When Midwives Lead: How One Health Centre Is Redefining Maternal Care in Malawi 

Midwives are often among the first health workers women encounter during pregnancy and childbirth. But clinical skills alone are not enough to deliver the quality care women and newborns need. Midwives also need mentorship, supportive systems, adequate infrastructure, and the opportunity to lead. At Limbe Health Center in Blantyre, Malawi, where around 2,500 babies are born each year, a midwifery model of care (MMoC) is showing what can happen when these elements come together. 

Between 2022 and 2025, Limbe recorded zero maternal deaths while managing more than 500 maternal complications each year. Not a single mother died during childbirth, in a country where around four women die every day while giving birth. This is a powerful demonstration of what can happen when health workers have the skills, support, and systems to provide lifesaving care. 

Behind the numbers, the midwives are now equipped to recognize and respond to complications, midwifery students are gaining confidence through hands-on mentorship from experienced midwives, and women are choosing the facility because they know they will be treated with dignity and respect. 

The transformation began in 2019, when Seed Global Health, Kamuzu University of Health Sciences (KUHeS), and the Blantyre District Health Office partnered to establish Malawi’s first MMoC at Limbe Health Center. 

From the classroom to clinical practice 

Professor Ursula Kalimembe Kafulafula, an associate professor in midwifery at the School of Maternal, Neonatal and Reproductive Health at KUHeS, said the vision behind Limbe was clear: students needed to see the standards and procedures they learned in the classroom reflected in clinical practice. 

“We wanted to close this theory-to-practice gap where whatever students learn in class, should at least be found in the clinical setting. Mentorship was built into everyday care. Seed provided a midwifery educator, while KUHeS contributed faculty expertise through a practicing midwife preceptor who worked alongside Limbe’s midwives,” she explained. 

Preceptors are experienced midwives who mentor and supervise students, providing an important link between classroom learning and hands-on patient care. 

Richard Marikwenda, a midwifery advisor at Seed, explained that the MMoC was designed to support both the practicing midwives and the students they would go on to mentor. “Mentorship worked in two aspects: the Seed educator, preceptor and faculty mentored the practicing midwives so that they could, in turn, mentor the students better,” he explained. 

The approach created a multiplier effect, with midwives strengthening their own practice while also developing the skills to teach, mentor, and support the next generation of health workers. 

Empowering midwives to manage complications 

“The biggest change at Limbe has been the confidence and autonomy of the midwives,” Richard said. With stronger clinical skills and clearer referral pathways, midwives are better equipped to identify complications early, provide timely interventions, and escalate care when needed.  

Dalitsolanga Manganda, who is in charge of Limbe Health Centre, described how investment in training has changed their practice: “The midwives are now trained in Basic Emergency Obstetric and Newborn Care (BEmONC). That has helped the midwives identify complications early and refer them to Queen Elizabeth Central Hospital sooner.” 

“When we identify a complication, we provide the initial management. We don’t keep the mother here—we escort her to the next referral hospital and make sure she is in safe hands.” That combination of early recognition, timely management, and coordinated referral is critical when minutes matter. 

What the evidence shows 

An independent evaluation of the Limbe midwifery-led ward from 2021 to 2025 found improvements across maternal and newborn outcomes, quality of care, and clinical education. 

Beyond maternal survival, the evaluation also found improvements across several areas of care: 

• 38.5% fewer stillbirths, with the number falling from 13 to 8. 

• 99.1% of women received active management of the third stage of labor, an important measure for preventing postpartum haemorrhage. 

• 94% of women reported receiving respectful care 

In a sign of growing trust in the care given at Limbe, the facility has seen growing demand, with deliveries increasing by over 55%.  

The experience of women themselves also helps explain the facility’s growing reputation. Some women travel up to 20 kilometers from neighboring communities to give birth at Limbe, drawn by its reputation for privacy, dignity, and birth companionship. 

One mother described the difference in simple terms: “I was afraid of giving birth because my friend told me nurses shout at you and leave you alone. But here, they were kind. They explained everything. My mother could hold my hand. I will tell other women to come here.” 

Building the health workforce of tomorrow 

Limbe is also helping prepare the health workers who will shape the health system of tomorrow. Student midwives completing clinical rotations at Limbe achieved a 100% practical examination pass rate. Eighty-nine percent of midwifery students were assigned dedicated mentors, and more than 90% met or exceeded their learning objectives. 

Richard explained the wider impact of this approach and the MMoC model, “When you train one health worker, you strengthen the people they care for, the students they teach, and the communities they serve.” 

Investing in health workers is a critical part of advancing universal health coverage (UHC) and building stronger, more resilient health systems.

From one facility to a stronger health system 

The results at Limbe have driven demand to expand the model. Four additional health facilities have been chosen to replicate midwifery-led model of care: Kabudula Community Hospital and Bwaila Hospital in Lilongwe, and Chileka Health Centre and Mlambe Hospital in Blantyre. The approach aligns with Malawi’s Health Sector Strategic Plan III (2023–2030) targets of reducing maternal mortality rate from 349 deaths per 100,000 live births in 2017 to 213 in 2030 and newborn mortality from 26 per 1000 live births to 17 by 2030. 

The MMoC model has the potential reach all levels of health service delivery in Malawi. With more than 3,500 already established midwifery positions, the model has a greater opportunity for implementation.

Seed is grateful to our philanthropic partners who have supported our work at Limbe Health Center including IZUMI Foundation, Vitol Foundation and Beginnings Fund.