Exploring Midwives’ Experiences with Intrapartum Care in Health Facilities in Ankole Sub-region, South Western, Uganda
This qualitative study of midwives in Uganda's Ankole Sub-region reveals that while they possess a strong professional drive, their intrapartum care delivery and career retention are significantly compromised by systemic limitations, resource shortages, and heavy workloads that lead to burnout and dissatisfaction.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine a group of ten brave midwives in the Ankole sub-region of Uganda, working in health centers that feel a bit like a crowded, under-stocked kitchen during a massive dinner rush. These midwives are the chefs trying to serve the most important meal of all: safe births for mothers and babies. But here's the twist: while they are incredibly passionate about their job, the kitchen is running out of pots, the stove is broken, and they are being asked to cook for three times as many people as the recipe says is safe.
This study, conducted by researchers Eve Katushabe, Mary Steen, and Ayishetu Musa-Maliki, listened to these midwives to understand what it's really like to work in this high-pressure environment. They didn't just ask "what happened?" but "how does it feel?"
The Good Stuff: The Heart of the Job
First, let's talk about the spark that keeps these midwives going. Despite the chaos, most of them have a deep, internal "superhero" feeling. They described the joy of being the very first person to see a baby enter the world and hearing that first cry. It's like being the first person to witness a magic trick happen in real life. One midwife said, "I am genuinely pleased to be a midwife, as I have aspired to this profession since my high school years."
Even when things go wrong, they feel a fierce loyalty to their job. They told the researchers, "Nobody studied midwifery to mistreat mothers, it's because of these challenges." They feel that if they stop working, mothers might die, and that thought haunts them. So, they keep showing up, driven by love and a sense of duty, even when the system is failing them.
The Bad Stuff: The Broken Kitchen
However, the "kitchen" they work in is full of holes. The researchers found three big problems that are making the job nearly impossible.
1. The "Orphan" Syndrome
The midwives feel like orphans in the system. They studied hard, upgraded their diplomas, and spent their own money to get better qualifications, but the government isn't promoting them. It's like running a marathon and crossing the finish line, only to be told, "Nice run, but you're still in the starting block."
- The Reality: Out of ten midwives, seven had upgraded their education to a diploma level, but only one was actually promoted to the higher job title of "Assistant Nursing Officer." The rest were stuck as "Enrolled midwives," the lowest level, even though they had the same or better education.
- The Feeling: They feel ridiculed by colleagues who didn't study, and they feel the government is using them as "cheap labour." One midwife noted that even asking to wear a different uniform to show their new status was denied. They feel invisible and unvalued.
2. Running on Empty
The health facilities are dangerously short on supplies. Imagine trying to bake a cake without flour, eggs, or a mixing bowl.
- The Space: The labor wards are so small that midwives sometimes have to tell mothers to wait outside until a bed opens up. Tragically, some women end up giving birth on the floor, covered by a plastic sheet (locally called kaveera), because there is no room inside.
- The Money Trap: When a mother needs to be sent to a bigger hospital for an emergency, the ambulance needs fuel. But the mothers are too poor to pay for it. The midwives are so scared of a bad outcome that they sometimes use their own meager salaries to buy the fuel. One midwife said, "I sometimes buy fuel to transfer the mother because I know if she delays, complications will occur."
- The Shortage: There aren't enough people. In one facility, there is only one anesthetic officer for the whole place, and they only work every other week. This means for a whole week, no C-sections can be done, and high-risk mothers have to be sent away. The midwives are also stuck working 12-hour shifts (8:00 AM to 8:00 PM) with very few days off.
3. Doing Things the "Old Way"
Because they are so overwhelmed and lack training, some of the care they give isn't based on the latest science.
- The Position: They often force mothers to give birth lying flat on their backs (the lithotomy position) because the beds are small and they are used to it, even though sitting up or lying on the side is often safer and more comfortable.
- The Timing: They sometimes give a shot to stop bleeding (oxytocin) too early or too late, or they fill out the "Labour Care Guide" (a chart tracking the birth) after the baby is born just to make the paperwork look good for the bosses. It's like writing a diary entry about a party after everyone has gone home, just to prove you were there.
The Aftermath: Burnout and the Exit Plan
The result of all this? The midwives are burning out. They are exhausted, emotionally drained, and physically tired. They come home feeling like "garbage" and can't even talk to their own families because they are too tired.
- The Threat: Some are even thinking about quitting. One midwife said, "I have a backup plan already. I'm taking a different course... so this workplace isn't ideal for me."
- The Risk: The researchers suggest that if these midwives leave, the shortage of skilled birth attendants will get even worse, putting more mothers and babies at risk.
What the Paper Says (and Doesn't Say)
This study suggests that the current system is broken and that fixing it requires more than just telling midwives to "try harder." It argues that the government needs to:
- Promote midwives who upgrade their education.
- Build more labor wards and buy more equipment.
- Pay midwives enough so they don't have to use their own money for fuel.
- Train them on modern, evidence-based practices.
The paper does not say that the midwives are bad at their jobs. In fact, it explicitly rules out the idea that they are unskilled or uncaring. Instead, it argues that the environment is forcing them into bad practices. It also does not claim that these problems are unique to this one region; it suggests these are systemic issues common in resource-limited settings.
The authors are confident in their findings because they listened to the midwives directly, recorded the interviews, and checked their notes with the participants to make sure they got it right. They didn't simulate this on a computer; they walked into the health centers and heard the stories.
The Bottom Line
The midwives in Ankole are the heroes who want to save lives, but they are fighting a battle with broken weapons and no backup. The study concludes that to save the mothers and babies, we need to save the midwives first by giving them the tools, the pay, and the respect they deserve. As one midwife put it, "We cannot lay down tools to let mothers die," but the system is making it very hard for them to keep holding on.
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