Empowered midwives…Satisfied mothers

Today marks an important annual event, but most people do not know about it. Though the International Day of the Midwife has been observed on every 5th of May for almost 20 years in over 50 nations, it is not as popular as other international days and doesn’t generally get much attention from the public. Nevertheless, as a strong believer in the role of midwives, I feel that they deserve to be celebrated.

I am a doctor specialized in family medicine and the mother of three young boys, all of whom were delivered by midwives in midwife led-centres. This was an active choice I made from the beginning of each pregnancy, because I knew from my medical training and obstetric experience, that it meant that the risk of complications both for me and my baby would be less, that my recovery would be quicker, and that the whole experience would be more personal and less clinical.

MSF, Doctors Without Borders, Lebanon, International Day of Midwives
Baby Alaa born at the MSF Birth centre in Rafik Hariri university hospital. Midwife Josianne and Nurse Nagham assisted his mother in the delivery,
and both the mother and the baby are in good health. Alaa is 3 kg and 51 cm. Photo: Severine Sajous/MSF

I first met the group of midwives that followed me at my antenatal appointments, and the relationship followed through from the clinic, to my delivery and the postnatal care I received to check on my recovery and the baby.  The word midwife literally means ‘the person who is with the mother during childbirth’ and I really felt that this was exactly what this group of midwives did for me, from the beginning to the end of each of my pregnancies.

A few years later, I started working with Doctors Without Borders (MSF) in Beirut. There, I realized that the caesarean delivery rate was much higher than the one in my own country.  Lebanon recognizes that it has a high caesarean delivery rate, often quoted as attaining 40-50%, whilst, as per the World Health Organization (WHO), the worldwide target rate is reaching approximately the 10 to 15 %.  There are many factors encouraging this higher C-section rate prevalent in the country, but there is currently support within Lebanon to try and redress this imbalance.

MSF, Doctors Without Borders, Lebanon,International Day of Midwives
A midwife is ‘a person who is with the mother during childbirth’. Rita, Mona, Wafaa, Najiba, Jilnar & Hind are proud MSF midwives. Photo: Severine Sajous/MSF 

I was happy to see that MSF had been contributing to this effort. Since 2012, the organization has been providing a comprehensive midwife-led reproductive health package in the country, with the objective to reduce medical costs for these services and the overall caesarean delivery rate and thus its associated complications. Indeed, evidence shows that the continuity of midwife-led care increases maternal satisfaction and prevents pre-term birth by 24%. A quality service provision also improves breastfeeding rates and psychosocial outcomes, reduces the use of unnecessary interventions in particular cases, and increases access to family planning.

MSF currently offers free antenatal care, post-natal care and family planning services in several clinics in the Bekaa valley and in South Beirut. These centres allow women to freely access all of the services related to sexual and reproductive health care in a fixed location, with staff who can follow their pregnancy from beginning to end. We witness every day trusting relationships being developed between the patients and the midwives throughout our project.

Since 2018, MSF is also engaged in a partnership with Rafik Hariri University Hospital (RHUH) in Beirut, where it pilots its midwife-led model, within the hospital’s compound. RHUH is the first Lebanese public hospital embracing this rather different approach. At our MSF birth centre, midwives manage non-complicated (low risk) vaginal deliveries and neonatal care, whilst any maternal and /or neonatal emergencies are transferred to the hospital’s specialist wards for further management by the hospital’s medical teams. The good collaboration between the hospital and MSF illustrates how obstetricians and midwives can actually operate hand in hand to guarantee safe and healthy deliveries.

MSF, Doctors Without Borders, Lebanon, International Day of Midwives
 Midwives ensure the follow up of the women from their early months of pregnancy, until after the delivery. In 2018,
almost 45,000 sexual reproductive health consultations were performed in MSF’ South-Beirut project. Photo: Severine Sajous/MSF

MSF also implements this model in two other maternity centres in Arsal and Majdal Anjar in the Bekaa valley. Some of the challenges to developing this model in Lebanon are the low number of midwives being trained each year and the lack of opportunities available for the midwives to practice and develop the skills they learn during their training. At MSF, we want to give midwives the opportunity to practice and develop their skills in our centres. Last year alone, they offered support during close to 5,000 deliveries in the country.

Throughout my personal and professional experiences, I have always been convinced that midwives play a key role in our societies. My current job in Lebanon just reinforces that feeling and I hope that more and more public hospitals will embrace this model of care in the country. Delivering a child is one of the most important moments in a woman’s life. Being able to do so naturally, when the medical situation allows, should always be made possible, and so should empowering midwives to manage these deliveries to the best of their knowledge, training and abilities.

Dr. Laura Rinchey is the Project Medical Referent of Doctors Without Borders (MSF)’ South Beirut project, in Lebanon