Stories about midwives slapping and hurling obscenities at women in labour are not unusual. Some women avoid giving birth in certain health centres because the midwives run the labour wards like a ‘torture chamber’.

Giving birth should be a special time for every woman but sadly, that has not been the case for some.

"I was left alone during labour and waited for hours for a midwife to attend to me. When I tried to signal her about how severe the pain was, she told me to keep my mouth shut since I wasn’t the first woman to experience labour pains,” says Jackie, a mother of two.

Jenipher, a mother of a 3-year-old baby had a similar experience with a no nonsense midwife who left her traumatised.

"I was in the labour ward and a midwife came in abruptly. She was rude and didn’t even ask me how I was feeling,” Jenipher says.

Jackie and Jenipher’s experiences are just some of the many; many women have experienced horrific experiences in labour wards.

"It’s bad enough that we have to deal with that ridiculous pain, but having a nurse shout at you and treat you like you committed a crime is unacceptable,” says Agatha Namuli, a freelance writer.

Iradukunda, a mother of one girl, living in Kabeza also shares a similar experience.

"The midwife was a nightmare; she had that I don’t care attitude and cared less for the women who were in labour. I was in pain when I reached the hospital, but the midwife who attended to me barely looked at me as she told me to wait despite my obvious pain. She harshly told me to keep it low because I wasn’t the only woman in the ward. I wondered how she could treat a fellow woman that way,” Iradukunda says.

Magnitude of the problem

Julie Kimonyo, the registrar of National Council of Nurses and Midwives, says that they get complaints but before they make any conclusions, they investigate the allegations.

"We get complaints but we investigate to prove the allegations. And it’s not just the midwives; sometimes it’s the women in labour that misbehave and are reported to the council. But all in all, we act basing on facts, that’s why we have to first investigate,” Kimonyo explains.

Andre Gitembagara, the president of the Rwanda Nurses and Midwives Union, says that the union has handled eight different cases this year, mainly about nurses accused of poor handling of the patients. One case was in Nyabihu and the other was in Ruhango.

He says that some cases arise as a result of poor training. For example, he says the trained midwives work in big hospitals whereas in health centres, trained ones are scarce; twenty midwives can be posted in over 461 health centres.

Such situations of neglect are called cases of misconduct and are handled by the National Council of Nurses and Midwives. When the midwife is found guilty she can either be suspended or her license can be revoked. For bigger cases involving murder, they are handled by the police.

"Midwives should take necessary care. The pain women in labour go through sometimes makes them react in different ways, but as trained nurses and midwives they should be able to understand,” Gitembagara says.

However he points out that sometimes nurses are victims too, for example, she could be handling a case beyond her scope of practice, or she could be handling a big number of patients, putting her under a lot of pressure.

He pointed out a case in Ruhango where a mother gave birth safely but on reaching home the baby got an infection and later died. The mother blamed the midwife for poor care but through investigations it was revealed that the infection was contracted after leaving the hospital and because the mother delayed to take the baby to the hospital, it led to the baby’s death.

"Our profession is a complicated one, it’s not like accounting where the mishandled cash is refunded through audit, but dealing with a human, any mistake can lead to death, and that can’t be resolved,” he says

What do the midwives say?

Beatha Mukarwego, a midwife at Polyclinique La Medicale, says that cases of midwives who mistreat women in labour are rare today, but were common in the past.

"I have ten years’ experience, I have worked with different hospitals but such cases are no longer there. We have a code of conduct and a council which regulates us. If one breaks the rules, a patient has a right to report the case to the council. First time mothers always have a lot of fear but when we explain to them what they should expect, they calm down. We explain what follows what and how to deal with the pain,” Mukarwego says.

She explains that it’s not wise for a delivery to be attended to by only one midwife; they should be two, one for the baby and the other for the mother.

"Our profession requires patience, love for the job, being active and hardworking. In a day, one can handle a minimum of three deliveries, but if the deliveries are for a C-section, then they handle less since the operation takes time. But all in all, nurses who are rude are handling their work unprofessionally,” Mukarwego explains.

Beatrice Mukashema, a midwife at Kibagabaga Hospital, says that there are times women in labour do not understand a nurse’s concerns because of the pain and fear.

"Being in labour comes with so much pain and sometimes one fails to understand what we explain to her. For example, a woman will tell you that she wants to be operated on due to the extreme pain she is in, yet medically we see that an operation isn’t necessary.

"But it’s not professional for a midwife to be rude; you’d rather bring in someone else to help you out instead of becoming bitter. I also advise midwives to find ways of dealing with stress because it’s hard to work when one is under stress. It would be nice to handle a woman in labour with care.”

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WOULD YOU PREFER A MALE OR FEMALE NURSE WHEN IN LABOUR?

Marie-Claire Bayizere

I would prefer to have my baby delivered with the help of a male nurse. Men are compassionate; they listen and treat a woman with respect, unlike their female counterparts. When giving birth, due to intense pain, a woman tends to be aggressive, which is not something female nurses are likely to tolerate. But men always understand.

Aisha Uwimana

I don’t have issues with any particular gender; both male and female nurses have provided good service for me which is all I need when I’m in labour. As women, I think all we should care about is delivering healthy babies, regardless of who gives us the service.

Jeanne Munkambibi

Females use harsh words and this is not good at all because they hurt our feelings. More so, they are never patient or understanding. I would prefer a male nurse to deliver my baby.

Ariette Ishimwe

Men provide good services; they tolerate a woman in labour, the process is done in the quickest time possible and, they value a mother and her baby more than fellow female nurses do. I wish I can get the chance to have a male nurse when I’m in labour.

Anitha Mutoni

As women, we all know how less understanding we are when it comes to fellow women. And this is the same even in labour. Female nurses tend to not understand a woman’s aggressiveness during labour. So eventually, this makes us prefer males.

Jeannette Uwamahoro

A woman is a mother; she will always understand and handle a fellow woman with care and sympathy. All the things we go through in labour, female nurses have more knowledge than males so I will always prefer a female to help me deliver my child.

Compiled by Dennis Agaba