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 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 sent 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. And in Lofa County the situation is worse, with 1,072 deaths per 100,000 live births, according to the 2013 Liberia Demographic and Health Survey.
The following is an edited narrative of two interviews conducted with Mulbah to understand the impact that midwives have on health service delivery.
I made the decision to become a midwife in childhood. I was prompted by the story my mother told me about her only sister and how she died during childbirth. Most women in my community do not go to the health facility to give birth and, as a result, many then experience a lot of complications. I advise women to go to the hospital, to not deliver babies in their homes or with the traditional midwives outside of the health facility.
My work begins at 6:30 a.m. and ends at 7:00 p.m. We usually do not rest unless the next shift comes and releases us. Sometimes as many as four women may be in labor at the same time while others need surgery; then others may need monitoring to check their blood pressure every 30 minutes and pulse every 15 minutes. Sometimes we have to do delivery by flashlight. Some days there is no water. Sometimes we need vitamin K to stop bleeding and there is none. Many times, when we are doing delivery, we do not have the right kind of gloves. The ones we have are too short. Sometimes we get blood on our hands and get exposed to infection—which is very risky.
I hope to see more midwives further their education and build their [midwifery] skills because the task we have is a huge one. I have learned a lot from delivering so many babies. I can now manage the entire delivery alone and have become more professional in my field. I can be relied on to deliver babies safely.
Cindy Shiner, MSH communications manager, contributed to this interview.