Luseshelo Sinwinga, midwife, Safe Motherhood Coordinator, and Maternal Health Quality Team Leader, recalls an unfortunate but preventable maternal death. The focus is on the overwhelming burden of midwives and how this compromises quality maternal care. 

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The World Health Organization (WHO) recommends a ratio of 1 midwife to every 175 women of child-bearing age, but in Malawi, the average ratio is 1:1,209. Photo: White Ribbon Alliance.

The World Health Organization (WHO) recommends a ratio of 1 midwife to every 175 women of child-bearing age, but in Malawi, the average ratio is 1:1,209. Photo: White Ribbon Alliance.


By Patricia Yosiaya, White Ribbon Alliance-Malawi, Citizen Journalist/Midwife

Clinical experience is an important component of midwifery education as it prepares students for their actual future midwifery career. During this time, midwifery students get real hands-on training on how to successfully help a mother to bring forth her bundle(s) of joy. As such, it must be acquired in an ideal environment with appropriate equipment to give students the opportunity to develop competency and confidence.

Because a well-trained, confident midwife plays a key role in reducing maternal and neonatal mortality, the midwifery workforce is critical in improving the performance of the total health system.

The recommended midwife-patient ratio by World Health Organization for developing countries is 1:175. Currently, the midwife-patient ratio for Malawi is 1:1,209. The long-standing shortage of midwives in Malawi has led to an increased intake of students by midwifery institutions now trying to meet the WHO standards and thereby improve maternal and newborn health around the country. This has created a ripple effect in the clinical area: the number of health facilities remains the same and yet these facilities are required to accommodate an increased numbers of students.

A case in point is Balaka District Hospital: it accommodates midwifery students from the colleges of Kamuzu College of Nursing, Malawi College of Health Sciences, Holly Family and St Luke's College with the same objectives to achieve at the end of their clinical allocation.

When the midwifery students arrive, they are a welcome relief to the health workers at the understaffed hospital. "We are there to cover shortages. When we are in the clinical area, they take us as staff, not students. We work for them and sometimes they relax and leave everything to us - we fail to achieve our objectives,” one of the students lamented.

However, another student feels that the qualified midwives do not deliberately allocate their duties to the students purposefully but are just forced to do so because they are understaffed. “They fail to guide the students due to pressure,” this student, who also preferred anonymity, says.

On top of having no guidance from qualified midwives and shouldering their workload, student midwives usually find that they have no resources such as urinary catheters, catheter bags, cotton wool and gauze that aid learning. ''We fail to conduct procedures according to standard operating procedures because of a lack of resources, and we internalize wrong skills and we end up failing examinations, '' a student said.

Midwifery students also feel that their lecturers are not supervising them enough to ensure they have perfectly grasped what they learn during clinical placements. The students also feel that it is unfair for the lecturers to simply shout at them when they make a mistake instead of demonstrating to them how things should be done.

''Lectures are not doing their job to the maximum. We learn on our own. When they come for supervision, they don't stay long, they mostly shout at us when we have made mistakes and they have no time to demonstrate right skills,” another midwifery student said.

While increasing the intake of students in midwifery institutions is a good step for Malawi to take in order to reduce maternal deaths and neonatal mortality, adequate support during clinical placement is extremely important because the lives and safety of patients cannot be exposed to this trial and error method of teaching.

Patricia was trained by White Ribbon Alliance as a citizen journalist. By equipping midwives with the skills and confidence to tell the stories of mothers, citizen journalists shine a light on vital maternal and newborn health issues, and ultimately, improve the health and lives of mothers and babies in their own communities.