Hesperian Health Guides
Working with medical centers and doctors
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Midwives, nurses, doctors, and other health workers must all work together for the health of women and families.
Midwives need medical centers and doctors. When a woman is having a medical emergency, a wise midwife knows that a medical center is probably the best place for her to be.
Sadly, many doctors do not realize how much they need midwives. Doctors are trained to look for emergencies, and many treat every birth as an emergency. But midwives are experts on normal, healthy birth. They often have more of the patience and trust that a woman in labor needs to give birth. Many midwives know how to use plant medicines, how to use massage, how to turn a baby safely, or have other knowledge that is not taught in medical schools.
Doctors may not appreciate a midwife’s special skills. Traditional midwives in particular may be looked down on and considered uneducated or not competent. It can be very difficult for a midwife to work with a medical center for the good of pregnant women.
Because of these challenges, it is important to build a relationship with medical centers and doctors before an emergency happens. This way, when you need help, you are more likely to be treated with respect. Try talking to just one doctor who seems to understand how important midwives are. Talk about the ways you would like to work with the hospital. If possible, a meeting between a group of midwives and a group of doctors can help everyone work together.
When midwives and hospitals work together, everyone benefits. If midwives refer women at risk more quickly, doctors can do more to prevent problems. And a midwife who is treated with respect will more readily bring a woman to the hospital. Here is a true story:
A midwife who would not give up
Neusa, a tiny farmwoman, is a health worker in Brazil. Laura, one of Neusa’s patients, had been pregnant 3 times before but had lost each baby because of high blood pressure followed by convulsions during the last month of her pregnancy. Laura was a sad woman, quiet and resigned to her fate of never having children. Neusa talked with Laura about her health, and gave her vitamins and encouragement about her pregnancy, care she had never received before. Laura looked forward to Neusa’s visits. One day in her 8th month, Laura woke up with a terrible headache and swollen legs. Laura had no mirror in her hut to see her face, but when Neusa arrived, she was shocked to see how swollen Laura’s face was. Neusa knew that without help, Laura would once more lose her baby and possibly her own life!
Since it was the week before Christmas, the hospital had only a few doctors and nurses working. They did not want to take more patients, so they gave Laura an injection and told her to go home and wait until her baby was ready to be born. Neusa would not accept this and went to the hospital director’s office to explain Laura’s situation and past problems. But even after seeing her badge and hearing that she was a health worker, he told her there was “no room at the inn” and that Neusa must take Laura home and wait.
But Neusa would not give up. She knew that Laura’s condition was too dangerous to return home. Instead, she took Laura to the police station. There Neusa made a ruckus. She may be a tiny woman, but she has a voice and a gleam in her eye that is unforgettable. When she is “in battle,” she is not easily ignored!
Finally, a police car took Neusa and Laura to a hospital an hour away from Neusa’s village. By the time they arrived, Laura’s blood pressure was very high, so the doctors did a cesarean and Laura gave birth to a healthy baby boy. Neusa’s health knowledge, determination, and love for her work saved this baby’s life — and perhaps his mother’s too!
In a health system that works well, midwives and doctors work together.
- When a midwife brings a woman to a medical center in an emergency, she should be able to stay with the woman throughout the birth. This will make the woman more willing to get medical help in an emergency, because she will feel more safe and calm. It also will allow the midwife to learn by watching how the medical center treats emergencies.
- Midwives, doctors, and other health workers should talk to each other about the common health problems in the community, and about how each of them can work to solve those problems.
- Midwives should be able to ask doctors medical questions, and doctors should freely answer them. Doctors and medical centers can provide training and equipment to midwives.
At the medical center
Medical centers and hospitals have their own rules and procedures. These will feel unfamiliar until you have experience with them.
If you are able to come to the medical center with a woman who is having a health problem, you can learn about these procedures and skills and explain them to the woman and her family. Perhaps you can even help change procedures that are not necessary.
Learn from medical centers
Watch everything that is done at the medical center. When you can, ask questions.
Explain what is happening
Let the woman and her family know why each procedure is happening. Make sure the woman understands and agrees to the treatment.
Work to change unnecessary, disrespectful, or harmful practices
Some hospital practices are not necessary. They may cause a woman discomfort for no good reason. For example, there is no need to shave a woman’s pubic hair before a normal birth. This is an unnecessary but common hospital practice. Anther common medical practice that can cause problems is episiotomy (cutting the vaginal opening) before every birth to be sure there will be enough room. This is not necessary. It can cause deeper tears into the rectum and may not heal as well as a small tear. If you have a good relationship with a medical center, you may be able to suggest a few changes. You will probably have the most success if you suggest only one change at a time. Here are a few things that you might focus on:
- Procedures should be clearly explained to anyone who is receiving care.
- Women should be able to eat and drink during labor.
- Women should be allowed (and encouraged!) to sit, stand, or walk during labor.
- Women should be allowed to give birth sitting, squatting, or standing.
- Unnecessary procedures and surgery (like routine episiotomy or cesarean surgery) should be avoided.
- Women should be allowed to hold their new babies right after the birth. They should be encouraged to breastfeed right away.
- Babies should be kept by their mothers, not in a nursery unless there is an emergency.