A CALL TO IMPROVE QUALITY OF CARE FOR PREGNANT WOMEN AND NEWBORNS

On May 5, we celebrated the International Day of the Midwife, and the extraordinary contributions of midwives across the world towards the health of women, their new-borns, and entire families. It is no doubt that midwives have and continue to play a critical role in bringing life to this world and this contribution cannot be understated.

This Year’s theme focused on the efforts of midwives and associations to action critical evidence like that of the State of the World's Midwifery report that calls for meaningful change in the midwifery profession and those it cares for. This theme calls us all to go beyond identifying evidence and using this evidence to change practice and improve the lives of mothers and their families under our care. For example, a recent UNFPA report stated that midwives could save up to 4.3 million lives a year by 2035 if they were to work to their full potential. This makes a case for investment in midwifery education and practice. However, challenges remain, and we still have a high maternal mortality rate(MMR) as a country. There has been an increase in institutional deliveries by mothers currently standing at 74% in Uganda, a great achievement that can be attributed to your work in sensitising and encouraging mothers to deliver at facilities. Despite this great achievement, we still see pregnant women dying every day due to pregnancy-related complications. According to the MPDSR Report for 2021/2022, institutional maternal mortality was at 84 per 100,000 live births, a reduction from 92 per 100,000 from the previous year. We have called mothers and communities to utilize health facilities and ensure childbirth is under a skilled health professional. Why do we see mothers and new-borns continue to die day in and day out? There is growing evidence that these institutional deaths point to challenges in the quality of care that mothers and new-borns receive. Without improving the quality of care for pregnant women and new-borns, it is highly unlikely that we will be able to meet Sustainable Development Goal (SDG) 3.1 which targets a global maternal mortality rate of 70/100,000 live births by 2030.

In light of this realisation, the World Health Organisation(WHO) has developed the Vision for quality of Care for pregnant women and new-borns from 2015 onwards that highlights seven characteristics of quality of care for mothers. These characteristics are as below;

● Safety: Is the care we are providing to pregnant women and new-borns safe? Does it minimise harm to users including minimising preventable injuries and reducing medical errors?

● Is it Effective? Are we providing care based on scientific knowledge and evidence-based practice? This includes having an ecosystem that supports the recruitment and retention of highly skilled and knowledgeable health professionals.

● Is it timely: Are we providing timely care to our mothers? Reducing delays in providing and receiving care? Mechanisms in place for quick access to the appropriate level of care for mothers, and timely interventions (diagnosis, treatment, procedures) for mothers and new-borns.

● Is the care we provide efficient? Delivering care in a manner that minimises resources and reduces wastage?

● Is it Equitable Delivering care which does not vary in quality because of personal characteristics, geographical location, or socioeconomic status.

● Do we provide a different level of care to our colleagues or people of higher socioeconomic status from what we provide pregnant women who may not be known to us or may be of lower socio-economic status?

● What is the level of care in urban areas such as Kampala compared to rural areas?

● Is our care people/patient centred? Delivering care which considers the needs of individuals, their culture, and their communities.

● Are we respectful, kind, and compassionate to the mothers we care for? Or are we driving them out of our facilities? This includes privacy, respectful maternity care, informed consent, and health education.

We have the mechanisms and structures in place to see how we are performing and learning from key outcomes such as mortality through quality improvement projects and Maternal and Perinatal Death Surveillance and Response Reports. These mechanisms and structures, if well utilised, enable us as teams to learn from such events and identify ways to prevent reoccurrence. I therefore encourage midwives to embrace and utilize these mechanisms to continuously learn and improve care for our mothers and new-borns. Key to these mechanisms, supporting us to improve the quality of care and maternal outcomes is documentation. Without documentation of simple details such as time of arrival, time of diagnosis and time of treatment administration, and more, it is impossible to know what and why things went wrong. Documentation is also key in enabling us to identify ways to improve our care, accountability, and learning. Of course, this does not come with its challenges such as patient-midwife ratios, availability of trained health professionals, shortage of supplies, and other key inputs to mention a few. These are system limitations and challenges that all stakeholders including the government need to collaboratively address.

Lastly, I call upon all of us nurses and midwives, the government, partners, and all stakeholders to work collaboratively to address the real reason why mothers are still dying under our care. Without honest discussions on this, we shall continue to see our mothers walk into facilities alive to bring life into this world and are unable to walk out alive. Only through honest discussions and identification of key bottlenecks, shall we be able to address the whole spectrum of care ranging from having a skilled, motivated workforce to providing the highest quality of care for pregnant women and their new-borns.

Irene Atuhairwe Duhaga

Ph.D. Health Policy (S), Stellenbosch University

Country Director

Seed Global Health

If you have been keen enough and listened to most of the pregnant women and mothers in urban areas such as Kampala, the majority talk about their personal gynaecologist or doctor. When you further listen critically, very few pregnant women or mothers will mention having a personal midwife. In Uganda, >97% of maternal and new-born health services are provided by midwives. So, this leaves one wondering if the work done by midwives majorly in urban clinical settings is not recognized.

Well, midwifery matters for all childbearing women, their babies, their families, wherever they live in the world, and their circumstances. Available evidence shows that skilled, knowledgeable, and compassionate midwifery care reduces maternal and new-born mortality and stillbirths, keeps mothers, and babies safe, and promotes health and well-being. In so doing, midwifery has a positive impact on the wider health system and the economic sustainability of communities and countries at large.

Midwifery achieves this impact by providing care for all women and babies, both with and without complications and across the continuum from pre-pregnancy, pregnancy, labour, and birth, and in the early weeks after birth. Thus, good quality midwifery care offers a combination of prevention and support, early identification and swift treatment or referral of complications, and respectful and compassionate care for women and their families at a formative time in their lives. Midwives all over the world work to strengthen women’s own capabilities and the normal processes of pregnancy, birth, postpartum, and breastfeeding.

Every year on May 5th, the International Day of the Midwife (IDM) takes place. While you would think it was an incredibly long-marked awareness day, it wasn’t made official until 1992, when it was launched formally by the International Confederation of Midwives (ICM). This year’s theme for International Day of the Midwife is “Together Again: From Evidence to Reality.”. This time of celebration honours the efforts of midwives and their associations to action critical evidence like the State of the World’s Midwifery (SoWMy) 2021 towards meaningful change for our profession and the women and families we care for.

This year’s celebrations took place in Soroti district, Eastern Uganda. The event was organised by the National Midwives Association of Uganda (NMAU) in collaboration with the Ministry of Health (MoH), Uganda Private Midwives Association (UPMA), UNFPA, Seed Global Health, and Uganda among others. Prior to this day, NMAU organised a blood donation drive in the capital city, Kampala which attracted many people, and led to the collection of > 200 litres of blood. The Association also held a midwifery symposium at Akello Hotel, Soroti district which started on 3rd May 2023. The symposium addressed areas in clinical midwifery practice, leadership, management and policy, midwifery education and training, regulation, research and more. Additionally, midwives from different facilities across Uganda are conducting various activities such as free cervical and breast cancer screening, provision of family planning services, free health education in nutrition, antenatal care, HPV vaccinations, free HIV testing, Hepatitis B and more.

Over the years, midwives and all maternity support workers have met extraordinary circumstances and risked their lives to provide excellent care to women, new-borns, and their families. Now is the time to not only celebrate how they’ve been there for our communities even throughout the pandemic but to show up for them in calls to the government to put money where it counts and invest in midwives and maternal and new-born health at large. Thumbs up to all the midwives for their great efforts in promoting maternal and new-born health.

I thus recommend the Government of Uganda through the Ministry of Health and other nongovernment entities to comprehensively invest in the education and training of midwives, involve midwives in meaningful policy-making and decision-making platforms and positions, and provide adequate tools (supplies, equipment, accommodation) for midwives to ease their work among others.

The author is Ms. Lilian Nuwabaine Luyima; a BSc Nurse and MSN-Midwifery & Women’s Health Specialist and the Heroes in Health Award Winner-Midwife of the year 2021.

The International Confederation of Midwives (ICM) Triennial Congress is a prestigious event that brings together midwives, healthcare professionals, and stakeholders from across the globe to discuss and address key issues in maternal and new-born healthcare. The engagement of young midwife leaders at this congress plays a crucial role in shaping the future of midwifery and advancing the profession. Uganda as a country was privileged that for the years 2021-2023, two midwives, Anitah Kusaasira and Hadijah Nakatudde from the National Midwives Association of Uganda were selected to be part of the Young Midwife Leaders (YML) programme under the International Confederation of Midwives.

The YML program is a 2-year part-time, online/ in-person learning and professional development experience. Its aims include nurturing the next generation of midwives, strengthening midwifery associations globally, building a global community among young midwives to foster support and learning, positioning and equipping young midwife leaders as advocates for the profession and SRHR, empowering midwives to address some of the biggest global health challenges of today and it's been very impactful. With seed funding from ICM, the YML is implementing a project on advocacy and Respectful Maternity care. As part of the program , the YML had an opportunity to attend the ICM Triennial Congress. In this article, we will explore the significance of the young midwife leader's involvement at the ICM Triennial Congress held in Bali, Indonesia.

The ICM recognizes the importance of empowering young midwife leaders and their unique perspectives in driving change within the profession. The Triennial Congress provides a platform for these young leaders to exchange ideas, network, and collaborate with peers and experienced professionals. This engagement not only nurtures their leadership skills but also inspires them to contribute meaningfully to the betterment of maternal and newborn healthcare worldwide.

The Congress creates an environment where young midwife leaders can showcase their innovative practices and research. Presenting their work allows them to gain recognition for their efforts and encourages them to continue pushing boundaries in their respective fields. These presentations offer valuable insights and inspire other midwives to adopt similar approaches, ultimately improving the quality of care provided to women and new-borns.

The congress provides numerous opportunities for young midwife leaders to network and develop collaborations with experts and leaders in the field of midwifery. These connections foster mentorship, allowing young leaders to learn from experienced professionals and gain insights into policy-making and advocacy. Such collaborations strengthen the global midwifery community and advance the profession by bringing together diverse perspectives and expertise.

Amplifying Voices:

The engagement of young midwife leaders at the ICM Triennial Congress enables them to voice their opinions, concerns, and aspirations for the future of midwifery. Their unique experiences, fresh ideas, and enthusiasm play a pivotal role in influencing policies, shaping strategies, and driving positive change within the profession. By providing them with a platform to address global leaders and decision-makers, the Congress ensures that the voices of youth are heard, acknowledged, and integrated into the broader narrative of midwifery.

The ICM Triennial Congress acts as a catalyst for the personal and professional growth of young midwife leaders. The exposure to a diverse array of topics, workshops, and presentations stimulates their critical thinking and fosters their passion for midwifery. They return to their respective communities not just with enhanced knowledge and skills but also with renewed confidence and motivation to make a lasting impact on maternal and new-born healthcare.

Conclusion:

The engagement of young midwife leaders at the ICM Triennial Congress in Bali, Indonesia exemplifies the commitment of the International Confederation of Midwives to empower and recognize the contribution of the younger generation. By providing them with platforms to network, collaborate, and share innovative practices, Congress not only strengthens the profession but also creates a sustainable future for midwifery. The voices, perspectives, and dedication of these young leaders play a crucial role in shaping the trajectory of maternal and new-born healthcare worldwide.

Authors

Anitah Kusaasira, Young Midwife Leader /ICM

Hadijah Nakatudde, Executive Midwife Leader /ICM

The NMLTT celebrated all Nurses and Midwives for the heroes and heroines they/we are! Millions of nurses and midwives around the world create small, and often unnoticed miracles through their skills and competencies, acts of kindness, compassionate caring, quiet strengths, therapeutic touch, whispers of grace and comfort, silent prayers and so on. When our lights dim, nurses and midwives stay by our side. May we always remember how blessed and lucky we are to have nurses and midwives in our world.

The Midwife

These eyes have witnessed beauty

Which some may never see, Of rawness, power, strength and love, Of two becoming three

These ears have listened carefully To each pure and unique song, When women feel vulnerable

But are so immensely strong

These hands have guided soft but firm, And gently rubbed and soothed, From bump to that first draw of breath, The mountains, they have moved

This heart has burst a thousand times, With each new perfect birth

A miracle, a small shot of joy, A blessing to the earth

This soul is full of happiness, Though sometimes cries and weeps, For most are born and taken home, But some, we cannot keep

These eyes have witnessed beauty

Which I’ve been blessed to see, Of rawness, power, strength and love Of women feeling free

A Poem by Emily Clayton

The Nurse a Poem by Randy L. McClave

Life for me could have been worse If it hadn’t been for a nurse, Others gave me a prayer, she gave her care Because of her I am not in a hearse.

Nurses have dangerous and sad jobs But for them no one ever sobs, They have been cursed and bit, and also hit Then they are health with their own stitches and swabs.

As I was in my hospital bed all alone Unto God my sins I began to atone, I thought I was alone and dying, I couldn’t stop crying Then a nurse’s love and compassion was shown.

It was a nurses that saved my life It wasn’t a doctor, or a sibling, or even a wife, People came and went, my unimportance was a hint Everyone else gets the applause, she gets the strife.

So unto the nurse I will always say a thank you Especially to the lady in blue, I am here today, I never passed away She helped me, and saved me, and led me through.

The nurse was there for me twenty four/seven Because of her I made no trip to heaven, She fought for my living, she was all giving She gave me a refuge, and a safe haven.