The midwife is the closest healthcare person that a community encounters, and women who need healthcare services and access to necessary healthcare information gain access to it via their midwife. In Sri Lanka, Public Health Midwives (PHMs) provide basic family planning services, pre-pregnancy care, domiciliary care, and clinic care for pregnant women and children less than five years of age. The PHM is a member of the community and her service is immensely valued, particularly by people living in rural setups. Since the pandemic and imposed lockdowns, the role of midwives has since become even more significant, as they function as the only link for many women between themselves and their necessary pre/post-natal medical care.
Healthcare in Sri Lanka is accessible in two ways; there exists hospital-based care and community-based care. Hospital-based care is under the purview of the MOH, i.e. the Medical Officer of Health, in your area. For pregnant mothers and children what is advisable is shared care, where they maintain a link with the community healthcare provider. However, if you are able to access hospital care without community assistance, you can do so.
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Midwives attending a training session [/caption]
Often women who are able to access a professional obstetrician on their own and are stable enough economically to channel private doctors, etc., would likely skip the community care step. However, they are still advised to register themselves with their local MOH but they would operate under the advice of their obstetrician. However, in rural areas, women often do not have this luxury and must seek out the community assistance afforded by the MOH.
Dr. A. Pubudu de Silva, writing on “The contribution of Public Health Midwives to better health in rural communities in Sri Lanka” also confirmed that Public Health Midwives (PHMs) have been an important part of the primary healthcare system in Sri Lanka since early in the 20th Century, and that while traditionally these health workers focused only on midwifery, they have evolved into a professional cadre, playing a role in preventive health covering many aspects other than midwifery. Their services are immensely valued in rural settings where health resources are scarce.
Speaking to an MOH in the Walapane area, he shared that there are two kinds of midwives, those who provide services in labour rooms and work exclusively in hospitals and obstetrician wards, and the other are the field midwives. The field midwives are those who play the imperative role of seeking out pregnant women and registering them with the MOH and taking care of their needs, reminding them of their clinic dates, educating mothers on the importance of supplements, and even providing post-natal care up to four to six months post-pregnancy.
Speaking to a midwife who works in an obstetrician ward in Dikoya Hospital, she shared that the training that all midwives receive is similar, and both kinds of midwives, much like nurses, must complete a residency with an obstetrician and work at an obstetrician ward to qualify to carry out their services. However, she shared that in the case of field midwives, they must also be able to navigate their community effectively.
She shared that in a society like Sri Lanka where hierarchy is a key aspect of health culture, PHMs play a vital role in creating access to health information and services by building trust with the communities. Hence, it is apparent that the work of PHMs has had an overall positive effect on the community, therefore often the field midwives appointed to an area are from that area to begin with. They would already have relationships with the people in her community.
An example of how the field midwife would function is, if she hears of a newly married couple in her area, she would keep tabs on that couple and expect notification of a pregnancy, and if there is no such information she would take initiative to look into it, to provide any information that the young couple may be looking for.
She shared that during the pandemic she had delivered a number of babies, and encountered some mothers who had contracted Covid. She said that in such instances it is quite heart-breaking, as the mother must be isolated, where she would otherwise be surrounded by a number of patients and other mothers. She would be moved to an isolated room and this results in the mother being extremely scared, and feeling helpless and vulnerable. She said that this really places a lot of stress on the mothers but in her experience, thankfully, they haven’t yet encountered an unfortunate incident caused by the added stress, and most mothers have safely delivered their babies.
We spoke to a field midwife in the Dikoya area who shared that things have been a little difficult for many of the women experiencing pregnancies during the pandemic. She particularly noted that travel restrictions have made it so that only those mothers at risk have been visiting clinics regularly while others have remained indoors. She said that there have been some occasions where some mothers would show up to their regular appointment only to be turned away. Additionally, the general fear that mothers experience have been challenging, she said, stating that pregnancy often places the mother in a rather vulnerable state, both physically and emotionally, and when they are thrust into an uncertain environment, it is a difficult situation for them to navigate. So much of her role as a field midwife has been to comfort mothers and to assure them that they are safe, and their children will be unaffected by this present situation.
She stated that generally, each PHM is responsible for a particular area consisting of a population ranging from 2,000-4,000. Midwives have to do the initial appointments with pregnant women, manage clinics and postnatal care in the home, but they also maintain the role of a caregiver not only attending to the medical needs but also their emotional wellbeing, as many women confide in their midwives, particularly if they are coming from abusive homes and economically unstable backgrounds, and they seek out this assistance via the midwife.
Midwives attending a training session [/caption]
Often women who are able to access a professional obstetrician on their own and are stable enough economically to channel private doctors, etc., would likely skip the community care step. However, they are still advised to register themselves with their local MOH but they would operate under the advice of their obstetrician. However, in rural areas, women often do not have this luxury and must seek out the community assistance afforded by the MOH.
Dr. A. Pubudu de Silva, writing on “The contribution of Public Health Midwives to better health in rural communities in Sri Lanka” also confirmed that Public Health Midwives (PHMs) have been an important part of the primary healthcare system in Sri Lanka since early in the 20th Century, and that while traditionally these health workers focused only on midwifery, they have evolved into a professional cadre, playing a role in preventive health covering many aspects other than midwifery. Their services are immensely valued in rural settings where health resources are scarce.
Speaking to an MOH in the Walapane area, he shared that there are two kinds of midwives, those who provide services in labour rooms and work exclusively in hospitals and obstetrician wards, and the other are the field midwives. The field midwives are those who play the imperative role of seeking out pregnant women and registering them with the MOH and taking care of their needs, reminding them of their clinic dates, educating mothers on the importance of supplements, and even providing post-natal care up to four to six months post-pregnancy.
Speaking to a midwife who works in an obstetrician ward in Dikoya Hospital, she shared that the training that all midwives receive is similar, and both kinds of midwives, much like nurses, must complete a residency with an obstetrician and work at an obstetrician ward to qualify to carry out their services. However, she shared that in the case of field midwives, they must also be able to navigate their community effectively.
She shared that in a society like Sri Lanka where hierarchy is a key aspect of health culture, PHMs play a vital role in creating access to health information and services by building trust with the communities. Hence, it is apparent that the work of PHMs has had an overall positive effect on the community, therefore often the field midwives appointed to an area are from that area to begin with. They would already have relationships with the people in her community.
An example of how the field midwife would function is, if she hears of a newly married couple in her area, she would keep tabs on that couple and expect notification of a pregnancy, and if there is no such information she would take initiative to look into it, to provide any information that the young couple may be looking for.
She shared that during the pandemic she had delivered a number of babies, and encountered some mothers who had contracted Covid. She said that in such instances it is quite heart-breaking, as the mother must be isolated, where she would otherwise be surrounded by a number of patients and other mothers. She would be moved to an isolated room and this results in the mother being extremely scared, and feeling helpless and vulnerable. She said that this really places a lot of stress on the mothers but in her experience, thankfully, they haven’t yet encountered an unfortunate incident caused by the added stress, and most mothers have safely delivered their babies.
We spoke to a field midwife in the Dikoya area who shared that things have been a little difficult for many of the women experiencing pregnancies during the pandemic. She particularly noted that travel restrictions have made it so that only those mothers at risk have been visiting clinics regularly while others have remained indoors. She said that there have been some occasions where some mothers would show up to their regular appointment only to be turned away. Additionally, the general fear that mothers experience have been challenging, she said, stating that pregnancy often places the mother in a rather vulnerable state, both physically and emotionally, and when they are thrust into an uncertain environment, it is a difficult situation for them to navigate. So much of her role as a field midwife has been to comfort mothers and to assure them that they are safe, and their children will be unaffected by this present situation.
She stated that generally, each PHM is responsible for a particular area consisting of a population ranging from 2,000-4,000. Midwives have to do the initial appointments with pregnant women, manage clinics and postnatal care in the home, but they also maintain the role of a caregiver not only attending to the medical needs but also their emotional wellbeing, as many women confide in their midwives, particularly if they are coming from abusive homes and economically unstable backgrounds, and they seek out this assistance via the midwife.