Midwives: “A Force for the Better”

Diana Garde, CNM, ARNP​Blog, Midwifery, Nursing, Uganda

People ask “why midwifery?” and “what drew you to this field?” and I often feel that my attempt to answer falls very short of explaining how it is that I ended up in Northern Uganda, teaching midwifery to eager, bright baccalaureate-level students. How does one adequately explain why we crave some thing, feel at peace in some special place or why we fall in love? How do you express the gut feeling that something is ‘right’? How do you explain the draw towards something that at once needs to be absorbed and simultaneously diffused outward in the world? My choice in career has been not so much a calculated decision, but rather an organic movement.

Each day around the world, there are 360,000 heroic women who experience childbirth. Approximately 830 of those women die in the process. Not all are offered the same access to antenatal care, education, skilled birth attendants, medications, appropriate diagnosis and interventions for obstetrical complications, or respectful interactions with clinical staff. Unfortunately, birthplace alone is often the factor that determines the risk of both maternal and neonatal mortality. There is significant inequity in access to comprehensive and safe obstetrical care for women as a result of many factors including but not limited to politics, conflict, weakened health systems, and infrastructure, and the world’s poorest inhabitants pay the price through no fault of their own.

In Sierra Leone, during the Ebola Virus Disease (EVD) epidemic, the number of pregnant women lost was staggering, not to the disease itself, but to the lack of timely response, advanced clinical knowledge and adequate supply chain. I had the opportunity to stand for 18 months alongside my Sierra Leonean colleagues caring for pregnant, postpartum and lactating patients in a maternity isolation center. All of these women deserved a high level of care during their illness; they deserved the opportunity to deliver safely and to watch their children grow. We all did the best that we could in the midst of chaos and we learned lessons that will make us better prepared in the future. This is no consolation however, to the many that lost their lives because they were pregnant and ill in a country facing a crushing epidemic.

Often, there is a gap between the supply of appropriately trained nurses and midwives and the in-service demand of patients. When a woman comes to a health care facility to deliver and there is a single midwife struggling to care for the entire labor suite, postpartum ward and antenatal clinic, the comprehensive care of the mother-baby dyad is compromised. An unfair and unrealistic burden of responsibility is placed on too few midwives. At times, trained clinical staff is available, but governments struggle to pay the health care workers, who then seek employment elsewhere to support their own families. Highly trained and well-supported midwives are crucial to the survival of mothers and babies, and to the growth of a healthy population.

Working with Seed Global Health in Uganda has allowed me to work at the pre-service level and to train future midwives. We talk often in class of respectful maternity care, evidence-based clinical guidelines, self-determination and critical thinking. I like to believe that we are growing midwife leaders – providers who will challenge the status quo, who will work hard, demand more, and who feel proud of their calling. My students challenge and inspire me and remind me that learning is a life long endeavor. We feed each other intellectually and emotionally, as professionals with a like-purpose should.

Inequity in the world of obstetrics needs addressing now. Governments need support in finding sustainable pathways for training and health care resources. Health systems need strengthening so that access to care can withstand and maintain in the face of epidemics and conflict. Schools need the support to foster strong, curious health care providers who will not grow stagnant in their practice, but will strive for a higher level of care and tolerance for patients regardless of income, class, race, or gender.

I am proud of where I am today. When I watch student midwives correctly diagnose emergent life-threatening conditions, gently touch patients during labor, collect breast milk from a mother with eclampsia to feed her newborn, or diligently wash a mother after delivery, I know I am where I should be. My decisions in life have not always been the most fiscally beneficial, but I am forever grateful that I have had the opportunity to follow the course of my heart. You don’t ask why you want to be a midwife – you allow yourself to move towards it and within it. You hope that others do the same and together you are a force for the better.


Diana is a volunteer midwifery educator serving in Uganda as part of the Global Health Service Partnership. GHSP has been a multi-year collaboration between Seed Global Health, Peace Corps, and PEPFAR to place educators in year-long teaching roles to build the local health workforce of five African countries.