Saturday, 8 November 2014

Midwifery leadership and a mini-strike long before the RCM's!

This week in Nepal I was privileged to spend some time with a retired midwifery leader.  She prefers not to be named so we'll call her Momo, the Nepali lunch-time snack we were eating whilst she told me this story.

Momo was matron of a busy maternity unit.  Under her leadership, midwives started to perform vacuum deliveries, an essential life-saving skill for midwives who would be going out to work in rural areas with no back-up.  For three years midwives had a faultless track record, performing vacuum births with much better outcomes than their medical colleauges.  Then, one busy day and one difficult delivery with the cord tight around the neck, a baby died during a vacuum birth. The woman's visitors complained.  Doctors and others blamed the midwives for the death.  The hospital director was unsupportive, sending the visitors to Momo's office. Momo had a difficult three days trying to support and protect her staff, not helped by vitriolic TV propaganda against midwives.  Momo drew staff together in her office and they all agreed to a 'mini-strike' or 'work-to-rule' until the issue was resolved.  No midwife (or nurse midwives as they are in Nepal) would do anything other than basic care - no episiotomies or repairs, no IVs or oxytocin etc.  Everyone stuck together.  If a doctor asked them to perform any extra task the midwives apologised but said he would have to discuss this with Matron as they were not allowed to perform extended roles.

After 24 hours of the work to rule, Momo was called to the Hospital Director's office.  The doctors couldn't cope and the maternity ward was in melt-down.  The director accepted that the death could just as easily have happened with a doctor performing the vacuum delivery. Momo scolded the director, asking her why she could not have just taken this stance at the outset, avoiding all the difficulties.  Midwives returned to their usual roles and have never since had anyone questioning their right to perform vacuum deliveries (according to the ICM, one of the additional skills a midwife  may be required to have  to make the difference in maternal and neonatal outcomes in their country).  

Some time later, Momo felt the staffing her maternity unit was dangerously low with only 5 or 6 per shift to cover the whole unit including for 30 labour/delivery beds.  She wanted to double this to 11 staff.  After weeks of unsuccessful campaigning she told the hospital director  she would close the maternity unit unless the staffing increased.  And so it was agreed!

What a great example of leadership.  It just goes to show that the RCM were not the first to host a midwives' strike!


  1. Can I please recommend all RCM staff take a look at Joy’s blog from Nepal. Fantastic example of midwives standing together to improve care. Joy – for some reason I can’t post a comment but I love this story.

    Cathy Warwick


Dhaka Diary

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