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Uganda: Are Midwives Justified in Beating Women in Labour?


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New Vision (Kampala)

2 May 2008
Posted to the web 5 May 2008

Carol Natukunda
Kampala

In a 2007 study, mothers mentioned unfriendly, rude and abusive midwives as a factor influencing their choice to not deliver at health centres

THERE was no sign the baby was coming out soon. Its head peeked out, then disappeared again.

"Push!" a midwife coaxed. "Didn't I tell you not to kneel? Lie on your back your leg here push! Okay? Push!" the mid-wife went on, despite pleas from the mother that she felt more comfortable kneeling down. "Push!" the frantic midwife shouted with full force, until the baby finally popped out from the birth canal.

Seven years later, Doreen Sanyu has neither forgotten nor forgiven that midwife who delivered her first child.

"Those women don't understand," she mutters sitting on a little mat at her home in Nateete in Kampala. "My mother always told me kneeling was the best position. Can you imagine giving birth with legs spread and everybody is looking at you? I can never go back to hospital, never!" Sanyu swears.

In her heart of hearts, Sanyu knows she is risking her life. She has seen some mothers bleed to death shortly after birth. She has also seen some new borns die, just hours after they are born. But the fear, the feeling that a midwife would mistreat her, keeps her glued home.

Next to Sanyu's one-room house, is Esther Nakanwagi, who is quick to defend her.

The 37-year-old mother of one says a midwife slapped her as she delivered her baby. She remembers wailing and "trying to do as the midwife instructed." unfortunately, that did not save her from the "wrath" of the midwife.

"She was telling me 'Push! Push... (Two slaps) Do you want to kill your baby? Push! (another slap)," Nakanwagi recalls. "I was thinking .'does she understand my pain?' Before I knew it, more slaps had followed!"

"At one point I even thought she was laughing at me; when she said 'just be like you are pooing!' I wondered if she was mocking me."

The stories speak volumes about the conflict between the midwives and mothers. While mothers accuse the midwives of being rough, the midwives and maternal health experts argue that they are only helping the mothers.

"I would not say it is slapping as such. Some women are naïve and don't know what to do. Others simply don't want to cooperate yet if they don't, they could lose their baby or lead to unnecessary operations, which may be costly," says Dr. Alfred Driwale, the Koboko district health officer.

He explains that ordinarily, the uterus should push out the baby without help, but often women need extra force to get babies out.

"The maternity service is a highly emotional environment, with two people at the extremes. All the mother wants is to get a healthy baby. The midwife wants you to follow her instructions, because technically, she knows you could harm the baby. So misunderstandings arise when the mother responds negatively due to pain, fear or anxiety," Driwale explains.

On the rude remarks, he says society has shaped people's mindset in a way that the private body parts should not be mentioned in public. "Things like "spread your legs" could offend the mothers, because their society forbids that."

He, however, acknowledges that some hospitals are many times understaffed, so midwives lose patience because they are stressed due to work overload. The issue greatly poses the challenge of convincing mothers to deliver from the health centres.

According to the 2006 National Demographic Health Survey, attendance of antenatal care had improved to over 90% but skilled deliveries remained at 42%.

Statistics further showed that only 5% of births are delivered with the assistance of a doctor, 37% by a nurse/midwife and less than 1% by a medical/clinical officer. While 23% of births are assisted by a traditional birth attendant, 25% are by relatives or friends, while another 10% of mothers did not receive any assistance.

While there are different reasons, research further shows that midwives' behaviours greatly discouraged women from going to deliver at hospitals and health centres. They would rather do it the risky way at home.

Relevant Links

In a 2007 study, "Midwifery behaviours and practices that affect utilisation of maternal health care services in Buikwe West, Mukono district," 35.3% mothers mentioned unfriendly, rude and abusive midwives as one of the factors influencing their choice to not deliver at health centres. The research, done by Edith Mwebaza, the principal nursing officer of Mulago Hospital, also shows that 42% do not want to lie on their backs and spread their legs as the midwives insist. Also, 36.7% argued that they were afraid of C-sections.

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Read comments. Write your own.

Author: Dr. Mickey

Tue May 6 22:52:48 2008

Good article. Exactly the sort of thing that a group of Canadian midwifery students & their Canadian mentors have witnessed for the past several years. The same mentors but a different set of students will be returning to Uganda this summer once again.

We hope to work with our Uganda colleagues and change the prevailing attitudes so that violence in childbirth becomes much reduced.

Would someone be able to give me the article's name, author and where published?

Thank you, Mickey Rostoker, MD Assistant Clinical Professor of Family Medicine University of British Columbia Vancouver, Canada

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