On an average day, midwife Daphine Twakire delivers up to 4 babies. That’s 4 precious, new souls joining the community at the Kyangwali Refugee Settlement in Kasonga, Uganda. When these little ones come into the world and open their eyes, Daphine’s kind, radiant smile may be the first thing they see of the world—a smile that lets both baby and mother know that they are safe, well-cared for, and loved. 

All pregnant women deserve access to high-quality maternal health care. However, every day, nearly 830 women die worldwide from preventable causes related to pregnancy and childbirth. 

The majority of these deaths occur in low- and middle-income countries, especially in areas where healthcare facilities are underequipped, inaccessible, or nonexistent. Places like refugee camps where millions of expecting mothers arrive daily after fleeing violence, war, and economic instability.  

It is places like this where midwives like Daphine step into a critical gap between doctors who are few and spread thin, and traditional healers and birth attendants who lack the medical resources to handle complications, illnesses, or emergency situations.  

AN EARLY CALLING 

Daphine found her calling to be a midwife early in life after experiencing a terrible tragedy in her village as a child.  

“We had a newly wedded couple, and when the lady conceived, she opted to deliver with the help of traditional birth attendants instead of going to the hospital,” Daphine recalls. This is common practice in much of Uganda, especially in rural areas that are deeply rooted in traditional practices.    

As the woman began her labor, the birth attendant assessed her and told her that her baby was in a breach position (bottom-down) and that she would have to go to a health facility right away.   

“When they reached the hospital, the woman was told her baby had already died in the womb, but the woman didn’t believe the health worker,” Daphine recounts sadly.

The woman went back to the birth attendant who told her that she thought the baby was still alive and would help her deliver it. Eventually, the mother delivered a stillborn baby and was bleeding profusely. The birth attendant told the woman to go back to the hospital to get emergency help, but she died on the way there.  

The loss of both the baby and the mother in this situation deeply impacted Daphine. She recalls asking her own mother “Are there people who can help mothers not to die?” Such a profound question for a child to ask. Even before she ever heard the term “midwife”, she felt compelled to become someone who protected, served, and healed mothers. She would become the person who “helped mothers not to die.” 

WHAT IS A MIDWIFE? 

Midwives are licensed healthcare providers who specialize in pregnancy, childbirth, newborn care, and postpartum care. Some midwives also provide routine reproductive care for women and tend to have a more holistic approach to their care. 

Thanks to this holistic approach that is bolstered with traditional medical training, midwives tend to be a great provider option for mothers wanting a more natural or unmedicated birth, and they often deliver babies in non-hospital settings like birth centers or even in a patient’s home if medically safe to do so. 

However, they are trained to recognize birth situations that require a higher level of intervention and are adept at liaising between doctors and patients for a more collaborative model of care.  

THE HISTORY OF MIDWIFERY 

The practice of midwifery has ancient origins, dating back to the earliest records of human civilization. There is evidence of birth attendants in historical records dating back to 3000 BCE! There is documentation of midwifery practices in Egyptian hieroglyphics, Greek medical text, and Roman surgical manuals. 

Although doctors were exclusively male, female midwives held and passed down generational knowledge and skills related to pregnancy and childbirth that earned them status as unchallenged experts in the medical community. Thankfully, many historical midwives left detailed notes and descriptions of care practices, remedies, tools of the trade, and birthing techniques that went on to influence modern obstetric care. 

JOINING MEDICAL TEAMS 

Daphine committed herself to learning everything that she could about midwifery and eventually enrolled in nursing school to become a nurse and certified midwife. While in nursing school, she learned about Medical Teams and the care they were providing in the local area, and she became passionate about joining the team. In August 2022, she officially joined Medical Teams as a midwife and began caring for pregnant and postpartum women in the refugee camps where we serve.  

“I was motivated to join Medical Teams because I’ve always wanted to work in settings where I can offer help, especially refugee settlements,” Daphine shares.

Growing up, she recalls watching UN buses full of refugees pass through her town, and she wondered if they had access to the same healthcare services that she and her family had. This curiosity blossomed into a passion for serving the refugee community.

SO, WHY ARE MIDWIVES SO IMPORTANT?  

Simply put, midwives save lives. In healthcare contexts where doctors are limited or unavailable, skilled midwives take primary responsibility for prenatal care, delivery, and postpartum care. They form relationships with their patients and other members of the community where they practice, advocate for mothers and babies, and educate mothers about important childcare topics like breastfeeding and safe sleep. As providers, they are true champions for women and add a vast and critical skillset to the local healthcare system.  

In a recent study that examined the impact of midwifery care in low-to-middle-income countries, they found that midwifery care significantly improves maternal and newborn health outcomes by: 

• Reducing medical interventions 

• Increasing physiological births 

• Enhancing maternal satisfaction with the birth experience 

• Increasing breastfeeding rates 

• Lowering maternal mortality 

The study also found that things like community acceptance, cultural competence, and collaboration with traditional birth attendants greatly improved health outcomes for not only the mother and baby, but the maternal health of the whole community. 

In areas where some people may be resistant to medical care in favor of more culturally specific remedies and health beliefs, a midwife can serve as an important bridge between respecting cultural birth practices while incorporating evidence-based care for the best health outcome possible.  

RELATIONSHIPS: A CRITICAL COMPONENT OF CARE 

Daphine recalls a particular patient that illustrates the fine line she navigates between supporting a mother’s traditional beliefs about birth while also providing evidence-based medical care when needed. 

A pregnant patient who Daphine had been caring for during her pregnancy was rushed into the clinic with bleeding and intense contractions that had come on too suddenly. Daphine had become a trusted friend and provider, so the woman admitted that she had been misguided by her relatives to drink a tea made with the local herbs, which forced her body into premature labor. The heavy, sudden contractions had ruptured her uterus.  

Thanks to the trust she’d built with her patient, Daphine understood the emergency and immediately checked the baby’s heartbeat… she heard none. In that moment of terror, Daphine confidently held her patient’s hand and mobilized help.  

She briefed the attending doctor and advocated for an emergency c-section, fearing that they’d already lost the baby and could lose the mother as well if something wasn’t done. To everyone’s shock and relief, the baby was born alive and healthy despite the mother’s ordeal.  

“I made sure to monitor this baby closely because I still couldn’t believe it. The baby survived and this was a total miracle,” Daphine recalls joyfully.

Her deep commitment to her patient, compassionate care, and quick response in the face of an emergency had saved another life.  

WHY WE MUST SUPPORT MIDWIFERY CARE 

According to the United Nations Population Fund, well-trained midwives working in a fully functional environment could help avert roughly two thirds of all maternal and newborn deaths and stillbirths. They can also deliver 90 percent of all essential sexual, reproductive, maternal and newborn health services. Yet they account for only 10 per cent of the global health workforce due to a lack of investment and support. 

During this month that we celebrate women and mothers, we want to highlight the incredible impact that women can make on the lives and health of others when given the support they need to pursue careers like midwifery.  

Daphine is one of the incredible women who works every day to support these positive health outcomes for birthing women in her community. She is inspired by seeing the children that she’s helped deliver thriving, playing, and enjoying life with their families.  

“When I run into the mothers I’ve helped to deliver, they say, ‘Come see how your baby has grown,’ and this fills me with joy. I feel like I’ve made a big impact on someone’s life,” she shares.

Surely, there can be no greater impact on someone’s life than by bringing them safely, and joyfully, into the world. How lucky a child is to have Daphine be the one to greet them as they come blinking into the light.