Nadene Brunk’s Call for More Midwives
Most of us agree that a trained midwife in every village with emergency transportation to a well-equipped and staffed hospital would be the most effective way to lower maternal mortality.
Nadene Brunk is the Founder and Director of Midwives for Haiti. She started her career as an OB nurse, which makes this post doubly timely. Yesterday was International Day of the Midwife and today is National Nurse’s Day.
In developing countries it is the pregnant women who live far from skilled care that make up the bulk of maternal deaths. It has been shown in countries like Sri Lanka, Jamaica and the Dominican Republic that maternal mortality is low when all women have access to skilled care. In data collected by WHO in 52 countries in 2010, the relationship between skilled birth attendants and maternal mortality is clear. When women have access to skilled care mortality goes down.
Most of us agree that a trained midwife in every village with emergency transportation to a well-equipped and staffed hospital would be the most effective way to lower maternal mortality. But we all do not agree on how to train those midwives and who should be called a midwife. I believe we should not wait for consensus on these issues and have chosen to begin doing what I can do with the resources I have. I do not oppose any effort to improve the education of midwives and look forward to the day when all midwives have PhD’s.
In Haiti the greatest numbers of maternal deaths occur in the rural areas where 84% deliver at home without skilled attendants. Midwives For Haiti has been working on a model of care that will increase women’s access to skilled care. This model provides rural women with each of the three components of care essential to save lives, a skilled attendant, emergency transportation and a referral facility for emergency care.
MFH trains skilled birth attendants and our graduates work in 14 facilities in Haiti delivering care to thousands of women. We have a mobile prenatal clinic that goes to 16 rural villages each month. We transport women with obstetric complications to a hospital. What we have done is a beginning but much remains to be done before the vast majority of rural women have the skilled care they need.
In the villages where we have our mobile prenatal clinics there are no birth centers and no skilled midwives. Most of the 300+ women we see each month for prenatal care are still going to deliver in their homes without skilled care. Our midwives will prevent many seizures, preterm births, and post-partum hemorrhages by the preventive care and screening for risk factors that we do in these clinics. But the reality for pregnant women in rural Haiti is that birth is scary and risky. It does no good to have a healthy pregnancy only to die from post-partum hemorrhage because the nearest hospital is one hour away and 5 hours if you have no vehicle.
We recently visited a new and well-equipped hospital built in Mirebalais. We asked, “What clinics will be screening and referring pregnant women here for care? The answer was that there were only 2 small clinics within an hour radius that were doing prenatal care and screening. Most of the women delivering in this modern hospital will be self-referred. They will make the transition from little or no care to what will probably be the best care in the Caribbean. The gulf between what is clearly inadequate health care and what is state of the art is dangerous and will lessen the impact of this wonderful hospital for the women that need it most. A large part of this hospital is dedicated to serving women and providing them with the best care possible. But how much more good could be done when this beautiful hospital and well-trained staff is connected to a system of rural clinics that screen for risks and teach danger signs of pregnancy?
A well-equipped hospital is only one leg of the solution for mothers and babies. Until every village has a skilled midwife who screens, teaches, refers, delivers, and transports it is just a building filled with educated people. It is not a solution for women in rural Haiti. Haiti needs over 1200 skilled midwives immediately. The world needs many thousands of them. We have to come up with creative ways to educate more of them faster and to equip them to live and work near the women who need them most. Until then mothers will continue to die unnecessary deaths every 1–2 minutes in this world.
