midwife

Women’s health volunteerism: Delivering care around the globe, where it’s needed most

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

Photo by Suzanne Saunders, CNM

I have been a certified nurse midwife for 21 years. Having worked with NCMA Women’s OB/GYN Center for nearly 18 of those years, I’m very happy to continue my work both in Sonoma County and in sometimes faraway locales where adequate care is scarce.

I truly love women’s health. And let me tell you, there is nothing like holding a brand new baby in your hands!

I have long had an interest in providing care to women in countries where access is challenging. In addition to my master’s in nursing at Emory University, I also completed a master’s in public health, with a focus on international health concerns. My public health program emphasized the need for sustainable programs that had a lasting effect rather than “Band-Aid”-type efforts. Most programs rely heavily on donated supplies, and on volunteer labor to sustain them over time. I knew I wanted to make an impact, but wasn’t sure how to get started.

My first adventure became a family adventure

On the advice of a local colleague, I looked into two programs that had lengthy histories in their host countries, and had made significant impacts on local maternal health. The one I chose in 2011 was with Mercy in Action. It is located in Olongapo, Philippines, which was a nice coincidence, as my brother lived a few hours from there! I wanted my kids to be a part of my efforts. Although they were too young at the time to participate directly, by traveling there with me they could understand why it was important to me. In addition, I wanted them to realize how different life can be outside the U.S. By choosing this project, I could start my adventures as a volunteer, as well as get the kids involved.

I participated in a two-week intensive training on providing care in a low-resource environment, in addition to hiking to remote areas to provide needed prenatal and post-partum care to rural Filipina women. It was an amazing learning experience! My kids stayed with family, and while they were not with me, I did my work. They still had a lengthy trip in a developing nation. They were 5 and 10 at the time, and have never forgotten it.

On the ground in Haiti

Two years later, I went to Hinche, Haiti, with a group called Midwives for Haiti. It is a non-governmental organization (NGO) based in rural Haiti for the last 25 years. A midwife colleague had been there, and highly recommended the work they were doing.

After some vigorous fundraising, two labor nurses and I flew into the unknown. Haiti is the most dangerous country in the Western Hemisphere to have a baby, due to factors such as:

  • difficult access for rural women,
  • very few providers per thousand population,
  • a preference for home delivery due to costs, and
  • a high rate of risk factors such as preeclampsia and malnutrition.

In the U.S., midwives are often in a position of protecting normal pregnant women from having a disturbed or interventive birth. In Haiti, many, many births are high risk, and many more women need intervention than actually get it.

Midwives for Haiti has three main directives:

  1. To teach as many Haitians as possible the profession of midwifery. The more providers there are in the country, the more women have access to care.
  2. To support the mobile midwife service. These are a group of 5–6 midwives that go to a rural village every day, for a total of about 25 communities a month. This is typically the only way the women in those villages will ever get prenatal care.
  3. To train the “matwons,” which are traditional or “granny” midwives, working in remote areas but typically without much medical knowledge. The mobile midwives work closely with the matwons, to encourage them to give the best care they can, and to refer high risk women back to them.
Suzanne Saunders, CNM, Haiti, newborn baby and mother

Suzanne Saunders (L) loves her volunteer work.

The conditions in Haiti cannot be more different than here, and can be quite shocking if you have not traveled to truly desperate, developing nations. I saw and experienced things you might only see once, or never, in an entire career in the U.S. We had a patient die of pre-eclamptic complications the second day of our trip, which would have been fairly easily treated and dealt with here. It’s crushing to know that every woman you treat knows a friend or family member (often several) who has died of childbirth complications. The ambivalence toward newborn babies that might not even survive their first six months is heartbreaking.

Watching what Midwives for Haiti can do on a shoestring budget is a bright light in all of this! They train 20–30 midwives a year, who then go and serve their own communities for years and years. They send midwives out into the villages to give women much-needed prenatal care. And support the home-based Matwons in their quest to provide home birth. All of this has made a significant impact on maternal and infant mortality in their corner of Haiti. I am very satisfied that their program meets many criteria of sustainability in the NGO realm, and have seen with my own eyes the impact they are having.

Going back to Haiti

I went back to Haiti two years later and it was just as powerful. The supplies and medicines we brought were eagerly distributed as needed. Our work felt important, in a way that is hard to describe. It is incredibly hard work, under ridiculous conditions (think, rare running water—in the hospital!, think 90+ degrees with nary a fan, think riding in a rattle-trap jeep over washboard roads for two hours to reach the mobile clinic, think mosquitos that are trying to kill you!). But fulfilling in a way that first world health care isn’t.

I am hoping to go again in December after a bit of fundraising. If you are able to contribute, please visit our GoFundMe campaign. We will be so grateful.

Every dollar goes to teaching students, purchasing meds and supplies to bring along, and to the very small staff that keeps it all running. Believe me, they make every dollar work double time! Certain supplies are highly desirable, as are certain medications.

Most needs are simple, like

  • sutures,
  • Tylenol/ibuprofen,
  • cloth diapers,
  • blood pressure cuffs, and
  • other basics.

A basic kit of equipment is put together for each midwife student, to make sure they are prepared for their training and first months of work afterwards.

If any of you have donations of medical supplies, and/or funds to purchase said supplies, they are very warmly and happily accepted.

Suzi Saunders, CNM
NCMA Women’s OB/GYN Center

Fewer Cesarean Deliveries Associated with Midwife-Attended Hospital Births

Women who gave birth at hospitals with a larger percentage of midwife-attended births were less likely to have two specific medical interventions, cesarean delivery and episiotomy, a new, hospital-level analysis. These findings raise the possibility that greater access to midwifery care, which is low in the United States, might enhance perinatal care and lower costs for low-risk women.

In a new, hospital-level analysis by health policy researcher Laura Attanasio at the University of Massachusetts Amherst and Katy Kozhimannnil at the University of Minnesota School of Public Health, they report that women who gave birth at hospitals that had a larger percentage of midwife-attended births were less likely to have two specific medical interventions, cesarean delivery and episiotomy.

Attanasio, an assistant professor of health policy and management at UMass Amherst’s School of Public Health and Health Sciences, explains that a growing body of research at the individual level has shown that compared to women cared for by physicians, women considered at low-risk for complications in childbirth who receive care from midwives have good outcomes that include lower use of interventions such as cesarean delivery.

The researchers analyzed hospital-level data reported in New York State over one year. Details appear in the current Journal of Midwifery & Women’s Health. Their study analyzes the experiences of individual women; an accompanying policy brief looks at hospital rates of medical interventions at the time of childbirth.

The authors say their findings raise the possibility that greater access to midwifery care, which is low in the United States, might enhance perinatal care and lower costs for low-risk women. In 2014, the year of the study, Attanasio and Kozhimannil point out that midwives attended just 9 percent of U.S. births, compared to more than 66 percent in other western countries such as Australia, France and the U.K.

They add, “More midwife-attended births may be correlated with fewer obstetric procedures, which could lower costs without lowering the quality of care. This raises the possibility of improving value in maternity care through greater access to midwifery care for childbearing women in the United States.”

The researchers used the Healthcare Cost and Utilization Project State Inpatient Database data for New York and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014 to estimate the association between the hospital-level percentage of midwife-attended births and four outcomes among low-risk women: induced labor, cesarean delivery, episiotomy and severe obstetric morbidity — that is, unintended outcomes of labor or delivery that have significant negative effects on the mother’s health.

Of the 126 hospitals included, the researchers say, about 25 percent of the hospitals had no midwives present. About 50 percent had some midwives present, but they attended less than 15 percent of births, while at 7 percent of the hospitals, midwives attended over 40 percent of births. They controlled for such variables as mother’s age, insurance type, and diagnosis of diabetes and hypertension.

Key findings were:

  • Women who gave birth at hospitals with more midwife-attended births had lower odds of delivering by cesarean and lower odds of episiotomy.
  • Hospital-level percentage of midwife-attended births was not associated with changes in labor induction or severe obstetric morbidity.

Attanasio says, “This study is contributing to a body of research which shows that good outcomes for women at low risk in childbirth go hand-in-hand with lower use of medical procedures. And, there is increasing attention now to overuse of cesarean and other procedures that are not resulting in better outcomes for mom and baby.”

Kozhimannil adds that the findings imply that a greater midwifery presence may have important clinical benefits. “From a policy perspective, this study should encourage legislators and regulators to consider efforts to safely expand access to midwifery care for low-risk pregnancies,” she notes.

Several states are considering expanding midwives’ scope of practice as New York State did in 2010 for certified nurse midwives, Attanasio says. “I hope that this work contributes to the evidence related to promoting the quality and value in maternity care that midwives can bring. A number of studies have shown that expanding their scope of practice and giving midwives more autonomy can increase women’s access to midwifery care.”


Story Source:

Materials provided by University of Massachusetts at Amherst. Note: Content may be edited for style and length.


Journal Reference:

  1. Laura Attanasio, Katy B. Kozhimannil. Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization. Journal of Midwifery & Women’s Health, 2017; DOI: 10.1111/jmwh.12702

Read this article on ScienceDaily: University of Massachusetts at Amherst. “Midwifery care at hospitals is associated with fewer medical interventions.” ScienceDaily. ScienceDaily, 16 November 2017. www.sciencedaily.com/releases/2017/11/171116132736.htm.