Zoom on Clinical Midwives: the Frontline of Maternal Health

Reflecting on my early days as a midwife, I found myself grappling with a huge gap between what I thought the job would be and the reality. Spoiler alert: it did a number on my self-esteem.?

It's with a heavy heart and filled eyes I shared my feelings as a beginners on this post a couple of months back. Ahh, the start...

Turns out, I wasn't the only one feeling this way. A recent study from South Africa shows that when our expectations clash with the actual role, it can lead to distress, moral dilemmas, and a whole lot of frustration. Midwives often feel like they’re falling short of the stellar care birthing women truly deserve (I highly recommend reading the full article, just for the comments ??).?

What young midwives say about kickstarting in clinical midwifery?!????????

So, let's uncover what clinical midwives really do on a typical shift and shed some light on the role before we dive in. Hang tight; it’s going to be a ride!

So, Who is a Midwife?

The World Health Organization (WHO) defines a midwife as “skilled, knowledgeable and compassionate trained professional caring for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life”.

Unlike obstetricians, who often focus on medical interventions, midwives emphasize on a holistic approach to childbirth. They are trained to support natural processes, respect women's choices, and provide comprehensive care that encompasses physical, emotional, and social well-being.?

Importantly, clinical midwives are not merely assistants; they are independent practitioners capable of managing normal births and recognizing complications that require medical intervention.

For the circumstances, a clinical midwife is a midwife that practises in the hospital setting.?

Clinical midwives as per position in the healthcare system??

Clinical midwives are essential players in healthcare systems worldwide, particularly within maternal health contexts. They are like the superheroes of healthcare, especially when it comes to pregnancy and childbirth.?

They’re the ones cheering on women during labor and fighting for their rights while handing out valuable health education like candy.?

In Cameroon, we’ve got a health system that’s like a three-tiered cake. At the top, the Ministry of Public Health whips up the policies, then the regional delegations sprinkle on technical support, before we get to the health districts (implementing health programs) where the real magic – usually involving midwives – happens.?

In my case, I’m stationed at a health center, the local go-to for handling those pesky minor ailments and promoting good health. Who knew saving the world one childbirth and health check-up at a time could be so rewarding?

My day serving at a health centre

My day at the health centre begins at 8 am with a crucial check of the fridge temperature to ensure our vaccines are in good condition. I then dive into the preparations for antenatal consultations, a task that keeps me engaged and focused.

Around 1 pm, as the day's rhythm settles, I shift to supporting women in labor and managing minor pregnancy-related illnesses, offering guidance to families in the maternity unit while juggling administrative tasks and community outreach. Occasionally, my shifts may extend into the night on vaccination days.

On a typical vaccination day, we welcome over 60 babies. The session starts with cards registration, book next visits, health talks and the vaccine administration. After the event, I label the leftover vaccines with the actual date to track their lifespan, tidy up space with my teammates, data input in registers and managed the vaccine inventory for the next session.

Despite limited resources and the occasional hurdles, her unwavering commitment of the entire team shines through.

While I’m still gaining confidence in family planning—a vital part of my role—I am fortunate to learn from experienced colleagues who share their knowledge and insights. My work extends beyond maternal health; I apply the nursing care process to serve the general population, although I tend to keep that aspect at bay for now given my current focus.

I find myself in a phase of intensive learning, soaking up all I can in this supportive environment.?

"Despite the excitement of the day, I feel a hint of dissatisfaction with my turnouts, as some sessions run late, leaving some mothers worn out from the wait. It's a reminder that each experience, even the challenging ones, is an opportunity for growth and improvement on my journey."

Other Roles of Clinical Midwives?

Midwives play a crucial role in providing personalized care at various healthcare facilities, adapted to the specific needs of the communities they serve.?

Consider the case of Marie-Anne, a 24-week pregnant first-time mother. After careful monitoring, it became clear that her baby was gaining excess weight, raising concerns about a safe delivery due to limited resources at her health center.

Recognizing the risks, the midwife took prompt action by informing Marie-Anne and referring her to a hospital with obstetrician services, where she could receive the best possible care.

In this collaborative environment, experienced midwives and nurses support complicated deliveries and manage any arising complications.

The obstetrician evaluates options, including vaginal or instrumental delivery, with a caesarean section as a backup if needed.

Following the birth, the midwives play a vital role in maternal and newborn care. They ensure that Marie-Anne receives education on topics like family planning, infant immunization, and the overall well-being of her baby, Georgia.

From handling common concerns like unusual stool colors to assisting with postnatal care, midwives remain a consistent source of support, empowering mothers through every stage of their journey.

Clinical midwives may serve from health centres, primary referral, secondary referral hospitals, training hospitals and fertility clinics.?

Midwives are chameleons (just without the colour changing abilities).

Different Types of Clinical Midwives

Clinical midwives come in various forms, each specialising in different aspects of maternal care. Here’s a breakdown of the different types:

1. Certified Nurse Midwife (CNM): A registered nurse with advanced training in midwifery who can provide comprehensive healthcare including gynecological services.

2. Certified Midwife (CM): Similar to CNMs but without a nursing background; they focus solely on midwifery care.

3. Clinical Midwife Specialist: Experienced midwives with expertise in specific areas such as high-risk pregnancies or neonatal care.?

4. Maternity manager/directors: Managing care plans for pregnant women, ensuring continuity across different services and coordinated activities among teams.

5. Digital Midwife: Completed a formal training in midwifery and specialised in Digital Health or other technology backgrounds. Leverage technology to improve the quality of care rendered in hospital setting

Ending Words

The take-home message is clear: clinical midwives are crucial for enhancing maternal health outcomes worldwide. Their dedication ensures that every woman receives the respectful, individualized care she deserves during one of life’s most significant transitions.

Keep in mind that clinical midwifery is best explored on an actual role. Not an internship or a clinical placement, but an actual role with duties. That's the real test.

Now, you know. Share it with your peers.

Till next week my midwife?