Think:Health cultivates and articulates the best in health research and news.
The following episode, which aired on Sunday 1 May 2016, features stories about midwives to celebrate the International Day of the Midwife this Thursday 5 May, including:
- a mother whose midwife made her birth experience memorable (0:01); and
- midwives who have worked in Afghanistan, West Africa and the Northern Territory (6:47).
Academic guests:
- Professor Caroline Homer - Associate Dean (International and Development), Professor of Midwifery at the UTS Faculty of Health
Host/s:
- Ellen Leabeater, 2ser
- Ninah Kopel, 2ser
START OF TRANSCRIPT
Jenna: I was on such a high, I was actually… once my second (baby) was out, I was like, “Oh! That was it? That was way easier!”
Ellen Leabeater: This is Jenna.
Jenna: Hi I’m Jenna. So, I’m a mother of three kids. My eldest has just gone four and started Kindy this year and her name’s Bria. My second is Reef, and he will be three in June and then my littlest is Jax, and he’s just turned one.
Ellen Leabeater: Jenna planned to have a drug free birth for her first child Bria, but she was four days overdue and her doctor was about to head off on holidays, so she chose to be induced. Nothing much happened after she was induced, so the doctors gave her medication used to speed up labour. A few hours later she had an epidural, and not long after that, Bria was born.
Jenna: So that was pretty straight-forward. There were no complications, but I guess it was a lot more medical than what I’d wanted. After my first, I was super happy to have my baby. But I was just, “I’m so glad it’s over - that was just awful” and there was a slight disappointment in myself that I couldn’t do it completely natural.
Ellen Leabeater: Compare that experience to that of her second child, Reef. The difference? A midwife.
[Music plays]
Ellen Leabeater: Hi. Welcome to Think:Health, I’m Ellen Leabeater Leabeater. This Thursday is the International Day of the Midwife, and to celebrate we’re exploring the work of midwives over the next half hour. You’ll hear from three midwives working in three very different places. We’re going to hear a bit more from Jenna first about why her midwife was important to her.
[Music plays]
Ellen Leabeater: In between baby number one and two, Jenna became a doula, that’s a person who offers non-medical support to women during birth. During her training, Jenna gained a greater understanding of pregnancy and labour, and decided her second birth was going to be different. She enrolled in a midwifery-lead group practice in her hometown of Bunbury, which is about two hours south of Perth in Western Australia. She was assigned a midwife called Susan who did all her antenatal appointments and was there when Jenna gave birth in hospital.
Jenna: Yeah, we gained a lot of trust. It was really personal and, yeah, I love her. By the end, she knew exactly what I wanted to achieve with the birth, she knew how to support me, she’d met my husband. So, when I went into labour, there was no, “Who am I going to get when I walk into the hospital” or “Quickly, try and learn me, let’s try and get a rapport. Here’s my birth plan – this is what I want to try and achieve.” She already knew all of that. I felt really safe going into my labour knowing that she was going to be there.
Ellen Leabeater: And this is all part of the role of the midwife. Caroline Homer is a Professor of Midwifery in the UTS Faculty of Health. She says that midwives are especially important in providing continuity of care – that is, making sure the same person is there for your antenatal appointments, birth and the weeks following your birth. It’s something Caroline would like to see for all women across Australia.
Caroline Homer: There are lots of divides in countries like Australia with access to midwives, so while we know that every woman has a midwife with her at her birth, what we would like is that every woman knows the midwife with at her birth, so that they don’t have strangers. So now, there is good research that midwifery continuity of care – knowing the midwife who is with you at your birth – will make a difference to your outcomes, regardless of whether you have risk factors or not.
Ellen Leabeater: Jenna says knowing her midwife was something that was important to her, and that it added to the whole birth experience.
Jenna: It just took away that scariness of not knowing if I am I going to get a good midwife, you know? That’s always something that people think: “I hope they’re nice, I wonder who it’s going to be.” It took away that whole extra fear that might be there, so you could really just focus on your labour without wondering who’s going to get there and having to establish that relationship and trust. It just makes the transition so much smoother and trustworthy.
Host: After all, birth is a very vulnerable time for women. Caroline Homer again.
Caroline Homer: Giving birth is a very vulnerable moment for women. They’re entering into an uncertain experience. You never know how your labour is going to go at the beginning. You’re very exposed, and I don’t mean that only in terms of being naked, but many women are naked. It is a very vulnerable time – you’re kind of exposing your soul. So to have strangers with you at that really vulnerable time is very hard. We know that if you know the midwife you trust her or him. Women want to know who’s with them in the room at this very precious moment. You only give birth to each baby once. You only get to do it once and you want to do it the best you can.
Ellen Leabeater: And for baby number three, Jenna had Susan as her midwife again. But this time, she chose a homebirth.
Jenna: So yeah, of course it was great, because we already had such a great rapport. We’d kept in contact between babies and so, yeah, it was just like kicking off like last time and it was even better planning a home birth. So yeah, it was really great as well.
[Music plays]
Host: Of course, Jenna’s story is remarkably similar to many Australian women, be that they give birth with a doctor or a midwife in hospital or at home. Whatever the choice a woman makes, the key advantage is that we have someone there to guide a woman through birth but also to help when something goes wrong. In many parts of the world, this is a luxury. Whilst homebirth may be a lovely choice for women in Australia, in Afghanistan, it’s basically you’re only option.
[Music plays]
Sabera: The culture is to deliver at home and not go to the doctor, especially with the parliament rules [in that time]. Women have to stay at home because, if they go out, they will kill them or torture them. The only choice was to stay at home.
Ellen Leabeater: And if you’re lucky, you’ll have another woman with you, but it’s highly unlikely that they’ll be a skilled birth attendant.
Sabera: The only person might be a family member, a mother-in-law, mother or sister-in-law to help them with the birth. And they’re not trained. In most cases, they’re dying because they don’t have access to a skilled birth attendant.
Ellen Leabeater: If something does go wrong or you do want help, it’s a couple of days walk to the nearest hospital.
Sabera: If a woman wants help from a midwife, they literally cannot find that midwife easily. They have to walk miles – three days or four days. There is no road also. No proper road to drive. There is no car. They have to go by donkey.
Ellen Leabeater: That is, if there is any point at all in going to the hospital. Most are ill-equipped to help anyone, let alone a pregnant woman.
Sabera: And when they reach the health facility, there is no help provided. If it is provided, there is no equipment. If there is equipment, there is no medicine.
[Music plays]
Ellen Leabeater: What Sabera is describing is Afghanistan circa 2003, although it’s questionable how different it is today. Sabera is a midwife currently working in the UTS Faculty of Health. She previously worked in Afghanistan after the fall of the Taliban helping to educate midwives across the country. Sabera and her family fled Afghanistan in the 1980s during the Soviet War. They settled in Iran, where Sabera was educated.
Sabera: During the Russian invasion, I was a kid and we migrated to Iran. There I received my education from primary to my Bachelor of Midwifery. After my Bachelor of Midwifery, I returned to Afghanistan. It was almost the same time it was announced that the Taliban are gone - that they’d collapsed. That’s why we decided to return to the country.
Ellen Leabeater: Sabera and her family returned to Afghanistan in 2002.
Sabera: When we returned, for me, coming from a stable country, seeing those scenes – they were very traumatic scenes. Every house had collapsed from bombing. Literally, there were no proper houses around the city. There was no running water, there was no proper hospital setting where you could visit a doctor and I came to our house, which was completely destroyed during the war. There was just one room which my father prepared for when we arrived – no running water, no bathroom, nothing. That was a shocking scene for me, to see such [involvement] and such a situation in my country.
Ellen Leabeater: It was so shocking, Sabera went back to Iran.
Sabera: I was in shock, and I said to my Dad, I’m going back to Iran. They took me back, but after a few months, I felt so guilty that I’d left everything behind because I couldn’t face those challenges.
Ellen Leabeater: But Sabera’s guilt got the better of her. She returned to Afghanistan for good.
Sabera: And then I decided this time to submit all of my identity documents to the government of Iran, so that I could not return again. I made a decision that my future is in my country and nowhere else. I had to go there and help my people.
Ellen Leabeater: That’s such an amazing sacrifice, because, like you said, Afghanistan was such a difficult place. That’s such a difficult decision to make.
Sabera: It was difficult, but when you have that passion inside your heart – that passion for helping my people.
[Music plays]
Ellen Leabeater: Afghanistan needed Sabera. In 2003, Afghanistan had one of the worst maternal and infant outcomes in the world: within the top three depending on what statistics you look at. In addition, only 14% of births had a skilled attendant there. Sabera says that in a population of 23 million, they had about 450 midwives in 2002. Other statistics suggest there are about seven doctors, nurses and midwives per 10000 people. That’s roughly one health professional looking after 1400 people. Sabera was part of a US-funded project that educated midwives across Afghanistan, giving them the skills they needed to return to their village and help women give birth. The problem was, immediately after the Taliban, they couldn’t find women who could read or write.
Sabera: In whole villages, when we were going around, we couldn’t find even one woman with basic education to recruit as a midwife.
Ellen Leabeater: So they set up schools for the girls closer to home to teach them basic reading and writing skills as well as midwifery.
Sabera: These girls were not ready to go to Kabul or somewhere far to get educated. So we had to establish schools in each province. We established 32 schools. In Afghanistan, we have 34 provinces, so you can imagine, we established a school in almost every province where girls could come in and receive their training.
Ellen Leabeater: They increased the midwifery workforce from 450 to 4000.
Sabera: We started with around 450 but by the time I left the country in 2013, it was more than 4000 and deployment rate was so high – almost 90%. We had a bit of dropout due to bad security, and that’s why most midwives who leave the profession – because of the insecurity. They are not safe – that’s why they leave the profession.
Ellen Leabeater: It’s well-established that educating and investing in women and girls has a powerful impact on society. Not only do these women go on to contribute to that nation’s economy, they are also better at managing their families and their own health. In Afghanistan, education women taught them to deliver babies. But it taught them a lot more than that as well.
Sabera: These midwives – we trained them as midwives but we actually also empowered them to be agents of change in their society. They are leaders, they are working as role models in their society.
Ellen Leabeater: Sabera says she has watched these midwives go on to do things like create a women’s health council, promoting things like family planning and even drive cars – a big taboo for women in Afghanistan.
Sabera: She learned to drive because she wanted to transfer women to higher levels of health facilities like from the village to the hospital in the city. And she spent six months of her salary to save money to buy that car and then her brother taught her how to drive and it was amazing to me. These are real demonstrations of women’s empowerment. We’re not just giving them the skills to deliver a baby – we’re giving them the skills to lead the change in their societies, and for me that’s not a small or simple achievement. We sacrificed to make that change happen in our countries.
Ellen Leabeater: Unfortunately, there is still a long way to go for healthcare in Afghanistan. When Sabera left in 2013, half of the midwifery schools had closed because of a lack of funding. When the military leaves, the money goes with them. Sabera says it’s what happens when politics is mixed with humanitarian activities.
[Music plays]
Sabera: Still, I’m not regretting the decisions that I’ve made. Deep inside my heart, I’m so satisfied with the things that I have done in the last ten or twelve years that I’ve been in Afghanistan. I don’t regret it, but it was a difficult decision to make.
[Music plays]
Ellen Leabeater: You’re listening to Think:Health on 2SER 107.3, online at 2ser.com or on your favourite podcast app.
[Music plays]
Ellen Leabeater: It’s an unfortunate reality of life that when it comes to conflict, women are the ones who are forgotten. There is some research that suggests that there are more female lives lost as a result of things like violence against women and maternal mortality than were lost in all the wars of the Twentieth Century. For Michaela, a midwife who has worked on the frontline of many humanitarian tragedies, it is an unfortunate fact that comes with the job.
Michaela Michel-Schuldt: Hi, my name is Michaela, I’m a midwife and I’m currently based in Germany but I’ve been working in many other places like Thailand where I worked in a refugee camp and Myanmar, where I worked with the internally displaced people, the Rohingyas. Then I worked in Bangladesh and in the last year I’ve worked a lot in West African countries due to the Ebola response.
Ellen Leabeater: Michaela’s work in a refugee camp on the Thailand-Myanmar border involved recruiting women from the camp to be trained as auxiliary midwives. There were two camps, with about fifteen to twenty thousand people in each. Medical facilities were few and far between and people were stuck in those camps for decades.
Michaela Michel-Schuldt: In that time, there was a military junta in Myanmar and the Karen people, they fought against the Myanmar government, so basically, their villages got mined, and they couldn’t return, and the Thai government didn’t accept them as refugees, so they could not proceed into Thailand to get education and so on. So they were basically stuck in between these two countries for decades.
Ellen Leabeater: So training women to be birth attendants isn’t just a Band-Aid solution – it’s a long term one. And this is exactly what Michaela did. The training was basic by international standards, and the women were only auxiliary midwives. If the birth was anything but normal, the woman had to be transferred to a local hospital.
Michaela Michel-Schuldt: We recruited some of the refugee population – mainly women who were interested in working as kind-of auxiliary midwives. They received their training and yeah, it was very basic, so they could only assist normal birth, but if a complication arose, we had to refer women.
Ellen Leabeater: The Ebola crisis is another example where pregnant women had the potential to be forgotten. Especially considering Ebola is a blood-borne disease, and there is no shortage of blood during pregnancy.
Michaela Michel-Schuldt: The healthcare system collapsed in all three countries basically, and all the attention was on the reduction of, or the fight against Ebola. In the meantime, because the health facilities or the health workers were afraid or died, there was nobody anymore to take care of pregnant women during labour and so women died. Women died because they haemorrhaged - basically they died because there was no system in place. There were no hospitals, no midwives.
Ellen Leabeater: In 2014, the world was rocked by the rapid spread of Ebola across Guinea, Sierra Leone and Liberia in West Africa. Michaela said she was part of a team that made sure pregnant women were still given priority.
Michaela Michel-Schuldt: Through the UN and part of the government we set up midwife-led units, so kind of a system that would allow the midwife herself to be protected, but also the women, because a lot of women actually didn’t go to the facilities anymore because they were afraid of getting infected, because all they knew was, once you’re in this facility, you’ll have this disease. A lot of people avoided going to the facilities, so we also established a component in this – a community component – where people were encouraged to go back to the facilities where the midwives were.
Ellen Leabeater: For Michaela, the attraction to midwifery stems from her interest in anthropology.
Michaela Michel-Schuldt: I studied anthropology before I became a midwife, so my desire was always to get in contact with different cultures, and I think as a midwife, you get very close to people. I think there aren’t many other professions in the world where you can get as close as this. I think with this profession being a midwife, it was easy for me to go out and get in touch with other people.
[Music plays]
Ellen Leabeater: Back on home ground, Cherisse wanted to be a midwife from a young age.
Cherisse Buzzacott: I probably decided that I wanted to be a midwife when I was in Year 10. I think I was going in that direction of working in health – someone wanted me to become a doctor, my mum wanted me to be a nurse and I heard about midwifery in Year 10 through a visiting university, and then it sort of stuck with me all the way through.
[Music plays with didgeridoo]
Ellen Leabeater: Cherisse is a midwife in the Red Centre, otherwise known as Alice Springs in the Northern Territory.
Cherisse Buzzacott: Hello, my name is Cherisse Buzzacott. I’m an Aboriginal registered midwife from Alice Springs. I’m an RN [unclear]
Ellen Leabeater: Cherisse is in her third year as a midwife and she works in a hospital in Alice. The majority of the women she sees are Aboriginal.
Cherisse Buzzacott: The majority of the women we look after in Alice Springs are Aboriginal women. Women from remote communities, lots of transient women or women that are moving. A lot of the time, it’s very hard for them to come in for visits because they’re moving a lot with their families, and we tend to get them at the late stages of their pregnancy. They come into the hospital, they have their babies and then they go back home. Then we probably see them again in their next pregnancy.
Ellen Leabeater: In Australia, Aboriginal and Torres Strait Island women have a disproportionately high level of maternal and infant deaths compared to non-indigenous women. Cherisse says it’s a combination of factors such as remoteness, but also the woman putting family before herself.
Cherisse Buzzacott: My feelings are, and from what I’ve heard from the elderly, the grandmothers – they say that, you know, for women, the family comes first, the husband comes first, and they tend to see the pregnancy or the baby as a natural and normal thing that happens. So they think, I’ll go into labour, I’ll have the baby then I’ll go back into my normal life. So they’re seeing at as a normal, natural thing which is great, but then we do have lots of chronic illness and other things that are going on in the community so we try and encourage them to come in and see us quite regularly, more so than they would.
Ellen Leabeater: You’re also dealing with women who may be speaking English as a third or fourth language, because of the dialects in their community. So when these women do get to hospital, it can be difficult to communicate.
Cherisse Buzzacott: In the hospital we just keep everything simple. It’s not dumbing it down, you know, we don’t want to make it seem like we’re talking over them or to them. We want to be able to communicate with them using different strategies, using diagrams, you know, different pictures and actions. If you’re teaching a Mum how to breastfeed you know, you’re using a doll and a fake breast and actually teaching her the actions of it.
[Music plays]
Ellen Leabeater: Cherisse says the best part of the job is the journey.
Cherisse Buzzacott: I think the best part of my job is just being a part of their journey. I’m not just a birth midwife – when I’m in birth I absolutely love it, but I love just being a part of their journey as well, and I love being able to make a difference, you know, even if I’ve just said something to a woman, or if I’ve helped them in anyway and then that’s something that they’ll take away from me. Then down the track I see women down the street and they come up and say, “Sister! Here’s my baby!” and they’re just so happy, and I feel like, you know, I was really proud to be a part of that journey.
[Music plays]
Ellen Leabeater: Before we wrap up, one last word from Caroline Homer.
Caroline Homer: I guess the last thing I’d like to say is that every midwife is special around the world, no matter where they work and under what circumstances they work, and that the work they do everyday is remarkable. It’s a wonderful thing that we can celebrate the International Day of the Midwife and I wish every midwife out there a very happy International Day of the Midwife and thank you for the work that you do.
[Music plays]
Ellen Leabeater: Don’t forget, if you’d like to find out more about anything we’ve heard today, you can visit us at 2ser.com/thinkhealth. You can also tweet us @2ser. Please remember that journalists are not doctors. If we’ve made you ask questions, go and see your GP. This show is produced with the support of the University of Technology Sydney Faculty of Health. I’m Ellen Leabeater, see you next week for more.
[Music plays]
END OF TRANSCRIPT