Our Clinic #8: Training Midwives Saves Lives in Niger

Carrie Blake, CPM, MPH, has been a practicing midwife since 2006. She is passionate about working with community midwives in those parts of the world where healthcare is the least developed to empower them to improve health in their communities. Carrie works with Remember Niger in Niger, and recently has begun work with Health for All Nations to empower and educate both skilled and unskilled midwives working in the most underserved countries in the world. 

Moussa dropped off a community midwife with whom I'd be exchanging birth knowledge for the past few years with the simple statement: "Amina wants to talk to you." Amina had never come to my home alone to talk and there was one problem: Amina and I do not share a common language, at least not fluently, and there was no one else around who could help us with communication." We sat in the tent in my yard and she excitedly told me about something that had happened the day before. Because our conversations are generally midwifery focused, I assumed that it had something to do with a birth. I started asking her questions in our limited common language. I pulled out my laminated cards showing different pregnancy, birth, and postpartum-related sketches. 

"Twins?"

"No," she shook her head. 

"Breech?"

Nope. 

Finally, I flipped over the card that showed how to properly resuscitate a baby — a topic we had discussed at length before. In their culture, a baby who appeared dead at birth is set aside with no attempt to revive him, no checking for a heart beat, or even a second thought as to whether the baby is alive or not. Amina and I had many conversations about this, and I had begged her to try resuscitating a baby just one time to see if there could be a positive result. Nevertheless, I doubted that she would ever do this, given the context. 

A few days later, I was at a baby-naming celebration in Amina's village. I sat on the bed with the mother of the baby for a few minutes and complimented her on the health of her baby. I sat down in the middle of the room, wrapped in the oppressive heat of the day. Large platters of food were brought in and the 75 or so women — young, middle-aged, and old — shared a meal. As we finished eating, Amina called for everyone to listen to her. 

"Do you see this baby?" she said.

Her audience replied with nods. 

"Does he look healthy?" she asked.

Her audience replied with a resounding "yes!".

"Do you know what happened when he was born? He looked like he was not alive. But by the grace of God, he is! Do you know how? I simply gave him five little breaths. That was all it took."

At this point, Amina went into a detailed lesson of how and when to properly resuscitate babes. She even addressed the benefits of using a bag-and-mask (Ambu bag) versus the mouth-to-mouth method. That day, every one of those women learned the importance of at least trying to help a baby. Since then, some of them have even implemented the lesson. That baby is alive today because one community midwife was willing to take a risk. Countless babies are alive today because that community midwife took responsibility to share an important skill with her community members. 

Shortly after this, Amina and her friend Tabitha came to me with a brilliant idea. They presented to me their dream to gather community midwives from surrounding villages to help them learn birth skills including resuscitation and community health education. They explained to me their goal to work with the local health clinic to develop a supportive network. They asked if I would help. 

And so the Train Midwives Save Lives in Niger was born. Since 2021, we have hosted seminars with a range of community midwives. Today, they are nearly fully trained in the World Renew's Mama Lumiere community health program, and are already implementing it. Each seminar, we continue adding to their skills and knowledge. Our topics include: risk factors and warning signs in pregnancy and birth, nutrition, relationships, wound care, resuscitation, preventing hemorrhage, breastfeeding, and any other issue that the community midwives are interested in learning. While their newfound resuscitation skills will likely have the greatest impact, we have many other exchanges that are equally, if not more, important to the health and well-being of mothers and babies. 

17 midwives and I gather on our mat, nearing the end of several days of exchanging knowledge. Despite the sweltering 46-degree Celcius day, their colorful dresses and scarves filled me with joy on this particular Thursday in October. 

"When we think that a baby goat is not getting enough milk, do we give it cow's milk?" I asked with a smile.

"No! Of course not! We feed the mama goat and try to get the baby goat to suck more at the teat!" They responded in earnest, laughing at my silly idea to give cow milk to a goat. 

"Ok, then, how come when we are worried that a human baby is not getting enough to eat, we give the baby goat's milk?" I challenged. 

17 pairs of bright eyes stared back at me as they realized a major flaw within their common practice. There was silence for a moment. Then, someone spoke up. 

"We must change this! We have learned about how women should eat while breastfeeding and we need to make sure they drink enough water and eat enough, then the babies will not be hungry." 

After her discourse, the group made a pact that they would no longer routinely give goat milk to the babies. 

Midwives usher in new life. Community midwives are in positions of great influence as they can speak to the lives of their villages, clans, and tribes. Simple and targeted education for community midwives can save the lives of many, and change the health status of entire communities. Empowering and equipping community midwives to work collaboratively with local and skilled health professionals will move the least-developed healthcare systems to the frontier of medicine. 

Sometimes, five little breaths and a mother's milk are all it takes.

Story written by Carrie Blake (carrie.blake@frontierventures.org) and edited by Kaitlyn Gosakti.