Strengthening Midwifery in PNG

Giving birth and being born is dangerous in Papua New Guinea.

According to the National Department of Health Ministerial Taskforce on Maternal Health in Papua New Guinea the staggering rate of maternal mortality in PNG is a national emergency.

Every day, at least five women die of preventable childbirth related causes. Sixty per cent of childbearing women do not have access to skilled birth attendants and because there are only 270 registered midwives in the whole country, outside of the understaffed and under resourced regional hospitals, maternity and newborn care falls on the shoulders of community health workers and nurses.

In  September 2000, Papua New Guinea committed to combat poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women and signed the United Nations Millenium Declaration, along with the other 190 UN member states. Eight Millenium Development Goals  were derived from this declaaration with specific targets and indicators. The PNG National Department of Health is targetting the 4th (reduction of infant mortality) and fifth goal (reduction in maternal mortality).

Midwives are internationally recognised as the number one primary health care professional for optimal safety for mothers and babies at birth. Even though there is recogntion of the vital role of midwives in optimising maternal and infant wellbeing and thereby reducing maternal mortality and morbidity in Papua New Guinea, the capacity to produce midwives too low and the number of midwives has remained stagnant. The midwifery workforce is aging and the registered midwives, few as they are, are rapidly approaching retirement.  Over the last five years, reports on the state of Midwifery Education and Maternal Health together with the National Health Plan have all focussed on increasing the midwifery workforce with the aim of having a midwife in every health centre and a skilled birth attendant for every childbearing women.

The reality is harsh. Too many women. A failing health system. Not enough midwives.

A sobering article in the Sydney Morning Herald in 2009 captured the issues and conditions succinctly on this date two years ago. Those issues and conditions are unchanged or worse.

Against this backdrop, the National Government of Papua New Guinea has partnered with the Australian Government to strengthen midwifery and capacity build the existing educational systems. Eight midwives started a month ago to work in pairs in four university programs with the educators and students to ensure the PNG National Standards and Competencies are achieved.

I'm fortunate to be one of the midwives, based at Pacific Adventist University (PAU) and working clinically with students and educators in the women and babies wing of Port Moresby Hospital.

The midwifery facilitation team, minus one and plus two!
From right to left Sue Englend (visiting Port Moresby), Lois Berry (based at Madang) Tarryn Sharp and her daughter Willoughby (PAU), Marie Treloar (based at Goroka) Alison Moores (University of PNG at Port Moresby), Glenda Gleeson (Mandang) Annie Yates (the Kiwi: University of PNG) and yours truly (PAU).  Missing from the photo is Heather Gulliver, who is also at Goroka with Marie.

Today, there was another big step in the right direction of strengthening midwifery in PNG.

The PNG Midwifery Society had their inaugural meeting in the conference room of the women and babies wing of the Port Moresby Hospital.

Fifty one midwives, nurses with midwifery education (unregistered) and student midwives crowded into the conference room to discuss professional midwifery matters.

Student midwives from PAU.

We booked a bus to bring the students and educators from PA University (about 30 minutes away from the hospital) and take them home again after the meeting. The students loved the experience. A very new experience for everybody.

The students are great fun and keen to learn. The educators are amazing people who are very welcoming and want their programs to meet the profession's needs and the Council's regulations. The midwives are appreciative of the students' work on clinical days as the midwifery workforce is scanty and the workload is huge. There is a lot to do to get things right in PNG.

Following the business of the meeting, the buzz was electric as the society member's shared food and conversation

                                                           

As part of the Australian College of Midwives committment to supporting and strengthening midwifery in our closest neighbour nation, four members of the society, two from Port Moresby and two from Goroka have been sponsored by the College to attend the Biennial Australian College of Midwives Conference in Sydney. Another initiative in strengthening midwifery in PNG is the  International Midwives Twinning Project. Two members of the PNG society are being sponsored by the Australian College of Midwives to go to the Hague, with two Australian College members to discuss and explore professional matters at the end of the month.

We know that when there is a strong and autonomous midwifery profession, mothers and their babies do well. The PNG Midwifery Society has the potential to play an enormous role in strengthening midwifery and creating a proud and powerful professional group for midwives, which in turn, creates a safety net for the  mothers and newborns of PNG.


Judging by today's conversation and the turn out for the meeting, the Society is well and truly up for the job!

Maternal intelligence: Calling the baby in

I've just read the most intense and illuminating blog post of a woman's birth story.

Rixa, of Stand and Deliver fame, posted the story of her baby Inga's unintended unassisted birth at home. One of my favourite comments, showing Rixa's wonderful presence of mind is when she was seeking to understand how close to birth she was...

"I knelt and reached inside. Sure enough, there was a hard round head about two knuckles deep. I felt around for a while, trying to figure out what was what. With all of the folded tissues and wrinkly baby’s head, it’s sometimes hard to tell where you end and baby begins!"

Baby Inga needed resuscitation, which Rixa did brilliantly.  You can see how Rixa managed the resuscitation of her baby with great mindfulness and focussed attention in the second video on her blog about Inga's birth.

Rixa explained that she had been certified in neonatal resuscitation a few years before. I'm not sure what other midwives do, but for anyone I considered could labour and birth quickly, I made a point of taking them through resuscitation of the newborn in case the baby arrived before I did. These days I recognise everyone needs that information, both for birth and beyond. We never know when those skills may come in handy; a woman told me that she was so glad I'd taught her as she had resuscitated a friend's child who fell in a swimming pool.

In terms of a newborn's transition to extrauterine life, certainly having the cord intact helps. Anyone who has seen a newborn with the cord clamped and cut immediately at birth would recognise the extra effort it takes for those babies to ground themselves and recover from the birth process.

Watching Rixa resuscitate her baby with five quick breaths and words of encouragement is a useful and informative experience for anyone to view. The way she talks to her baby is so important and I encourage mothers and fathers to do the same when they are in labour and when the baby is born.  "Calling the baby in" to its body is an essential part of the birth and transition to extrauterine life process and the importance is an understanding shared by Indigenous cultures and homebirth midwives. "Calling the baby in" is a recognition of the spiritual essence or consciousness of the baby and indicates an understanding of the way that the spirit can separate from the body (also known as 'out of body' experiences) during intensely emotional and/or challenging times. My personal view is that a mindfully aware, welcoming and lovingly focussed on the baby mother (and father) is the most important safety feature of labour and birth.

Rixa's birth and action to help her baby reminded me of the maternal intelligence in this video (following) of an elephant mother.  Some people may be offended by the association of an animal's behaviour with that of a human. However it is important to recognise that scientists use animals in all sorts of  ways to see how they respond to get insights into human experience and behaviour. Therefore it is highly appropriate to think about the commonalities in these two mothers and their attention to the needs of their newborn babies.  We are wiser with the way we treat animals as we realise we have to leave them alone to birth normally. We recognise that surveillance and well meaning intervention does more harm that good with animals. We have yet to fully appreciate that with human labour and birth.

The elephant mother is Nikki, her baby is Riski.  Note the mindful attending presence of the elephant mother and the way she calls her baby in. Watch the baby's eye as the spirit enters and stays.

Whatever your perspective about spirit, consciousness, birth, danger, surveillance, mother's innate intelligence, newborn babies resilience etc, these videos and the maternal intelligence that is evident in these videos invites us to think deeply about these matters.