BEING A MIDWIFE IN
MALAWI
Presented by Rose Piaroza Chamanga MSN, RNM
Principal Lecturer
Malawi College of Health Sciences
International Day of Midwives
Aberdeen,Scotland
MAY -5, 2014
Presentation outline
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Background of Malawi
Context update
Midwifery in Malawi
Being a midwife in Malawi
A day in the work of a Malawian midwife
(scenarios)
Lessons learned
Conclusion`
Background of Malawi
 Meaning ‘flames of fire’ is named after the shimmering
effect of Lake Malawi in the sun
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It is a land locked country in south eastern Africa, about
118,000 km²
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Has a population of about 15.4 Million
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85 % of this population live in rural area, and depend
on agriculture for their livelihood
Context update
Life expectancy 48 years
(male) 50 years (female)
Births attended by skilled
personnel is 71 %
Total fertility rate 5.7
Unmet need for family
planning is 42%
Neonate mortality rate
is 31 per 1000 live births
HIV prevalence among
adults (15-49)is 11.8 %
Maternal mortality rate
per 100,000 live births is
675
Malawian Midwife: Training
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3 Cadres of nurse/midwives
◦ Registered nurse/midwives
 BSc in nursing/midwifery
 Diploma in nursing/midwifery
 Kamuzu College of Nursing, Mzuzu University and Malawi
College of Health Science (MCHS)
◦ Nurse/Midwife Technician
 College diploma in nursing
 Christian Health Association of Malawi (CHAM) colleges and
MCHS
◦ Community Midwife Assistants
◦ 18 months training
◦ CHAM colleges and MCHS
Nurses and Midwife council of Malawi regulates the
nursing/midwifery training and practice
Being A midwife in Malawi
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Both a fulfilling and
challenging profession
A day in the work of a Malawian
midwife
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Scenario A
◦ Midwife R at a health centre receives a 14 year old
teenager with incomplete abortion
◦ She prepares her for Manual vacuum Aspiration but
discovered that the syringe was not functioning and
there was no valium for sedating the patient
◦ The midwife called for an ambulance, but it never
came
◦ Advised the mother to take the daughter to the
District Hospital (DH) which was 22km away from
the Health Centre (HC)
Scenario A cont.
◦ Three weeks later the adolescent was brought to the
health centre very sick with pusy PV bleeding which
was green in colour and foul smelling, in shock and
very anaemic
◦ She died within few minutes of her arrival to the
health centre while the midwife was trying to
resuscitate her
A day in the work of a midwife
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Scenario B
◦ A midwife arrives at a central hospital for her night
shift in the labour ward
◦ There are only 2 nurses on duty with 40 patients to
attend to
◦ She attends to a cubicle where the woman is in
second stage as she starts to assist that patient, the
patient on the next bed starts screaming for help.
◦ After the midwife has finished with the first delivery
she moves to the next bed where she finds the baby
already out lying on the bed. The woman is also
bleeding profusely
Scenario B cont..
She calls for help, but the other midwife had gone to
theatre to receive the baby after caesarean section of
another patient
 She takes the baby who is cold and needs observation
in a heater. She can not take the baby to nursery
because she wants to go back to put an IV line in the
mother
 She places the baby on the heater and rushes back to
resuscitate the mother
 She manages to put an IV line and takes blood for FBC
and cross match. She also finishes up management of
third stage.
 She informs the doctor who is in theatre performing a
caesarean section
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Scenario B cont..
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Patient continues bleeding despite uterine message
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Dies in the theatre at the resuscitation table while
waiting to be taken into theatre for examination under
anaesthesia
A day in the work of a midwife;
Lessons learned
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Health facilities in Malawi are running with critical
shortage of nurse/midwives and other medical
professions e.g. physicians. They also lack medical
supplies, essential drugs and equipment. Its referral
system is also poor
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This makes the provision of patient care especially the
vulnerable groups such as pregnant women very
difficult, and the midwife is ended up frustrated,
distressed and demotivated
A day in the work of a midwife
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Scenario C
◦ Midwife H is on day duty at the central hospital
◦ She receives a referral from the health centre of a
multigravida with high blood pressure
◦ As she is receiving the patient, the patient starts to have
convulsions
◦ The midwife calls for help, of which a student
nurse/midwife responds
◦ Together they are able to place an IV and start the
woman on MgSO4
Scenario C cont..
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Further evaluations reveals she is fully dilated with a
descent of 1/5
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The Midwife is able to perform a vacuum extraction and
extracts live male infant birth weight of 2700 grammes,
Apgar scores of 6/10- 8/10
A day in the work of a midwife; Lessons learned
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Midwives in Malawi are knowledgeable,skilful and
competent in the way they carry out their duties
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They are able to make right decisions regarding their
patients’ care and carry out procedures to save the lives
of mothers and babies
CONCLUSION
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With 675 maternal deaths per 100,000 live births, 11percent of
HIV seroprevalence, severe shortage of human resources for
health at every level of service delivery, and critical shortage of
medical supplies and equipment, a midwife in Malawi face almost
impossible challenges to provide optimal care to the women
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However, despite all these challenges, a Malawian midwife surpasses
all those odds and challenges and still provide care to the mothers.
Conclusion cont…
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She is able to do that because she is courageous,
knowledgeable, skilful, competent, self motivated,
patriotic, and able to cope up with stress. She therefore
works amidst and above those enamours challenges and
difficulties in order to provide care to the mothers!
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THIS IS WHAT IT TAKES TO BEING A MIDWIFE IN
MALAWI!!!!!!!!
A Malawian Midwife
THANK YOU FOR YOUR
ATTENTION!