Midwives: First Responders for Preventing Fistula

This article is part of a series by RH Reality Check with contributions from  EngenderHealth, Guttmacher Institute, the International Women’s Health Coalition, the Fistula Foundation, the United Nations Population Fund (UNFPA), and the Campaign to End Fistula.  All articles in this series represent the views of individual authors and their organizations and can be found at this link.

Shipra and Puah the Israelite midwives during the birth time of Moses; Sadie Sump of Dickens era; old women who have birthed many children all deemed qualified to assist women during the birthing process.’ Mit wife’ – old German for with the woman, the wife; the paraclete, the one called alongside, the mothers advocate.

Then came qualification, the mothers needs were being met, a profession was recognised by governments of the developed world. This was transferred to the developing world; young women and men were being trained after their basic nursing training, then there was direct entry pure midwifery, diploma level, BSc level and the midwife becomes a luxury working in private clinics, living in the big towns, a qualified person to use in one of the many government offices or to work in one of the many non-governmental agencies.

This sophistication and raised profile for the midwife has created distance from the evry ones who need the midwife most; the remote, the poor, the overworked, the undernourished, the very young, the mother of too many children and my friends; they remain still alone in their valleys, their mountains, their desert plains, their mud or straw huts, their junk boats, their islands of isolation.

It is thus that our mothers, our sisters and our daughters labour long, weary, agonizing hours assisted by a few ill equipped women hoping for the best but never really certain of the outcome…

The midwife is the first point of referral for the pre-conceptual, the pregnant, the labouring, the post-natal mother and the skilled attendant for the new born; s/he is the teacher, the guide, the support, the medical helper and the friend of these solitary women. The normal birthing process is the midwives speciality, but even in the normal are irregularities that may lead to handicaps (viz. obstetric fistula) and death. This is where the value of the good midwife lies, s/he is able to identify early on the problem and refer her client rapidly for expert help; creating an environment of trust and faith in the medical system of any given nation.

Our nations must raise the profile, the salary, the support systems for midwives across the board, we must see midwives taken away from the cities and into the countryside, pay them extra for a few years, then bring them into the cities to teach others of their value; provide vehicles to transport women to centres of skilled excellence that support the midwives in their rural roles, now with mobile telephones the ease of communications has permitted rapid support systems where a midwife can call and ask for help when there is not time for transfer, when a more expert health professional can walk-talk the midwife through life saving procedures.

The death or disability of our mothers in this century is to our shame…

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  • kate-waha


    Thank you so much for that post Ruth.  I just wanted to share with you some of the work we’re doing at WAHA International concerning this issue, not only addressing the role of midwives in terms of prevention but also in the early treatment of vesicovaginal fistula.  We are working on a campaign to promote the use of early catheterization  by midwives to provide treatment systematically when they see a woman who is incontinent shortly after childbirth. You can find all the medical explanations in a blog post carried out by our medical coordinator on the MHTF website which you can access here. When we co-organised a conference with midwives from west and central Africa on this issue, many of them voiced that they had not realised  that they have a crucial role to play in the early identification of VVF patients and in the early treatment.  So thanks for bringing light to this issue again. After all the vast majority of women with fistula have a much higher likelihood of seeing a midwife than of seeing a special fistula surgeon, so midwive’s role in the early identification and treatment of patients is crucial if all women affected are to have access to treatment.