation and sustainability. Given the success at Frere, the team is hopeful that maternity care at QECH can be strengthened with potential for this model to be implemented in other regions of Sub-saharan Africa where similar problems with midwifery education and poor patient outcomes exist. The KCN faculty were received with incredible warmth and enthusiasm and the lessons learned there have already made a difference. There is potential for an ongoing partnership between KCN and Frere.
Linda spoke with Seed Global Health about the idea for a midwife-led ward:
How did you first develop this idea?
The idea came from a brainstorming session with colleagues when we were discussing the challenges of supervising students at their clinical sites. Our dean said she’d had a long-time dream of creating a model ward at the hospital where midwifery faculty could model care the way it should be delivered.
What is the long-term goal for this ward?
We want to improve the student experience and improve overall maternity care. The idea is to empower midwives to function as independent practitioners, promote respectful care of women in labor, and reduce maternal mortality through a self-sustaining midwifery-led practice housed within Queen Elizabeth Central Hospital in Blantyre, Malawi.
In addition, we’d like to see a relationship develop with midwifery schools around the world for an exchange program. We want students and faculty from other schools to come work on this ward, and give Malawian students a chance to travel to other settings for an international experience.
How can training students on the ward improve care for patients?
Protocols on the midwifery-led ward will be set in accordance with the International Confederation of Midwives standards for respectful maternity care. These standards are not currently practiced on the traditional ward and students are witnessing unsafe, disrespectful practices. They are not in a setting where they learn to question these unsafe practices or advocate for women. They are quickly discouraged.
No woman should die while giving birth – and no woman should face a higher chance of dying simply because of where she lives. Empowering midwives with the skills and training they need to care for their patients, and to lead and make decisions for high quality care for all women is critical. Linda Robinson’s model provides an example of leadership in midwifery – and a potential solution that can be implemented to save women’s lives.
Read more about Linda’s work in midwifery and her vision for the ward here (p.28)