HOLD ON A MINUTE Episode 1: Midwives save lives

[00:00:21:10]

Hello! You are listening to “Hold on a Minute!” by UNFPA Asia-Pacific, a podcast series by the United Nations Population Fund that presents inspiring stories and information on the sexual and reproductive health and rights of women across the Asia-Pacific region.

[00:00:38:08]

I am Chaowarat Yongjiranon or Poupée, your host. The month of May is an important month for mothers. Many countries around the world celebrate Mother's Day in May, and globally, we also celebrate the International Day of Midwives on 5th May. The day raises awareness about how essential midwives are around the world in promoting the health and well-being of mothers and newborns. Midwives play a critical role in improving maternal and child health outcomes. They are often the primary healthcare providers for women and newborns in many communities, and are crucial in preventing complications and reducing deaths of mothers and babies. 

[00:01:14:16]

In short, midwives save lives. 

[00:01:19:02]

Well-trained midwives can avert roughly two-thirds of all maternal and newborn deaths around the world. To understand first-hand about the lifesaving work of midwives, let’s hear from a midwife herself. Here is the story of Aya. 

VOICE TALENT - FEATURE STORY OF AYA

[00:01:34:23]

My name is Aya, and I am a midwife.

[00:01:38:09]

As a midwife, I play an important role in bringing new life into the world. 

[00:01:44:01]

Every birth is unique and unforgettable, and it is an honor to be a part of such a big moment in people's lives.

[00:01:52:05]

Growing up, I always loved listening to birth stories. Especially how my mother and her friends had given birth to their children; and I knew from an early age that I wanted to become a midwife. 

[00:02:06:09]

After completing my nursing degree, I decided to specialize in midwifery, and I have never looked back. 

[00:02:13:16]

Every day, I get to help women bring new life into the world and I make sure that both the mother and baby are healthy and happy. 

[00:02:24:10]

I've seen the joy on the parents' faces when they first hold their newborn child, and it's a feeling that brings me so much happiness and fulfillment. 

[00:02:33:15]

But the job isn't just about the happy moments. 

[00:02:37:01]

Sometimes, things can go wrong, and it's in those moments that I am thankful for my training and expertise. 

[00:02:44:15]

I clearly remember one experience. 

[00:02:47:12]

It was a typical day at the hospital, and I was in the middle of a normal delivery. 

[00:02:52:24]

Everything was going well – until suddenly, the mother began to bleed heavily and her blood pressure started to drop rapidly. 

[00:03:01:10]

I knew right away that she was experiencing a hemorrhage, and I had to attend to it fast.

[00:03:06:07]

I quickly informed the others working on my shift, and I got out the necessary medicine and equipment. I began to work carefully to find out why she was bleeding so much. I had to stop her bleeding and also stop her from going into shock.

[00:03:23:02]

I stabilized the mother as much as I could and monitored the baby's heart rate to make sure that it wasn't affected. 

[00:03:30:06]

It was a tense few minutes as we rushed the mother into surgery, but thanks to the quick response of the team, we were able to stop the bleeding and save her life.

[00:03:40:18]

The mother made a full recovery, and both she and the baby were healthy and happy. 

[00:03:47:04]

It was a reminder of why I became a midwife - to make a difference in people's lives and to make sure that they receive the best possible care during one of the most important moments in their lives.

[00:03:59:19]

Being a midwife isn't just a job; it's a calling. It’s my calling.

[00:04:05:22]

I'm proud of the work that I do and the difference that I make in people's lives every day. 

[00:04:12:02]

It's a privilege to be a midwife, and I wouldn't want to be doing anything else.

[00:04:18:05]

‘Hold on a minute, the story doesn’t always end like this!’

HOST - INTERVIEW – EXPERT TALK

[00:04:22:24]

Aya’s story is inspirational. She is a well-trained midwife and knows how to handle complications during deliveries. But, not all health facilities have well-trained midwives. 

[00:04:35:16]

While a lot of progress has been made over the years, thousands of women still die giving life, every day. In Asia and the Pacific, for every 100,000 births in the region, 150 women die from complications related to pregnancy and childbirth. 

[00:04:52:16]

To gain real insight into the progress and challenges that we face in ensuring safe births across the region, we are honored to have with us two women who are well known in the field of midwifery.  

[00:05:04:11]

With me is Catherine Breen Kamkong, the UNFPA Asia-Pacific Regional Advisor on Sexual and Reproductive Health and Rights. Catherine is known for her work with UNFPA on maternal health, midwifery, and reproductive morbidities. She has worked in countries across the region, such as Thailand, Cambodia, and Nepal. Prior to joining UNFPA, she worked with international NGOs in India, Thailand, and Myanmar. 

[00:05:33:10]

Also with us is Cherolyn Polomon, a midwifery educator at the Pacific Adventist University and a PHD understudy in the field of Health Nursing and Midwifery  at the University of Technology Sydney under the Australia Awards Scholarship. Having worked as a midwife since 1997, Cherolyn has applied her many years of clinical experience to her work as a nurse manager, educator, and midwifery developer and course coordinator. She has contributed to research that includes stillbirth in Papua New Guinea and secured funding to build the capacity of midwifery students through conference participation. With a community of over 500 professionals, she seeks to improve maternal healthcare.  

[00:06:18:21]

Hello Catherine and Hello Cherolyn!  Thank you so much for joining us on our podcast today.  

[00:06:25:07]

QS: Host 

Catherine, you are UNFPA’s Regional Advisor on sexual and reproductive health. Can you tell us a bit about your work in terms of overseeing the Asia Pacific region? 

[00:06:35:14]

ANS: Catherine 

Good morning. So my role in the UNFPA Asia Pacific Regional Office is really to support 22 countries in the Asia Pacific region on their work on ending preventable maternal mortality and really trying to ensure that women and girls have their rights realized in sexual and reproductive health. I'm by background an Australian, I'm a nurse, and I've also worked in a number of countries in the region, including in Thailand, on the border in Myanmar, and in Nepal, and in Cambodia.

[00:07:12:12]

And it's really my life passion to be doing this work on ensuring that all women have a dignified birth and pregnancy, and that we can save their lives.

[00:07:25:21]

QS: Host 

As we give importance to the International Day of Midwives on May 5th, I think we should really look at the term midwife and how it is unique. For most people, they may be confused as to who is a midwife and who is a nurse. Catherine, can you clarify the terms? 

[00:07:42:04]

ANS: Catherine

Yes, so, a nurse in general is somebody who looks after and supports people who are sick, who are ill, and who need that supportive care - whether it's for children or for people that have diseases like cancer or all sorts of other diseases. But a midwife, the word midwife actually means ‘with woman’ and the role of a midwife is really to be with women during their pregnancy, during their birth, and after their birth.

[00:08:15:12]

And they have this very special role in ensuring the care of women and mothers in this reproductive period in their lives. And birth and pregnancy, it's not an illness. This is something, it's a natural and healthy part of life. But of course, sometimes it can go wrong.

[00:08:36:18]

And that's where midwives also play a really critical role.

[00:08:40:15]

QS: Host 

As a midwife educator, Cherolyn can you tell us more about the role that midwives play? 

[00:08:50:05]

ANS: Cherolyn

Like in Papua New Guinea, I'm a nurse-midwife, where I am trained to be a nurse who came to take on midwifery, to become a midwife. There was a saying that it [midwifery] is a specialized nursing programme, but now with the definition and with the role that midwives play, it is totally a distinct profession that needs to stand out, to be seen as a midwife.

[00:09:15:22]

It's a special group of people and the activities or the roles they play is totally distinct from nursing. They are more, to the women - promoting the normal birthing process, to advise and prevent any complications that may occur during pregnancy. So there is a difference and a distinction between a midwife and a nurse. In most countries like Papua New Guinea - our people at home in Papua New Guinea - may not know and can’t tell the difference between a nurse and a midwife.

[00:09:49:06]

But a nurse is someone who is always providing care to the sick, while a midwife should be the one promoting to be with women and traveling with the woman throughout her process of pregnancy.

[00:10:00:10]

QS: Host 

As we give attention to the International Day of Midwives this year, let’s reflect on the current situation in terms of maternal health and mortality.  With your work within the region at UNFPA, Catherine, can you tell us about the situation on the ground?

[00:10:14:23]

ANS: Catherine

Yes. So, very sadly, ending preventable deaths of mothers during pregnancy and birth, really remains as something that is an unfinished agenda for us. And it's a really shocking statistic for us. But we have about ten women dying every hour in pregnancy and childbirth, and that's despite huge progress that we've been able to make. So I mean, this issue of having women in our region that are still dying of preventable causes, I mean, it's -- we all can imagine what it's like if, you know, if a family is without a mother and also a mother that survives a pregnancy, but the baby dies.

[00:11:00:19]

This is also something that a midwife has the ability to help prevent and save. So, yes, so in our region, it's really something that we're very proud of the progress that's been made, but we are still not where we need to be yet. And we have countries in our region of Asia-Pacific, like Afghanistan, who are very deeply affected by crisis and conflict and the rates of maternal and newborn mortality in those countries is significantly higher.

[00:11:36:21]

So, we really have to focus very much on what we need to do to end these preventable maternal deaths. And midwifery is a huge part of that and we have a lot of evidence, in fact, on this that midwives hold part of the solution to ending these preventable deaths.

[00:11:56:15]

QS: Host 

Let’s now take a closer look on the ground. Cherolyn, you have been known for your work in your home country, Papua New Guinea. How has the situation been like in the country?  

[00:12:08:15]

ANS: Cherolyn

I think Papua New Guinea is also one of the countries that has a high maternal mortality rate and neonatal birth rate or death rate. The thing with the statistics is that we cannot say that these statistics are accurate because of the estimations that we can give. So, currently in Papua New Guinea, we have different statistics that are published where one says it's 215 per 100,000 women dying and that is very high in Papua New Guinea.

[00:12:43:08]

We have the training of midwives where it's much more the strategy used to reduce the maternal mortality rate, which I believe it did show some evidence that the maternal mortality has reduced in the last five years when the training of midwifery came into effect and there was more support from the stakeholders in supporting the training of midwifery.

[00:13:08:24]

So having that statistic or having that type of figure indicates that the training of midwives is a way forward to reduce the maternal mortality that we have in the country, as well as around the world. And evidence shows that and has proved that midwives do 90% of the role of sexual reproductive and neonatal health, but they only account for 10% of the workforce, which is a struggle in many of the countries - and Papua New Guinea is one of them - where we have some districts with no midwife working there and that is where we receive a lot of mortality.

[00:13:53:11]

Some maternal mortalities are not recorded because they die in the villages and no one takes that record. So the estimated figure that we have is just an estimated number, but the way forward is to have more midwives knowing that midwives can provide and can prevent those preventable deaths. Having more midwives will save more lives by 2025, if we are really to achieve the UN Sustainable Development Goals.

[00:14:23:15]

QS: Host 

Interesting. Thank you Cherolyn. I would like to ask you, Catherine, with the significant statistics mentioned by Cherolyn, what are the main challenges that hinder the progress of midwifery? 

[00:14:34:06]

ANS: Catherine

Yeah. So in many of our countries where we've made progress, we have seen that has been because we've been able to ensure that more women are delivering in a health facility with a midwife who's trained according to international standards, and that we have all of the drugs and all of the supplies that the midwives need to save those lives.

[00:14:56:03]

Also, that a midwife works with an interdisciplinary team. You know, so we need to work with our obstetricians, with our nurses, in this collaborative way to ensure that we can save the lives of mothers. So some of the things that we see that are really blocking us are very basic. The amazing thing about ending preventable maternal deaths is that we know the solution.

[00:15:21:10]

Now we just have to do it. So the things that we see that are holding us back, that we don't have in many countries, as Cherolyn said, we have this shortage of midwives. So we really have to scale up and invest in quality midwifery education. It's not about just quantity, it's about quality. So this is one of the very important things we have to do.

[00:15:48:04]

The second thing is to really ensure that midwives are deployed to the furthest corners of the country. Many women that are in remote and rural parts of countries, or like I said, in Afghanistan, in conflict affected areas, they're very far from a facility and they’re very far from a midwife who is trained and equipped.

[00:16:12:21]

So we've really got to make sure that countries invest and ensure that midwives are deployed into those remote parts of the countries and that they're supported. It's a very scary situation to be a lone health provider out in a village, in a rural village, you know, without support. So that's another really important thing. The other thing that we say in our region is that we have this dichotomy.

[00:16:41:03]

We have two sides. We have countries where there's too little, too late, and other countries where there's too much too soon. So, you know, and that's why we have to sort of have this balance in the countries where we work and really --

[00:16:58:00]

QS: Host 

Wait, so what do you mean ‘too much, too soon?’

[00:17:01:19]

So in some countries there is an over medicalization and over intervention. For example, they quickly ship a woman off to have a cesarean section when it is not really clinically indicated, and that can lead to all sorts of complications for that mother, especially if she has a subsequent pregnancy and she's not able to have a cesarean section.

[00:17:29:09]

And sometimes also there's overmedication to speed the delivery along. And that leads to sometimes the labor of a woman going into complications. So these are some of the examples of too much, too soon. But then we have situations of women that desperately need to have a cesarean section because she cannot deliver the baby. Naturally, the baby's in distress.

[00:17:52:24]

It's in the wrong position and she doesn't have access because there's no ambulance. The road is too rough. There isn't electricity in the health facility. There isn't a doctor. There isn't the equipment that they need to do this lifesaving care.

[00:18:09:11]

QS: Host 

Cherolyn, are the challenges mentioned by Catherine similar to what you are facing in Papua New Guinea? You mentioned that there is a need for more midwives. Can you please elaborate?

[00:18:19:20]

ANS: Cherolyn

In Papua New Guinea, there's five schools of midwifery in the country and every year we receive like 20 midwives -- less than 20 enroll every year and it's an 18 month programme. Now look at the 20 within those five schools - at the end of the year we graduate about less than 100.

[00:18:44:23]

Now the country's population is almost 9 million, and we have a high mortality rate and we need more midwives to be out there in the rural areas and we cannot meet that target if we keep on going on the trend that we are now going. Having the 25 schools and training just five midwives. Now these midwives are not coming from like grade 12 or from high school, they're coming from nurses.

[00:19:11:21]

So we are taking out nurses and training them to become midwives. So we're leaving the gap again in nursing.

[00:19:18:11]

ANS: Cherolyn

So the idea is if midwifery is seen as part of nursing, that is where midwifery is taken out or it came out from nursing. So they have to become nurses first in order for them to become midwives. And that is when we are leaving the gap in nursing and we are trying to increase the number or have more midwives to become midwives.

[00:19:38:11]

By the time some of them come for midwifery, they are about to retire or, you know, finish from work. So again, there is always a gap in between that we create. Now I like that training midwives does not only come with the quantity - it's not about the numbers that we want, it is about them coming out and becoming qualified, having them to perform and in meeting the international requirements or the standard to become a midwife and to practice.

[00:20:11:21]

QS: Host 

Cherolyn, what is keeping people away from registering to be a midwife? 

[00:20:16:22]

I am saying that we want more midwives, but if the midwives are not looked after and they're working in an environment that is not healthy for them, with no support, they'll definitely leave and move out to another place. Now there are rural facilities where there are no midwives, and those are the facilities that I believe have been referring a lot of women and have encountered a lot of maternal mortality or morbidity.

[00:20:44:04]

A midwife cannot go there when the environment is not safe for them. And knowing that midwifery is more female-focused, currently now in Papua New Guinea, we have some male midwives who are coming up to take up midwifery - and thanks to the Australian Awards and our partners that are at the back of the trainings and UNFPA and the other UN partners that have supported us in training more midwives in Papua New Guinea, we have males and most of these males tend to go back to the rural areas.

[00:21:15:09]

QS: Host 

With the challenges in mind, let’s take a look at the possible solutions. Catherine, how has UNFPA supported the growth of a qualified midwifery workforce in the region?

[00:21:27:03]

ANS: Catherine

So what I'd like to say is that midwives really do hold the solution for us in ensuring that women everywhere are able to have a safe pregnancy; a pregnancy that's wanted and that is safe, and that midwives really are the champions in this work. They're really the ones that have the power to make this difference, to save lives and to transform and ensure that women have dignified pregnancy and birth.

[00:21:56:12]

So as UNFPA, we invest very much in supporting countries to really improve the quality of midwifery education, because we believe that's the backbone. If a midwife is trained according to international standards, equipped and supported, then you know, she's going to be in the best place that she can be to do that work. And for me, it's just really important.

[00:22:20:16]

And for UNFPA, Asia Pacific Regional Office, it's really important to create this community of practice and connections between the midwives across all of our countries and regions because they together hold lots of answers. You know, they can share in the challenges, but they can also share the successes and in how they're advancing midwifery and how they're improving maternal health and newborn health in their countries.

[00:22:46:05]

QS: Host 

Cherolyn, do you agree with Catherine?  What more can be done to support midwives in the Asia-Pacific region? 

[00:22:54:03]

ANS: Cherolyn

Yeah, I think a way forward for that is to invest in midwives. Investing in midwives needs also in education, strengthening the education and training regulations and the working environment for midwives that will make us see more progress in the reduction of maternal mortality and neonatal mortality. And strengthening the capacity of midwives to deliver not only just services, but high quality maternal and newborn health services.

[00:23:27:18]

That is very important for us. It is only when they receive quality international standard education or training that it allows them to do that. And in that way they will reduce and help to reduce the preventable deaths that are occurring at the moment in our countries. And also increase the coverage of midwives in each of the countries, as well as like in Papua New Guinea.

[00:23:54:22]

The districts in the provinces should have that capacity or midwives in each of those facilities, so they will be able to provide the care to the women that need it. There are women out there that need this care, but because there are no midwives there, they lack those and they don't access the midwifery care. So I would say that increasing or investing in midwives should be the way forward in our countries to promote more midwives so that midwives can provide that care.

[00:24:25:05]

And in that way we will achieve the UN Sustainable Development Goals and by having maternal health as the focus of the UN SDGs, the other UN SDGs will fall in place. Yeah, so I would say, and I strongly believe that if there is a strategy to increase the number of midwives in training and education with training, and the working environment should also be recognized and be seen and captured in the planning of having midwives in the country.

[00:24:59:20]

That will really help us to have the mortality rate reduced to a bigger drop.

HOST- SUMMARY

[00:25:07:24]

Thank you so much Cherolyn and Catherine for sharing your experiences and insights into how midwives can be better supported within the Asia Pacific region and around the world as we celebrate the International Day of Midwives. 

[00:25:20:22]

Thank you for your work and for shining a light on a role that is so important to women around the world.

[00:25:27:00]

This has been just the start of our journey into the inspiring stories from women across the Asia-Pacific region. You can find more insightful episodes on issues relating to sexual and reproductive health and rights on Spotify, Facebook, YouTube, and Apple Podcast. Just search for our podcast, “Hold on a minute!” by UNFPA Asia-Pacific.  

[00:25:48:05]

Thank you for joining us.  See you in our next episode!