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Supporting Zambian midwives to improve maternal and neonatal care

Lucy Hines

Birth Centre Midwife, PRUH, King's College Hospital NHS Trust and KGHP Volunteer

05 December 2022

Ever since I became a teenage mother at the age of 17, it has always been my ambition to help deliver babies in challenging contexts. But it was only once I finally became a midwife, at the age of 40, that I realised how difficult it can be to ensure the safety of mothers and babies during childbirth in low and middle-income countries (LMICs).

More than 300,000 women die during pregnancy and childbirth every year around the world – and most of these deaths could be prevented (WHO, 2019). Maternal mortality in Zambia is estimated at 183 deaths per 100,000 live births, compared to less than 2 per 100,000 in the world's highest-performing countries, with the reasons including poverty, cultural practices, poor care and distance to healthcare facilities.

As one NHS midwife, I wondered if there was much I could do to make a difference, but as part of King's Global Health Partnerships, in November I travelled to Zambia with two colleagues to take part in a project to help local midwives develop their lifesaving skills.

Haemorrhage, severe high blood pressure, and infection are three of the leading causes of maternal death globally, and as part of a week-long training course, my colleagues - Dr Lucy Caird and fellow midwife Harriett Earp – and I devised and delivered a package of lectures and practical skills sessions aimed at helping staff to recognise, treat and stabilise women suffering from these conditions.

In addition, the course covered subjects such as breech delivery, cardiac arrest, safe abortion, and vacuum delivery of the baby, with the objective of 'training the trainers' – that is, enabling the 11 managers of local healthcare facilities to later 'cascade' the course to their nursing and midwifery staff, and to help improve the survival rates of over 40,000 women and babies.

Five months of intensive preparation went into developing the course, until I finally found myself boarding a tiny plane from Johannesburg airport, after around 24 hours of travelling from London, in torrential rain and lightning. Three days later – and after a brief visit to a game park during which I held a python! - we met the midwives who would impress us so much with their incredible levels of skill, caring, innovation and optimism amid a working environment desperately short of staff and resources.

KGHP Volunteer Lucy Hines holding a python in Zambia

During the training they talked of managing emergencies without the basic equipment we take for granted in the UK, such as plastic syringes and urinary catheters, both of which are essential in a torrential haemorrhage. And when we mentioned that British women in labour have their own midwife during labour, they were stunned; in Zambia, one midwife can care for up to 10 women at once.

The training participants were highly competent, with a far wider scope of normal practice than most NHS midwives, including family planning and manual removal of the placenta; however, some of their skills did need updating, and several that we taught were brand new to them, such as vacuum delivery, and manoeuvres to release the impacted shoulder of a baby when stuck during birth.

By the end of the week their test scores had improved by 30 per cent, and they had demonstrably developed their skills in communication, teamwork and assessment of the sick patient. In addition, on the final day the midwives practised delivering the teaching sessions to each other, in preparation for the training courses which they will lead themselves, assisted by refresher modules in midwifery skills, neonatal care and leadership which will be delivered by the project's volunteers over the next two years.

Zambia midwife training practicing on watermelon

The learning did not just extend to the Zambian midwives. I personally delivered sessions on haemorrhage and severe high blood pressure – both of which are everyday occurrences even on British labour wards – and as a result, I experienced a definite improvement in my own skills and confidence when such emergencies later arose in my role as a birth centre midwife.– Lucy Hines, Midwife and KGHP volunteer

As a first-time global health volunteer, I had worried that I would have nothing to contribute to the development of healthcare workers already doing an amazing job in a hugely difficult situation. But sometimes small changes can actually make a difference; after the course, we received a message from one of the midwives who had helped her staff to successfully deal with a haemorrhage the very next day, and she thanked us for the new skills we had given her.

Zambia midwives training with KGHP volunteers

Overall, the maternal mortality rate in LMICs has roughly halved since 2000 (WHO, 2019), and if I can help to make just the tiniest contribution to this, my 20-year ambition as that naïve teenage mum will have been realised.