Giving Birth in Rural Liberia: A Midwife’s Account
Giving Birth in Rural Liberia: A Midwife’s Account
Amelia G. Mulbah, 33, is a newly trained midwife working in a remote region of Liberia. She received a scholarship through the USAID Collaborative Support for Health (CSH) Program and graduated from nursing school in December 2016. After passing the state board test, she became a registered midwife and was deployed for two years to work at the Lutheran Referral Hospital in northwestern Lofa County.
CSH, led by Management Sciences for Health, offers scholarships to prospective midwives and laboratory technicians at accredited schools in Liberia as part of its health systems strengthening efforts. The program also conducts regular monitoring visits at four training institutions in the country, ensuring they meet quality academic standards. The aim is to boost the number of qualified health workers in critical cadres, reduce maternal and infant mortality, and improve quality of care. So far, 143 Liberians have received scholarships. Twenty-three midwives, including Mulbah, have graduated and been deployed to health facilities in hard-to-reach areas of Lofa County, where reducing maternal deaths is particularly challenging. Liberia’s maternal mortality ratio is 725 deaths per 100,000 live births—more than double that of nearby Ghana, for example.
CSH’s Gladys Lavien spoke with Mulbah to understand the impact that midwives have on health service delivery, their contributions toward reducing maternal and infant mortality, and the difficulties they face. The following is an edited narrative of two interviews with Mulbah.
I made the decision to become a midwife in childhood, prompted by the story my mother told me about her only sister and how she died during childbirth. This trauma has remained with my mom since. Since she told us about her pain and sorrow, I decided to become a midwife in order to prevent other women from dying while giving birth.
Most women in my community do not go to the health facility to give birth and experience a lot of complications. I advise women to go to the hospital and not deliver babies in their homes or with the traditional midwives outside of the health facility. There is a huge need to increase awareness here because a lot of women experience unnecessary challenges simply because of lack of knowledge about safe birthing practices.
At our facility sometimes it gets very difficult. Sometimes electricity goes off while doing delivery, especially during the night shift. Sometimes we have to do delivery by flashlight. Some days there is no water. Sometimes the lab technicians are not available [for tests] and we have to do delivery without knowing the patient’s status. Sometimes we need vitamin K to stop bleeding and there is none. With the issue of infection prevention and control, we are really having a challenge. For example, many times when we are doing delivery, we do not have the right kind of gloves. The ones we have are too short, and sometimes we get blood on our hands and get exposed to infection—this is very risky.
It is very challenging with so much scarcity. I would like to see an increase in the number of staff at the health facility, an increase in resources and medical apparatuses such as thermometers and stethoscopes to listen to the babies’ heartbeats, and better housing and more incentives for staff.
My day is usually very busy and tense. My work begins at 6:30 am and ends at 7pm. We usually do not rest unless the next shift comes and releases us. My activities include doing delivery, serving medication, observing patients. Sometimes as many as four women may be in labor while others need surgery and others need monitoring to check their blood pressure every 30 minutes and pulse every 15 minutes.
Photo credit: Gladys LavienFor the first six months I have worked during the weekends. I have spent only a few weekends with my family. After I have completed my service I want to go back to school to get a Bachelor of Science in Midwifery. Adjustment has been slow family-wise, the salary has not been forthcoming, and it has been difficult to meet personal and family needs. I had to send for my mother to be with me because it is so lonely out here. She helps to take care of my child as well as do housework while I am at work. Many days I do not get to see my son because by the time I get back from work I am so exhausted and it is time for him to get ready for bed.
I hope to see more midwives further their education and build up their skills because the task we have is huge. Most of the midwives here in Lofa are always willing to do whatever it takes to save the lives of both the mother and babies. I have learned a lot from delivering so many babies. I now know when it is appropriate to deliver the baby and when to allow for surgery. Also I have learned when to call for help and when to deliver the baby alone. The experience is wonderful and joyful when the baby is delivered safely. I am happy that I can now manage the entire delivery alone and I am also happy that I have become more professional in my field and can be relied on to deliver babies safely.
One case in particular—a patient who came to the facility with a case of preeclampsia—she was in her ninth month of pregnancy. When she got to the facility, I assessed her and discovered that her blood pressure was very high. I advised her to take bed rest and gave counter-hypertensive drug to control the pressure because her situation was critical. After that, the pressure dropped significantly. I later discovered that she had a history of pressure. At the end of the day she had to be taken in for surgery. It was one of the best things that happened because so many women die here of such cases and I was able to manage it.
Cindy Shiner, MSH communications manager, contributed to this interview.