Sumaya Joseph, a midwife from the Midwifery Obstetrics Unit in Maccassar, South Africa, writes…
I used to describe my work as catching babies. But the truth is that it is much tougher than simply catching babies. My workload is unpredictable and I need to be prepared for any eventuality.
The midwives here, and at many maternity units around the country, frequently work without the support of a doctor in emergency situations. Yesterday a woman came in with high blood pressure and she was 8cm dilated. We realised that she wouldn’t make the trip to the referral hospital. I called the doctor at the hospital and she gave me instructions over the phone and we cared for the patient here.
The outcomes are not always good though, and there are many stillbirth cases. Our unit is set up for normal deliveries so doesn’t have a separate area away from other mothers and babies for women who have stillbirths, which is traumatic for them.
I believe that many of the problems women face are because of poor pregnancy planning and not having access to proper services at the right time. We typically offer two or three month injections or pills. But many who deliver here are still in school. They can’t come every three months for the injection. We should really offer them a long term solution that would cover them for a longer time.
We don’t have practical training in inserting long-acting reversible contraception (LARCs), so we do not feel confident inserting them. I think patients will definitely take up the offer of LARCs. It means that as a midwife, I can give my patients something that they want. None of my patients want to be pregnant again in three months. It’s obvious to me that the ideal time for inserting an IUD or implant would be immediately postpartum. I am looking forward to offering this new service.
I know there will be other midwives who will be willing to be trained. Some are concerned that there will be too much blood postpartum, but I reassured them that they will be taught everything and that doctors are doing it the same way and I will continue to reassure them they can do this simple procedure. We just need training and continued support to help us feel confident.