Since the dawn of time, when there were no doctors or hospitals, it was the midwife who took care of female health problems, assisted in secure childbirth and helped families grow. A midwife is named so because she assists the expecting mother and her child during labor and delivery. The profession of midwifery is an art as a midwife understands the needs of the expectant mother and encourages her efforts during delivery; midwifery is also a science with a midwife’s ability to exhibit expertise and decisive decision making.
If a prospective mother is asked as to why she would prefer a midwife, she would surely tell you that a midwife is well informed, humble, and tolerant and values the traditions of service towards humanity. A midwife’s task requires a great sense of responsibility which she performs through a high degree of proficiency and knowledge.
Responsibilities of a midwife
- To provide basic information and suggestions regarding family planning.
- To examine and invigilate whether a pregnancy is normal.
- To identify the possible risk factors and prescribe the necessary laboratory tests.
- To provide a guideline to the parents about their future responsibilities and about the diet and health of the newborn.
- To assist the mother during delivery and to examine the status of the fetus through appropriate medical instruments and methods.
- To assist spontaneous deliveries, episiotomy (where necessary) and breech deliveries in case of emergency.
- To identify the signs of abnormality in a mother or child after delivery and refer to the doctor and to take emergency measures in the absence of the doctor.
- Detailed examination of the newborn, to take care of him/her and to take possible measures in restoring breath.
- To take care of the mother’s health after delivery and providing information regarding her child’s health.
- To continue the treatment prescribed by the doctor.
- To compile important records and keep them safe.
But why would midwives be required when there are doctors and hospitals present in this day and age? Why is a midwife still used the world over as a health worker when there are alternatives present which are regarded as more professional? There are several reasons to be considered.
Importance of midwifes as health workers
- Midwives are confident that they could help the mother and the child during labor and delivery through a safe method.
- Midwives usually live in the same communities where they serve; therefore the families of that vicinity trust them.
- They can devote more time to the mothers under their observation as compared to professional doctors and nurses. Thus they are quicker in sensing the risk factors and addressing their health issues.
- Pregnant women are comfortable in sharing their problems with midwives.
- Midwives charge lesser fees as compared to doctors and hospitals, they believe in service rather than money or authority.
- In marginalized communities which lack health facilities, midwives are the only available health workers for the inhabitants.
Due to above mentioned factors, midwives are the first and in some cases only option who can be contacted during pregnancy or for any other women health issues. But not everything is a simple as one would like. Midwives today have to face some very difficult and at times nearly insurmountable challenges.
Challenges faced by midwives
The biggest challenge for midwives, as with all health workers, is to fight diseases and death of women and children. Every year thousands of women are injured, become handicapped or die during delivery and labor. The victims of these cases are usually the poor women who suffer from insufficient diet, insecure living conditions and inadequate health facilities.
Three Delayed Decisions - Danger Zone for the Mother
The death toll of mothers in Pakistan during labour and delivery has three reasons.
Midwife should be well aware of these causes and should prepare the husband and family to deal with them.
- Delayed decision making
If a complication arises during pregnancy or labour then it is an emergency situation for the pregnant mother which requires spontaneous decision making in shifting the mother to the hospital. Delay in taking this decision endangers the mother’s life. A midwife should help the family in taking timely and correct decision.
- Delay in shifting to the hospital
It is the duty of the mid wife to advise the family to arrange ambulance or any other vehicle before hand. Under construction roads and traffic blockage due to processions and rallies must be considered while planning the activity.
- Delayed treatment
A midwife should take possible measures during the delayed treatment after reaching the hospital emergency. A policy could be formulated in consultation with the hospital management, doctors and town counselors to avoid delayed and ensuring safety of the mother and the child.
The bottom line for planning and adopting precautionary measures is for the safety of the lives of expecting mothers.
Mostly midwives belong to the deprived communities, thus they live hand to mouth all their lives. They often provide their vital services with next to little to no pay which makes it extremely difficult for their basic survival.
Besides meager remuneration, the services of midwives are usually ignored by the doctors and other segments, and this in turn reduces their level of commitment. If a midwife is restrained from accompanying her patient in the hospital, it excludes her from the health profession.
Traditional Birth Attendants (TBA) is the term used for midwives who are believed to be among the population migrating from the villages to the cities. Such midwives are believed to be incompetent and unqualified by professional midwives and health workers. However TBAs at times are well informed in alternative medicine such as herbs and massage techniques and are proficient in safe and secure childbirth methods. They usually render their services in exchange of either ordinary or no remuneration at all since they want to serve the women of their communities selflessly.
Midwifery status in Pakistan
During the past sixty years, very little progress has been made in the health sector resulting in fewer health centers and maternity care in low income communities. Pakistan is in dire need of trained midwives to take care of mothers and children especially during the labor and delivery period.
However, there is an acute shortage of licensed practicing midwives in spite of the fact that thousands graduate every year. That in part is contributed by the fact that midwifery is not regarded as a distinct profession, independent of nursing. And those that are trained and licensed are not being used effectively as there are no policies or plans to utilize them properly.
Also there are no opportunities for advancement in midwifery in the country due to a lack of a career structure for midwives. The midwife starts at the lowest rung of the pay scale and retires in the same grade.
Midwives also do not enjoy the same or even similar status that other professionals related to the field of health care do. Midwifery as a profession is not understood in Pakistan. A professional midwife is equated with a daai (the illiterate woman who delivers 80 per cent of babies in Pakistan). And because of this ignorance, midwives in Pakistan do not enjoy the prestige awarded to them in the developed countries like Europe where the babies are delivered by professional midwives.
To improve the situation, the local government needs to invest in appropriate training and surgical instruments as the poor women who lack access to health facilities depend heavily upon the midwives’ services. A lot needs to be done to create awareness about the role and functions of a midwife at very high levels. Only then will the career prospects and reputation of this profession gain a respectable status in Pakistan. The art and the science of midwifery needs to be invested in and reinvigorated on a national scale for the betterment of women and children and the nation on the whole.
Compiled from:
- Aasan Midwifery’ published by Pakistan National Forum on Women’s Health
- ‘Darsi Kitab Baraey Midwife’ published by Pakistan National Forum on Women’s Health
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