Sue Ndwala, World Vision Maternal Child Health Advisor is a nurse, midwife, early childhood nurse, sexual and reproductive health nurse. She has worked extensively in the developing world including Southern Sudan, Ethiopia and East Timor.

In English midwife means to be "with woman". In French a midwife (sage femme) means a "wise woman". I don't know if that is true of me, but in my 20 years as a midwife being with women from many different nations of the world, I have shared both the joy of life that every new births brings and the sadness of birth related suffering and death.
Every year more than half a million women die in pregnancy or childbirth and this number has not changed in 20 years. Every year more than three million babies are stillborn. Every year more than four million newborns die before one month of age. Every year many children lose their mother at a time when they depend on her most. I know this reality intimately and I know that something must be done!

Mostly it is the women and newborns of the developing world who suffer the terrible consequences when a labour or birth goes wrong and they cannot get help. Every year more than 60 million births occur at home. Families and traditional birth attendants are the primary carers of these birthing women and their newborns. When things go wrong they can be catastrophic.
Many poor nations are struggling to educate, support and keep their doctors, nurses or midwives. Many families and communities do not know the value of these health providers. Rich nations such as Australia must support poor nations to make the education and training of health professionals a priority. A major goal must be that there is enough health staff to attend every birthing woman in every district of every nation.

A Story - Obstructed labour

I was working as a midwife in a mud hut emergency field hospital in remote in Southern Sudan during the civil war. One night I was woken in my tent by a soft voice of the compound watchman calling "Shoo Shoo" and asking me to come to maternity. I found a woman who had been labouring for three days. Her family had carried her from far away on a stretcher. In transit the family had taken her to another clinic, but there had been no doctor or midwife and no equipment. Someone untrained had tried to pull the baby from her. What I found was a woman suffering terrible pain, with a baby lodged deep in her pelvis, so much so that I could see the head. But the baby was completely stuck and the mother was in obstructed labour. This woman needed a caesarean section operation to save her life and should have had one two days ago. I listened for a heart beat feeling sure that after this long the baby would have died in the womb. Miraculously I found her baby to still be alive. With the right medical and midwifery care we were able to save this mother and this baby. It seemed like a miracle. We did not have access to an operating theatre, that was 2000km away and our call to the Red Cross evacuation flight told us it would not arrive for three days. So we did what we had to do in that situation. We provided her with pain relief, emptied her bladder, stopped her labour with drugs, and prepared to open up her pelvic bone surgically with a small scalpel and local anaesthetic. Once the pelvis was opened I used a vacuum extractor to gently delivery her baby. The baby needed some of our help to take his first breath. I will never forget the site of this mother holding her beautiful but battered baby to her breast.

Action

The ways and means to combat these deaths are well known and have resulted in huge reductions in maternal deaths in countries like Australia during the twentieth century. All women need access to health services during pregnancy, birth and the post natal period. No birth should be without help. No woman should suffer in labour for three days. Every year around 50,000 of the half a million women who die during pregnancy or childbirth die from an obstructed labour. Many are young woman forced into early marriage before their bodies are matured and ready for birthing. Many women are too short and have small pelvises, the consequences of chronic malnutrition as a child. Urgent action is required to support governments to ensure basic health equipment, obstetric drugs and health staff is available for all. Word Vision is working in some of the world's poorest countries to ensure communities are provided with maternal and newborn health support. World Vision also works with governments and other aid agencies prioritising maternal and child health as a key issue.

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