Compassionate Care for Mothers and Success in Maternal Health in Uganda

I am the Executive Director of a US-based organization, International Midwife Assistance (IMA). IMA works with local populations to create sustainable programs that lower maternal and infant mortality in communities experiencing health care crises. In the past our project sites have included Afghanistan and Haiti. Currently, we are working in Soroti, Uganda with the Teso Safe Motherhood Project, a Ugandan Level III health facility and registered NGO. The following is written by Jennifer Braun, a US-based practicing midwife, and Program Director for IMA.

I was in Soroti, Uganda early this year, working as a midwife at the Teso Safe Motherhood Project (TSMP). When I’m working with pregnant and laboring women at TSMP, I am constantly struck by the importance of what we do in women’s lives, the immediacy of the care we provide. But sometimes a particular individual is a particularly intense reminder of the lack of alternatives these women have, and Martha was one of those people. When she came into the birth center in labor, it was obvious just laying eyes on her that if she managed to get the attention of someone at the hospital, they would decide to do a cesarean section as soon as it was convenient for them. Martha is really small. She’s very short, and she looks younger than she is, which is 14. Having a cesarean section at our local hospital is a risky undertaking. It’s a really bad idea to do without a really good reason. Not only were we unwilling to condemn this young woman to surgery, we have an incredibly cost-effective, innovative technology to optimize her chances at a normal, safe birth: kind midwives. Both of those words are critical, kind midwives.

Midwives assessed Martha and were able to get all the information they needed, because they were patient and explained to her each thing they needed to do before doing it. Midwives held Martha when intensely painful labor pains frightened her. Midwives brought her sweet tea while she labored. Midwives reassured Martha when she felt too young and too frightened to push her baby out. Midwives helped her deliver a healthy baby without having to cut anyone. Midwives made sure Martha’s low-birth-weight baby was placed in an Embrace warmer (another cost-effective, innovative technology we use). Midwives helped Martha breastfeed her baby successfully, and midwives have been teaching her many skills she’ll need to be a mother. Midwives have participated in family counseling to see that Martha gets back to school, and midwives have made certain that Martha has access to a modern form of birth control.

These midwives and nurses are skilled, they are paid a living wage, they are treated respectfully by their employer, they work no more than five shifts per week and they have all the essential supplies and medications they need to do their jobs. All these things are innovative and unusual in Uganda. But none of them would mean anything without the Teso Safe Motherhood Project’s dedication to kindness and compassion. The communities we serve have come to access the care at TSMP because they’ve learned that the staff at TSMP treats patients with dignity. TSMP provides patient-centered care. Every mother and child is treated as a unique individual.

In 2013, we know a lot about pregnancy and childbirth. We have some amazing technologies available now. Misoprostol, the Ambu-bag, oxytocin…how to lower maternal and newborn mortality is a question of how to reach communities, how to distribute resources equitably. We know what to do, it’s a question of how to get there. At TSMP we demonstrate that a critical part of the how to get there is simply being kind. When a community experiences a health facility as a fundamentally friendly place, the cornerstone of trust is laid.