Midwife Paulina determined to make every delivery safe
Paulina has received specialised training to help her manage critical and emergency obstetrics and newborn cases
Ermera, Thursday, 7th July 2023 – Paulina Fernando da Costa Silva’s 35-year career as a midwife is filled with gratifying memories of seeing mothers’ first bonding moments with their babies, and also the heart wrenching reality of losing a mother or the baby during childbirth. This is part of the story she shares about her experience of being a midwife at Gleno Community Health Centre in Ermera, on the western part of Timor-Leste, and a story which motivates her to do more to make every delivery safe for mothers and their babies.
"It is always painful to witness the death of a mother or child during delivery. So many questions come to mind as we ask what we could have done differently to avoid the death," says Paulina, who leads a team of five midwives at this intimate health centre, surrounded by long stretches of rugged terrains, steep mountains and lush green forests.
It is these difficult geographical features, coupled with household poverty, poor mobile phone network coverage, bad road networks and limited public transport, which reduce women's access to timely, quality healthcare services and increases chances of fatalities during delivery.
Of the 50 women who come for delivery at the Gleno Community Health Centre in a month, an average of five have complications such as eclampsia, vaginal bleeding, anaemia, prolonged labour or the baby is in a breech position. Handling of these complications requires specialised skills and equipment, which are not always available at Community Health Centre level.
"Cases which cannot be handled by us are immediately transferred to Dili for specialised attention. Unfortunately, many mothers come to the health centre very late, and the time it takes to transfer them to Dili often takes away critical time to save the mother and baby," says Paulina who is always determined to bring a happy ending to every delivery.
Challenges of fatalities during delivery are not confined to Ermera. Across Timor-Leste, newborn deaths, maternal deaths and pregnancy complications remain high. For every 1 000 live births, 22 babies do not make it, while for every 100 000 deliveries, 215 mothers lose their lives.
It was therefore a welcome opportunity for Paulina to be one of 40 midwives to receive specialised training in Safe and Clean Delivery, aimed at upgrading the skills of midwives to manage critical and emergency obstetrics and newborn.
Participants were drawn from Ermera, Viqueque and Baucau Municipalities, three of the Municipalities with poor maternal health indicators.
UNICEF supported the Ministry of Health in developing and rolling out this training, targeted at the midwives who provide the first level of obstetrics and newborn care at community health facilities.
The outline of the course included lessons on managing eclampsia and pre-eclampsia cases, inducing labour, using forceps in cases of prolonged labour and managing neonatal conditions such as breathing difficulties, hypothermia and caring of prematurely born babies.
Over a five-day period, theoretical lessons, practical demonstrations and simulations helped to improve the midwives' skills to provide clean and safe deliveries which will help the midwives to provide high impact interventions to reduce newborn and maternal deaths.
To complement this training, basic essential equipment such as ambu-bag, baby warmers, pulse oximeters and delivery tables have been supplied to the health, replacing the old and dilapidated equipment which was in use previously.
Already, the impact of this training is evident. Just yesterday, first time mother, Natalia Soares endured a prolonged labour, which ended when the midwives at Gleno induced the labour. Paulina and her team were also able to immediately suture Natalia’s raptured birth canal.
"Prior to our training, we would have transferred Natalia to Dili, but thanks to the new skills and equipment we have, both Natalia and her baby girl are here in Ermera, happy, healthy and waiting for their discharge," says Paulina as she shares yet another proud moment in her career.