I wonder if the midwives I have met and worked with in rural East and Southern Africa know that today is the International Day of the Midwife.  In their honor, I wish to share the typical working day of one midwife I’ve observed. I’ll call her Jane. How does her day compare to yours?

Jane is the only midwife at a rural health center. She is in charge of the maternal and child health clinic and the maternity ward for women who arrive with postabortion complications or for labor and delivery. She works with a nursing assistant she has trained to perform some antenatal and family planning services.

Jane graduated from midwifery school six years ago, where she completed a curriculum based on the International Confederation of Midwives’ competencies for midwifery practice. She has had in-service training on emergency obstetric care, postabortion care, family planning, and prevention of mother-to-child HIV transmission (PMTCT).She is very good at her job.

Open for Business

Officially, Jane’s work hours are 8:00 AM to 5:00 PM. In reality, she never knows when she will start or finish. She is on call 24/7.  In the morning, Jane first makes sure the delivery room is ready for the day. On average, she manages at least three deliveries each day in addition to her other duties.

Next she rushes to check on and examine the new mothers and their babies. She counsels them on breastfeeding, infection prevention, family planning, immunizations, growth monitoring, and newborn care, and teaches them the warning signs that warrant a trip back to the health center before discharging them. She includes the fathers or other family members who have come to take the mother home. The mothers are grateful and happy as they prepare for the journey home. For some, this will be a long walk or bicycle ride.

Meanwhile, the nursing assistant has started giving today’s health education talk in the antenatal clinic to over 40 clients. Jane takes extra time with new antenatal clients and helps them make a delivery plan.

If a client opts to test for HIV, it is Jane who conducts the pre-test counseling, performs the rapid HIV test, and gives the result and post-test counseling. She may need to withdraw blood for further testing.  She dispenses iron and folate, deworming medication, and gives tetanus toxoid. To some, she gives antiretroviral drugs.

Throughout the day, postnatal and family planning clients come in and out. The nursing assistant gives them injectables, oral pills, and condoms. But only Jane can provide long-acting reversible methods.

And children show up from time to time, referred to Jane from the health center’s immunization and growth monitoring clinic.

It is now past lunchtime and Jane has not even had a coffee break. Most clients have been waiting for a long time. She does not consider asking them to return the following day.

And now it is late afternoon. The queue has cleared. She can finally take a break before completing all the registers and monthly returns for antenatal care, family planning, PMTCT, and immunizations.

Jane wishes there was just one register for all services. 

Night Duty

The security guard is likely to knock on Jane’s door in the middle of the night. When he does, she grabs her flashlight and hastens to the maternity ward.

In this community, women generally deliver at home when it is nighttime. If a woman comes to the health center at night, she likely is in trouble.Jane does not like conducting deliveries at night. Her only source of light is a small kerosene lamp, a candle, or her flashlight. It’s hard to properly assess the baby and mother or to repair a laceration or episiotomy or to resuscitate a newborn.  Emergency referral at night is an even bigger challenge. Jane can use her mobile phone to call the ambulance at the nearest hospital, which is three hours away, to come pick up the client and take her to the hospital, but six hours is far too long for a woman who is bleeding, in obstructed labor, or who has severe pre-eclampsia.

Jane remembers the last mother she lost, the one who died waiting for the ambulance.

Despite Jane’s training and confidence, she sometimes feels helpless. Her training cannot make the ambulance arrive faster or eliminate stock-outs of lifesaving drugs. She wishes the Ministry of Health could send another midwife, make sure she has enough equipment, eliminate stock-outs, and improve transportation. She wishes the health facility had a generator or solar lighting. She wishes to connect with other midwives.

And her biggest wish is to serve her clients better and change their lives, one family at a time.  But Jane likes being a midwife and working in this community, she says. She has seen babies she delivered grow up and start school.

Happy International Day of the Midwife, Jane. And thank you for all you do.