A mother has an unplanned Caesarian and her tubes are tied without her consent. A woman is scolded when her child dies of malaria when she admits he was not sleeping under a mosquito net. A baby is delivered by the maid at the health center because the midwife has not responded to the late night call.
All of these are examples of disrespectful care that women should not need to tolerate. Yet too many women have too few choices: they have no money for private care, few resources, poor education, and a growing fear of health care that only get worse when they receive such inadequate and disrespectful care.
There is no more vulnerable time in a woman’s life than when she is laboring, anticipating the birth of her child. The global lifetime maternal mortality risk is 1 in 3,300. In East Africa, as many as one in eleven women will not survive, making childbirth a time of high anxiety. The risk goes up when women are not attended by skilled providers during labor and birth. And when women are disrespected or abused they are less likely to utilize resources even when they do exist.
Why is maltreatment of childbearing women so widespread, especially in developing countries? It is a question I am continually asking myself. I’ve worked in several different cultures and seen women maltreated during pregnancy across them all. This will change slowly but midwives have a responsibility to set an example of respectful care.
The basis of midwifery care is respect and advocacy for women, it’s the cornerstone of our profession, yet mothers still face mistreatment. Midwifery education programs (or lack thereof) vary tremendously around the world, and respect and compassion may not always be emphasized or taught.
Midwifery is a demanding profession with exhausting hours. In many settings midwives are not treated with respect yet they have tremendous responsibility and few resources. When midwives are disrespected that behavior can trickle down and women suffer.
Women’s lives can be saved if trust can be restored in health facilities and providers. Women will often stay home with people they trust even if those people are unskilled. When a problem arises there is no one with the expertise to intervene in an appropriate way. Women would rather die at home than be treated so poorly in a health care setting.
Education and empowerment are the keys to changing this – We need to train our students, early in their education, that it is unacceptable to disrespect women in labor. We need to model respectful care. Then we need to provide the resources they need to do their jobs. If an adequate number of midwives are trained and empowered, and have adequate time to rest and recuperate, the maltreatment of women throughout their childbearing experience will diminish.
It’s up to midwives to empower women so they can advocate for themselves and demand respectful care whether they have financial resources or not. Recently, I presented an idea to help achieve this: a model midwifery ward to demonstrate, in practice, what respectful care looks like as an experiential teaching mechanism. Midwifery faculty would manage the ward and abide by the protocols and standards set by the International Confederation of Midwives for respectful maternity care. Students would rotate through the ward and see what true midwifery care is. When I presented this to my Malawian colleagues they worried how students would then function in settings where there were limited resources. “Respect is free,” I said. “Compassion is free. Integrity and dignity are free.”
The advantages of this type of care surpass measurement. When a woman receives compassionate respectful care, when she and her baby survive because of that care, when she in turn treats others with respect and compassion, then the lives of women worldwide will truly improve. No one can put a price on that. And it’s up to us, the midwives, to do this.