This weekend marks International Day Of The Midwife. Fabulous meets the British nurses delivering babies in some of the most dangerous places on earth
Cradling sleeping baby Moses in her arms in a bloodstained tea towel, Anna Kent’s face is a mixture of joy and relief. And it’s no wonder. His weak and starving mother, Nyachou, 20, walked for three days in the blistering heat across the plains of Sudan, searching for help. She arrived at Anna’s clinic by night, and it was the midwife’s job to deliver the baby, aided only by the beam of a torch, with no electricity or running water.
Anna, from Market Drayton in Shropshire, is a midwife. But her work is as far removed from the scenes on Channel 4’s One Born Every Minute as you can imagine. In the UK, we probably spend more time worrying about if we are able to conceive than what will happen at the birth.
Only one in 4,700 British women will die during pregnancy or childbirth*. However, in the countries Anna chooses to work in – ranging from Sudan to Haiti and Bangladesh – no woman is guaranteed to survive it.
“There’s a saying in Sudan: ‘A pregnant woman has one foot in the grave’,” says Anna, 31. “The country has one of the highest maternal mortality rates in the world – one in 32 mothers will die giving birth. I don’t want the women I work with to become another statistic.”
Anna worked as a midwife in Bangladesh last year
This time, both Nyachou and baby Moses – born weighing 5lb 8oz – were able to leave the clinic after 24 hours. But a safe delivery is far from the norm. British women like Anna work to change that.
Lives in danger
She is employed by Médecins Sans Frontières (known as MSF or Doctors Without Borders), to work in some of the world’s most deprived countries – risking her own safety to help others.
“Having a baby is a natural thing and yet in some parts of the world it can be life-threatening,” says Marc DuBois, executive director of MSF UK. “Every day, British midwives are working to save the lives of mothers and children in war zones, refugee camps and places where there is no health-care system.” And to do so, they often endanger their lives.
Medic Dr Karen Woo, from Stevenage, who specialised in maternity care, was shot dead in Afghanistan in August 2010,
along with nine colleagues. They worked for Christian charity the International Assistance Mission (IAM). The Taliban has claimed responsibility for the murders, saying the group were killed because they were Christian missionaries, but the IAM insists they weren’t doing missionary work.
Cases like these are on Anna’s mind when she accepts postings. “You have to weigh up the risks, but MSF takes staff safety very seriously.”
And she has been in some scary situations.
“During a mission to Haiti in November 2010, after the devastating earthquake, my colleagues and I were trapped in a hospital for a week because the building was surrounded by an armed mob,” she says. “The streets were a no-go zone, as violent protests against ongoing elections were happening outside.
“In between shifts, we slept on the floor on sheets with cotton wool in our ears to try to block out the noise. There were guards outside the hospital, but our greatest protection was the patients themselves. No one wanted to come into a cholera hospital. But I had to push my fears aside and just get on with my job.”
It’s not just terrorism and civil unrest Anna contends with. Poverty and disease make her work incredibly challenging.
“When I first arrived in Haiti in October 2010, the cholera epidemic was causing huge problems as it can bring on early labour,” she says. “So I was caring for premature babies who were often very sick. We didn’t have incubators, and if the babies did survive, sending them home was heartbreaking.
“At that time 1.5 million people were homeless, so ‘home’ was often plastic sheets on the street. Watching the babies leave, strapped to their mothers, I hoped they would be OK. But not knowing what shelter or food they’d have was awful.”
Anna first started specialising in midwifery in 2007 after qualifying as a general nurse at Nottingham University.
“My interest grew from my first mission with MSF to southern Sudan, when I delivered triplets,” she says. “They were delivered by torchlight in a mud hut and the experience was so emotional. All of them survived – two girls and a boy – and although it was nerve-wracking, it felt amazing seeing them in their mum’s arms. That’s when I decided to come back to the UK and get my midwifery qualifications, which have allowed me to help people all over the world.
“When I’m in the UK, where I also work as a midwife in between missions, I face questions about the best pain relief and birthing plans. Whereas the mums I see in the course of my MSF work worry about whether they’ll survive the birth and if they’ll have a live baby,” says Anna.
“These inequalities motivate me. Why should giving birth be a joyous occasion for one woman and a terrifying ordeal for another? I now divide my time between MSF and the NHS in Nottingham.”
Taking its toll
Anna’s currently single and admits her job takes its toll on her personal life.
“I was in a relationship when I went to Sudan, but we were far apart and living different lives. My job was my focus and I didn’t have space for anything else.”
And working in countries where the maternal and infant mortality rate is among the highest on earth, Anna has faced heartbreaking situations most midwives here couldn’t contemplate.“When I arrived in Bangladesh in January 2011, much of my work involved delivering babies who were dead, because their mothers came to us too late. It’s the norm for women to give birth at home, so they would only seek help when they were really desperate, perhaps after days spent in labour. By that stage many were too weak or the baby too distressed to deliver safely.
“It’s horrendous delivering a dead baby. It makes you question whether you did everything you could to save them.
But as word spreads about the birthing unit we work in, more women are seeking help, and the live birth rate is rising.”
Anna has received counselling to help her cope with the horrors she’s seen. She says: “I’ve had nightmares about dead babies. But when you’re out in the field, you have to bury your emotions and get on with the job. So it helps to deal my emotions when I come home.”
For 29-year-old Bree Cant, her nine-month mission to Pakistan in 2011 was a baptism of fire, coming just two years after she’d qualified as a midwife in the UK. Bree, from south-east London, was in charge of a birthing unit outside Quetta, in the west of the country.
“Sitting on the plane about to take off, I was terrified. Would the dangers I’d been briefed about become a reality?” she recalls.
Because Pakistan shares a border with Afghanistan, the security situation there is very precarious. The Taliban and insurgent groups are active in the area, and there are regular bombings, murders and kidnappings. “I knew the risks, but I was still excited about working somewhere so different,” Bree says.
Because of the risk of hijackings on unlit roads, Bree was only able to work in the clinic from 7.30am to mid-afternoon every day. However, the clinic stayed open 24 hours a day, staffed by local midwives, and Bree was at the end of the phone to give advice.
“At least once a month, myself and the other MSF staff would be put on ‘lock down’ in our house for a couple of days because of gunfire or bomb scares. The fighting was between religious groups – we weren’t the target but it was still frightening. On days like that I felt very far from home.”
Tragedy was commonplace at the clinic, often due to the lack of health care available.
“There are no scans available during pregnancy so I delivered babies with severe deformities, and babies that had died in the womb. I cried for every one of them,” she says.
“No baby was ever abandoned by its parents though. Some came to hospital in the hope of a miracle cure, but decided to go home to let nature take its course. But there were happy times too, like when I delivered my first twins.
“The clinic staff – all local midwives who spoke some English – became like a family to me. When you’re far away from home it’s great to have people to give you a hug or make you a cuppa after a long day.”
Bree met her boyfriend, civil engineer Matt, 33, in Pakistan where he was helping to build medical facilities for MSF. “Romance does crop up in the field. I did wonder how being back in the UK would affect us, but we came home in October last year and have adjusted well.”
Now looking after women with high-risk pregnancies at St Thomas’ Hospital, London, Bree treasures her experiences in Pakistan.
“It’s made me a better midwife – if you can work in those conditions you can do anything. I’d consider doing it again, but I’m happy to be in London now.”
Anna may also undertake a fourth mission for MSF.
“It’s been lovely being back in the UK, having a glass of wine and a gossip with friends, but I would consider going away again,” she says.
“Yes, there are drawbacks to my job – it takes its toll on relationships, I have no home when I’m in the UK so stay with friends, and it takes me away from the people I love for months at a time into dangerous situations. Yet the reward of saving lives and helping people makes all of those sacrifices worthwhile.”
‘The danger didn’t put me off’
Gina Short, 36, is an NHS midwife and lecturer from London. She is single and spends her holidays working for charity Life For African Mothers. She says: “The memory of one of the births I attended in Liberia last year will stay with me forever.
A 15-year-old girl in labour was having a fit caused by high blood pressure. She could have died – along with her baby – and the local midwives stood back watching helplessly. They simply didn’t know what to do.
Putting her in the recovery position, I kept her airways open until the fit stopped and gave her some medicine that I’d brought with me.
Thankfully, her baby was born safely, but it could easily have been very different.
It brought home to me how vital the work of British midwives abroad is, not only in delivering babies but also in training local midwives, which is what I specialise in.
Last year, I went to Liberia and Sierra Leone, both of which are deprived countries, still recovering from violent civil wars. Armed robbery and rape are common, but I felt very strongly about helping other midwives, and the danger didn’t put me off going.
Hearing that many of the expectant mothers say goodbye to their other kids before childbirth, in case they die in labour and don’t see them again, was heartbreaking and felt so unjust.
The slums in Sierra Leone were a million miles away from my comfortable life in London.
People crowded into dilapidated shacks – women were giving birth with no pain relief and no bed to lie on. It was shocking to see.
I’m going to Ghana later this year to train more midwives and I can’t wait. It’s amazing knowing that, by passing on my knowledge, I am helping to save lives.”
For more information, visit Msf.org.uk; Lifeforafricanmothers.org