MAP’s community midwives caring for mothers and babies in Lebanon

The health of women and children is a major cause for concern for Palestinian refugees in Lebanon, with rates of maternal and child mortality and morbidity remaining high. Medical Aid for Palestinians (MAP)’s team of community midwives play a vital role addressing this, providing the only home-visiting midwifery service in Palestinian refugees camps in Lebanon.

We sat down with Ola, a MAP community midwife, to discuss how she and her colleagues are promoting the health and dignity of Palestinian mothers and their new-born babies.

Hi Ola, what made you decide to become a midwife?

“I always knew I wanted to be a midwife. I love children and I feel that the midwife helps to bring a child to this world. I am a mother of three children myself. I had many complications during my pregnancies, so I empathise with every pregnant woman and new mother I work with and try to give her the care that she needs to have the best outcomes.”

How are you helping expectant and new mothers?

“In hospitals, the role of the midwife is limited to delivery. In the Maternal and Child Health project we [MAP midwives] follow-up on mothers throughout their pregnancies and then during six months after childbirth. According to mothers, UNRWA services are good but not sufficient. The consultation time [less than an average of 5 minutes] is not enough to provide health education, discuss the mother’s concerns, and make sure the messages were understood correctly. Our home visits last 30-45 minutes which gives mothers time to discuss their concerns and thoughts. We work with the mother to set a plan that suits her specific situation and condition. For example, if a pregnant woman is not complying with the iron treatment she is given, we try to understand the reasons and advise accordingly.

“I work on establishing a relationship with the mother, understanding her situation, and gaining her trust. The more I know her and her situation, the better I am able to give her suitable advice and to help her.

“I do my best to keep pregnant women from feeling worried or guilty. They often blame themselves for anything that goes wrong. Many times, mothers ask me if they had the complication because of something they ate or because they cleaned the house, etc.

“Mothers-in-law often try to impose their traditional and sometimes unsound ways of caring for a child. For example, they think that giving a newborn sugared or rice water in addition to breastfeeding is a good practice as the baby puts on weight faster. I try to work with the mothers-in-law through group health awareness sessions to help them see benefits of the evidence-based methods. They usually end up becoming our best advocates.

“In the awareness sessions that we conduct, past project users get a chance to meet with new mothers enrolled in the project and exchange experiences and advice. I feel that the project has built a small community of proud and confident mothers.”

How do you know you have succeeded in your work?

“When I run into women who I worked with nine years ago and they are happy to see me and update me on their situation, I know that I have made a difference to them. When women I worked with in the past years refer other pregnant women to the project, I know that they believe that the project has helped them. Many mothers also feel sad to exit the program six months after childbirth; they wish to continue to be visited by the team.”

What are the key challenges you face?

“Women in the camps face many challenges that make their pregnancy experience difficult. Many families in the camp suffer from extreme poverty which means that having a nutritious and balanced diet is not always possible. The unstable security situation in some camps also causes mothers to be constantly stressed and worried for their children.

Also, as mentioned earlier, the prevalence of unsound traditional practices related to infant care can sometimes make our job difficult. For example, we have to convince a mother that putting salt or garlic on the baby’s umbilical cord is a bad practice, even if that goes against her mother’s or mother-in-law’s advice.

In some cases, mothers face adverse conditions, and I wish there was more that could be done to help them. For instance, one project beneficiary I can’t forget was 18 years old when she got pregnant. A few months after I started visiting her, her husband was diagnosed with terminal cancer. She was in a very bad psychological state and was working hard to secure money for the tests he needed. Sadly, the husband passed away shortly after his diagnosis and right before she gave birth to their first child. I visited her frequently to support and take care of her and the baby’s health. I still remember her sometimes, and I hope she and her child are doing well now.”

In Lebanon there is a shortage of midwives, why do you think this is the case?

“There is a shortage in the midwifery and nursing workforce in Lebanon. Midwives in hospitals are in general not fairly treated in terms of salaries, rights, and benefits. Sometimes, their role is not well-defined either. When compared with physicians, the role of midwives is largely undermined especially in normal deliveries.

So many young people are either discouraged to study midwifery or they travel abroad to work after graduating, because they are confident that there are better opportunities or conditions for practicing this job. Despite the shortage in the workforce, Palestinians are still not given the right to work in this domain in Lebanon.”

Thanks for talking to us and the important work you do, Ola.

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