Restoring trust through compassionate midwifery: A community-based impact story from Uganda  

Brenda is a midwifery student in her third year at Lira University who recently engaged in domiciliary practice early this year, an experience she says helped improve the way midwives are perceived in the community. 

Every year, Seed Global Health supports Bachelor of Midwifery students to undertake domiciliary midwifery practice as prescribed by the Uganda Nurses and Midwives Council.  

This involves maternity-related care that’s provided in the home rather than in a hospital or clinical setting. It includes prenatal, labour support, postnatal, and newborn care. 

Midwifery students and their supervisors are provided with the requisite logistical support to reach more mothers, especially those in hard-to-reach areas. As such, Brenda participated in a community outreach in Adyel, Lira district, where she met Susan, who was pregnant with her second child. 

Brenda took time to explain to Susan what domiciliary care entails. While Susan was initially worried that she couldn’t afford it, her fears were allayed when she learned that all pregnant women are entitled to such care and can access it freely. Susan agreed to participate and be supported by Brenda. Like her, many women in low- and middle-income households often long for respectful and individualized maternity care but are unable to access it. 

Seed’s mission is to ensure that health workers like Brenda are highly skilled so that mothers like Susan can receive optimal care. “That’s what the organization’s partnership with Lira University and others fosters,” says Dr. Winifred Ukoha the Seed educator (faculty) adding that this level of care is not typically provided in most public hospitals where women seek maternal services.  

Our students are specifically trained to offer care that is often not provided in many government health facilities. Brenda supported and walked the pregnancy journey with Susan, assisted her during delivery, and even accompanied her home afterward. 

According to Brenda, this is a key step in comprehensive maternal care. “When we visit the new mother’s home, we are trained to assess environmental conditions that may affect the health of both mother and baby, and to provide appropriate health education.” She adds 

During one of these visits, Brenda’s course mate, another student, noticed her client’s mother-in-law was using cow dung to plaster the outside of the house and intended to do the same inside. 

 The student intervened, explaining that such materials could expose the neonate to serious infections. In another home, students observed mothers cooking indoors while neonates were present, and they educated the families about the risks of carbon monoxide poisoning for young children. 

Susan received individualized and holistic care, and she later shared her joy and satisfaction with other women in her neighbourhood. Many were curious about the private hospital where she had delivered, only to be surprised when she told them that her midwife had come from the local government facility. 

One neighbour, Sharon, who was pregnant at the time, confided in us that she was receiving antenatal care at a private clinic due to a previous negative experience with midwives at the government facility. She expressed interest in registering for care at the government hospital, on the condition that she would receive the same kind of compassionate support. 

“We promised to be there for her, even though it was outside our official period for domiciliary practice. We supported Sharon through her pregnancy, and she safely delivered her baby,”. Brenda shared.  After delivery, she experienced primary postpartum haemorrhage, which was effectively managed at the government facility. This condition could have posed a serious threat to her life had she delivered elsewhere, without access to skilled personnel and adequate resources, Brenda emphasizes. 

Her positive experience helped rebuild community trust in healthcare workers at the government facility. We are proud that the extended care we provided made a meaningful impact on both women and the wider community, says Brenda. 

Quotes from Susan and Sharon: 

“If I compare this to my first delivery, I can say this has been so much better. In my first delivery, I didn’t know how to care for the baby or myself, because no one showed me. But now, I’ve gained the skills to take care of the baby, and I can teach other women as well.” said Susan. 

“My experience this time was very different from my previous deliveries. This is my third baby. In the past, I wasn’t treated well, which made me afraid to go to the hospital. At one point, I even considered not going at all because I feared being mistreated.” Sharon intimated 

According to the recently released Midwifery Accelerator Report, achieving universal coverage of care provided by midwives could avert two-thirds of maternal and newborn deaths, including stillbirths. This vision is embodied in Seed Global Health’s mission where together with our partners ensure health workers in training are well trained and skilled to deliver respectful, skilled, and life-saving care to every mother and baby.