A number of women in Rwanda are not offered prenatal counselling and care, yet during pregnancy, it helps detect potential concerns early and reduces the risk of pregnancy and birth complications, says Aude Kaze, a 33-year-old midwife.

It is for this reason that she started the Kwezi Midwife Initiative in 2021 to empower midwives and enrich the collaboration between them and their patients, whilst giving expectant mothers much-needed prenatal counselling.

Kaze also offers classes for delivery preparation, and these start at 32 weeks of pregnancy to when the woman’s due date is close. The aim is to help ease the labour process and ensure safe delivery.

"I create a safe place for women to open up about any conditions that could have implications on their pregnancy, and advise them on how to manage them. Some of these include diabetes, hypertension, thyroid disease, and others,” Kaze says.

The midwife says expectant mothers are also informed about the appropriate care their babies require, and assisted to prepare for birth.

According to Kaze, many women worry about the pregnancy and delivery experience, thus triggering anxiety and depression. Some don’t seek professional assistance, and if these anxieties are not properly handled, it can result in challenges for the mother and baby.

The midwife conducts eight classes once a week, and after each week, evaluates the previous weeks to allow pregnant women to inquire or ask questions.

She notes that a French study on these classes pointed out that better preparation reduces the number of C-sections among women, and the use of instruments during childbirth. Adding that preparations result in fewer cuttings, fewer baby blues, fewer cases of postpartum depression, and less anxiety during childbirth.

"With prior preparation, you know better how to handle all issues that will arise. You’re well equipped. For instance, when a woman is pregnant, her adrenaline (a substance produced in the body when excited, afraid, or angry) isn’t supposed to increase but rather decrease to enable her to feel good and be ready to give birth.

"We have Pro Bono (free) classes for the mothers who cannot afford our prenatal classes. We have a platform where women who can afford the classes can sponsor the less fortunate and this enables us to render them free services,” Kaze says with a smile.

Kwezi Midwife

Kaze is of the view that midwifery is one of the most beautiful professions that exist. It allows midwives to give life and enable mothers to have children.

She had a desire to motivate midwives because, for the longest time in most parts of Africa, they’re only considered assistants to gynaecologists, and yet they have an independent job description and rules they ought to follow.

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Kaze notes that midwives ought to be seen and appreciated for their work because gynaecologists don’t have time to follow up on the issues of an expectant mother and all her concerns, yet midwives guide them through their questions and worries.

"With these kinds of concerns, it’s important to create awareness for expectant women about their pregnancy journey and what to expect.”

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Having studied in Belgium, Kaze returned to Rwanda in 2019, to exercise her skills at home, however, while practicing in one of the hospitals, she noticed a lot of anxiety and fear of childbirth among unprepared mothers.

To her dismay, many women went into labour without preparation, which she wanted to change.

"I started advising women on a number of things regarding childbirth. When I encountered an anxious mother, I would ask them questions like, ‘what kind of birth do you want and what is most important for you?’, ‘What wouldn’t you want for your birth?’ ‘What are you looking for to have a safe delivery? And so forth,” she says.

The answers to these questions helped her to understand the trigger for anxiety and stress. She explained to women everything they needed to know, from preparation to birth, breathing, to the positioning of the body to ensure the contractions and more.

Kaze says that she encourages pregnant women to be open-minded as they go into labour because things do not always go as expected.

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Her classes also look into the labour process, C-sections, inductions, breastfeeding, the support and role of men during the pregnancy stage and after, and everything that concerns labour, postpartum, and contraception after birth.

Kaze’s services don’t stop at delivery, there are follow-ups after childbirth to find out how the breastfeeding is going, if the mother manages to feed her baby well, and they also ensure that the mother is having enough sleep at night, or if she suffers postpartum depression.

For now, she offers prenatal counselling at Iranzi Clinic, Nyarutarama, but has hopes to open her own place.

The midwife says Kwezi’s two years of operation have seen good results. For now, among the 90 pregnant women who have gone through her training, only two had a C-section, and others have had safe and natural births.

"I monitor the women well with attention which I noticed they love, and I believe it is one of the reasons for positive results.”

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Way forward

Kaze calls on the Ministry of Health to empower, and extend support to midwives, by acknowledging their work and ensuring that birth preparation is one of the necessities for child delivery.

She is optimistic that when the ministry enforces midwifery services, insurance companies will come on board to cover them, thus giving expectant mothers ways to afford the services.

For now, women who don’t have health insurance to cover these classes pay from their pockets and a session is between Rwf 30,000 to Rwf 50,000.

She anticipates holding workshops even outside Kigali where women who are ignorant about the significance of prenatal classes can benefit.

Kwezi’s vision is to have every woman in Rwanda have at least five birth preparation sessions before child delivery.

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Love for midwifery

From the age of 12, Kaze was certain she wanted a career in healthcare, and to be specific, one that dealt with women and babies.

On many occasions, Kaze prayed to God to guide her career path as she wanted to serve, make an impact, and save lives. Her father advised her to opt for a course in obstetrics and gynaecology.

She took her father’s advice even though it wasn’t exactly what she wanted to do. "I pursued a course in medicine for two years before dropping it. The first year I failed and the second year I passed albeit with struggles and depression.”

Growing up, there was no room for failure, which is why she had to prove herself to her parents. However, it was time to change the course.

"I remember praying to God for about two months and when I finally understood what I really wanted to be, it got really easy. I connected well with midwifery, and the rest was history. My joy is seeing a mother living a healthy life, before, during, and after delivery,” Kaze says.

She urges mothers to never forget that they’re capable of anything. For midwives, she heartens them to stay strong, and recognise their own strengths.

She calls upon the media to increase coverage and awareness of healthcare articles to enable the public to know about issues concerning contraception, childbirth, and preparation.

Kaze also offers pregnancy care tips on Instagram Kwezi.midwife.