Rural midwives: The unsung heroines saving lives

Across many rural communities, midwives continue to provide care in circumstances that tests their skills, patience and resilience.

They attend to women at all hours, manage emergencies, work with limited supplies and support mothers and newborns even when the resources available to them are far from adequate.

Their work may often go unnoticed, but for the mothers and babies whose lives they touch, the presence of a committed midwife can make all the difference.

At Jeffisi in the Sissala West District of the Upper West Region, demands of the job as a midwife meant that Hafisatu Sadik Gbanha does not close from work when she should.

Antenatal care (ANC) services at the facility officially ran from 8am to 2pm but labour and delivery cases could come at any time.

A woman in labour could arrive after the ANC session had ended, late in the evening or in the early hours of the morning, and Mrs Gbanha had to be ready to attend to her.

Sometimes, she works through the day and night, depending on the number of cases that comes to the facility.

“I used to live in the facility. ANC services start at 8am and end at 2pm. Labour and delivery cases were managed anytime they arrived. So I can work day and night alone depending on the number of cases that come to the facility,” she recalled.

Her experience gives an insight into the realities of maternal healthcare in rural Ghana, where midwives often have to work under demanding conditions while dealing with shortages of equipment, medicines and other basic supplies.

Mrs Gbanha identified lack of logistics, heavy workloads, overtime, stress and burnout among the major challenges she faces at Jeffisi.

The situation, she said was made more difficult by poverty among some clients and poor road networks, particularly when women needed to be referred to higher-level facilities for further care.

At the facility, some essential items were unavailable, including a fetal Doppler, a standard delivery bed, gloves, basic life-support medicines and machines.

For a midwife handling a difficult delivery, the absence of such basic resources can turn an already challenging situation into a desperate one.

One particular delivery remains with Mrs Gbanha. It involved a woman carrying twins. One of the babies was presenting in a breech position while the other was presenting cephalically.

At the time, there were no gloves available. With the delivery needing immediate attention, Mrs Gbanha improvised by using rubber gloves.

Both babies were eventually delivered, although they had low birth weight. She recommended that the mother be referred for further management, but the woman declined.

Mrs Gbanha then initiated bonding, exclusive breastfeeding and kangaroo mother care for the babies. She also conducted home visits for two weeks to monitor the mother and her newborns. The twins are now two years old.

The experience, she said, reflects the difficult decisions rural midwives sometimes have to make when resources are limited and a patient needs care beyond what the facility can provide.

In such situations, early referral and reliable transportation to a higher-level facility are critical, yet arranging transportation and referrals can be a major challenge.

Mrs Gbanha said arranging referral could be very difficult citing poverty and poor road networks as major factors.

For women in rural communities, access to maternal healthcare can also be affected by factors outside the health facility.

Mrs Gbanha identified ignorance, lack of family support, including support from husbands, long distances and poor roads as some of the reasons women delay seeking antenatal and maternity care.

Such delays can have serious consequences when complications develop and urgent care is required. The consequences, she said, can include complications from disease conditions and, sometimes, loss of life.

Challenges

While much of the attention in maternal healthcare focuses on mothers and babies, the demands placed on the midwives providing such care is sometimes overlooked.

Rural midwives are faced with long working hours, heavy workloads, overtime and the pressure of dealing with emergencies which often takes a toll on them physically and emotionally.

This could lead to stress, depression and burnout, adding that rural midwives often receive little support.

Despite these difficulties, Mrs Gbanha said there are moments that make the work worthwhile.

She said seeing mothers and their babies healthy and happy remains one of her greatest sources of satisfaction while drawing strength from the trust that women place in her, particularly when former clients continue to call her by name for her services and assistance.

Those moments, she said, remind her why she chose the profession.

Way Forward

Mrs Gbanha urged government and policymakers to better understand the realities of working in rural communities and provide midwives with the resources and training they need.

“Rural midwives lack support and basic logistics and on-the-job training that will aid them carry out their duties,” she said.

She called for greater support for rural midwives, including basic logistics and regular on-the-job training.

By Esinam Jemima Kuatsinu