Meet the Midwives: Martha Malolela, Tanzania
Even after 35 years as a midwife, Martha Malolela still lights up when she talks about attending a birth. “I love this profession because if you do it well, you see life,” she says.
She’s attended thousands of births throughout her career. During her first appointment to a hospital labour ward, she said it wasn’t uncommon to see upwards of 20 cases in a single overnight shift.
In 1994, a decade after she donned her uniform for the first time, Martha decided to become a midwifery instructor, so she could help others in her profession. Since then, she has trained hundreds of midwives in emergency obstetric care, postpartum family planning and providing prenatal and postnatal care.
“In those days, there were no other options for professional development unless you wanted to become a specialist in pediatric nursing,” she says. “I felt that if I became a trainer, I could share my knowledge with a lot of people.”
In December 2018, Martha was one of four experienced instructors at a workshop on postpartum family planning through the Midwives Save Lives (MSL) project, a partnership between Cuso International, the Canadian Association of Midwives (CAM) and the Tanzania Midwives’ Association (TAMA).
Nurse-midwives in Tanzania often finish their training with a limited understanding of the practical aspects of the profession, especially when it comes to complications.
“Midwives are being trained to deal with normal births. With anything abnormal, they are trained to refer the mother to a specialist,” says Martha. “Now how can they refer something they are not knowledgeable about? How would they help this woman get the care she needs?”
Pregnancy complications such as postpartum hemorrhage or infection, blood pressure disorders and obstructed labour pose a major threat to the survival of Tanzanian mothers, according to the World Health Organization.
More than half of Tanzanian mothers give birth at home without the help of a trained midwife, and many rural women need to travel long distances to reach a health centre, which contributes to an increased risk of complications and death. Martha believes every midwife in the country has probably witnessed a preventable maternal death.
“Sometimes a woman arrives with a postpartum hemorrhage and you don’t have blood to replace the blood that’s lost. Or she arrives too late and you don’t have the chance to do first aid,” she explains. “Sometimes a woman can have postpartum hemorrhage and have to be transferred more than 100 kilometres. Now, with that distance, the woman is in critical condition, and then what can we do? It makes me sick.”
Fortunately, the Tanzanian government and partner organizations are working to reduce preventable maternal deaths by expanding access to emergency skills training for midwives. These professional development activities play a fundamental role in equipping midwives to deal with emergencies and to counsel families on nutrition, birth spacing and preparedness.
Martha wants her students to leave her workshops with the understanding that with every birth, they hold in their hands not only a baby’s life, but a family’s survival.
“If a midwife is able to diagnose early, it means she can take action early. It means the mother would have the required services and timely care, and reduce the complications,” says Martha. “When they listen to someone’s story, they should take it seriously and be ready to help. Because when a woman dies, it means the family dies.”
Martha says she’s optimistic for the future of mothers and newborns in Tanzania thanks to the willingness of her students and the importance the country is placing on maternal and newborn care.
“If midwives are well-skilled, our country will be happy and healthy. We will reduce the number of deaths of women, we will reduce the number of deaths of children, and we will even increase our lifespan. Because if you are healthy from the beginning, we expect you to continue to be healthy over a lifetime.”
Midwives Save Lives (MSL) is a four-year initiative in Benin, DRC, Ethiopia and Tanzania. Led by Cuso International in partnership with the Canadian Association of Midwives (CAM) and local midwifery associations, MSL is contributing to the reduction of maternal and newborn mortality by improving the supply and demand of health services and strengthening the work of midwives’ associations. MSL is funded by the Government of Canada through Global Affairs Canada.
This article is published with permission of Cuso International. Midwives Save Lives is managed by Cuso International in collaboration with the Canadian Association of Midwives and local partners including MAs in each of the countries.