Supporting midwives to deliver essential care to mothers and babies during the pandemic

An effort to improve health service delivery in Sierra Leone

Tapuwa Mutseyekwa
A nurse helps a mother initiate breastfeeding to her baby
UNICEF Sierra Leone/2021/Mutseyekwa
24 May 2021

Freetown - As a midwife, Agnes Hagan gets fulfilment and joy from safely bringing babies into this world and ensuring that each mother coming through King Harman Road Hospital in Freetown, receives the best care throughout their pregnancy, delivery and after the birth of their child.  The emergence of COVID-19 in Sierra Leone in 2020 however threatened to steal this joy from Agnes, as some mothers reneged on visiting the hospital for maternity services, while on her part, there was fear of contracting COVID-19 while in the line of carrying out her duties.

“The first thing I recalled when I heard about the COVID-19 outbreak in Sierra Leone, was the many colleagues and friends of mine who died in 2014 due to Ebola.  I therefore started to recall some of the Infection Prevention and Control (IPC) measures we adopted during the Ebola outbreak so that I could protect myself, the mothers and the babies from contracting the disease,” says Agnes, as she explains the importance of keeping frontline workers such as midwives well protected during the pandemic.

With a high patient load of more than 50 patients attending antenatal and postnatal services at the hospital, five deliveries being attended to daily and more than 15 mothers recovering from deliveries in the post-natal ward on each day, the team of five midwives and 31 general nurses at King Harman Road Hospital faces a high level of contamination risk if proper infection prevention measures are  not adhered to. 

To support service providers like Agnes around the country to regain their confidence in doing the work they love and keeping the essential health services including maternity health services available and safe in the context of a highly contagious disease, 2868 service providers were trained. The trainees included midwives, general nurses and community health officers who received training on COVID-19 screening, prevention, management, and proper referral. The training, which was led by UNICEF, with financial support from the World Bank, has helped service providers to properly carry out their duties while protecting themselves and their patients from COVID-19. 

The training adopted a cascade approach, which started with training of master trainers who imparted the skills and knowledge to the district trainers, who in turn trained the service providers from the hospital and Peripheral Health Unit (PHU) staff.  The training focused on familiarizing the service providers with the guidelines of discharging their duties, while protecting themselves and their patients from contracting COVID-19 as well as providing them psychosocial support during the difficult times.

Two nurses monitor a newborn at a hospital in Freetown
UNICEF Sierra Leone/2021/Mutseyekwa
Agnes, together with colleague Victoria Dixie, provide ongoing monitoring of a newborn.

“As a midwife, we cannot avoid being in close contact with the mothers and babies we attend to,” says Agnes, as she explains the close physical proximity they have with women in the maternity hospital setting. “I need to be in close contact with them to get an accurate record of their vitals such as blood pressure or drawing blood samples, listening for the baby’s heartbeat and being with them in the labour ward.  All these interactions can expose us as midwives and the expectant mothers to COVID-19.”

Equipped with the knowledge and skills from the training, midwives such as Agnes now begin their interactions with expectant mothers by washing their hands with soap and clean water and then putting on their clean Personal Protective Equipment(PPE), such as aprons, face masks and gloves. 

This is then followed by going through the detailed triage form to check if the patient has any of the COVID-19 symptoms such as dry cough, fever, or body weakness.  Should a patient present with either of these symptoms, they are put into isolation for 24-hour observation with the essential care continued and then referred to the nearest COVID-19 treatment centres if symptoms do not subside.  During each visit, patients are also given adequate information on how to prevent COVID-19 and are made aware of the importance of the screening exercise that is being done vigilantly by the midwives.

“It has been important for us to observe these guidelines and to reassure expectant mothers that the maternity hospital is still the safe facility for them to deliver their newborns,” says Agnes.

Within the maternity hospital, beds in the labour wards and those in the post-delivery wards are now well spaced out to reduce close contact between patients. Proper systems are in place to ensure the safe disposal of used PPE.

“Since the outbreak of COVID-19, UNICEF in collaboration with partners has supported the Ministry of Health and Sanitation in ensuring measures for the continuity of life-saving health services such as maternity services. Promoting the safety and self-care of our midwives is one of the key ingredients to help our health facilities to continue delivering services during this period of COVID-19,” said UNICEF Chief of Health and Nutrition, Yuki Suehiro.

Although the number of new COVID-19 seems to be going down, Agnes cautions that this is not a call for midwives to relax on adhering to the protection safety measures they have learnt.  She believes that these lessons and practices should become a part and parcel of how general hygiene is maintained while providing services to mothers and babies.