19 January 2024 by Pascalinah Kabi

Est Read Time: 5 min(s) 30 sec(s)

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Retired midwife, Keneuoe Fobo, now serves as the president of the Independent Midwives’ Association of Lesotho. Credit: Keneuoe Fobo.

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“Losing an expectant mother during labor was a devastation beyond words,” begins Keneuoe Fobo, a 64-year-old retired midwife from Lesotho.

“It dimmed the light in my heart,” she says, her words, though conveyed over the phone, resonating with profound emotional strength.

“These losses, rare as they were, left deep scars, permanently marking my soul. The thought of children left motherless forever haunted me,” she shares in an interview with Uncensored News.

Fobo speaks with the clarity of someone who has faced profound dilemmas. “The relentless ‘what-ifs’ were my constant companions. Could I have spotted a complication earlier? Was there more that could have been done?”

Her voice, laden with the weight of responsibility and introspection, reveals her inner struggle. Also, she reveals that the grief was all-consuming, even when the mother was battling a condition unrelated to her pregnancy.

“Each loss felt like a personal failure,” admits Fobo. In Lesotho, for every 100,000 live births, 566 mothers die due to pregnancy-related complications.

According to the World Health Organisation (WHO), this number is higher than the average for the African region, which stands at 545 maternal deaths per 100,000 live births. This high maternal mortality rate in Lesotho indicates a significant health concern for pregnant women in the country.

Study uncovered midwives’ hidden trauma in Lesotho.

With every maternal death, a midwife in Lesotho suffers an enormous loss. This stark reality is detailed in a study by Lethato Mohale and Isabel Nyangu, published in December 2023.

The study, titled ‘Psychological Experiences of Midwives Regarding Maternal Death at Two Selected Public Hospitals in Lesotho’, reveals a troubling range of emotional impacts.

“Psychological experiences such as trauma, shock, fear, stress, depression, loss of trust, helplessness, bad dreams, and insomnia were reported by the midwives after the occurrence of maternal deaths,” the study notes.

Authors Mohale, from the National University of Lesotho, and Nyangu, from Edinburgh Napier University, interviewed ten midwives from two public hospitals in Lesotho.

In these interviews, one unnamed midwife described feeling shock after a maternal death, a sensation that led to a pervasive fear of re-experiencing such a loss during future deliveries.

“It is very tearing and psychologically draining,” the study quotes one midwife.

Another midwife reported grappling with trauma and depression after witnessing the death of an expectant mother in the delivery room.

“Even at night, I encounter challenges sleeping. At times, I feel like it is our fault and that something needs to be done.”

The fear of judgment among midwives

In rural health facilities, midwives often become integral parts of the communities they serve, living in close proximity to those they care for. This closeness can breed a fear of judgment from colleagues and the community following every maternal death.

“I was so frustrated and afraid that whenever I saw a pregnant mother, I re-experienced the trauma. It took me days.

“At times, I would wake up feeling very low, haunted by thoughts of a similar incident. I felt like the community and my colleagues were talking behind my back whenever I was among them,” another study participant shared.

Conveying the news of a mother’s death due to pregnancy-related complications exacerbates the trauma for a midwife already distressed by losing a patient.

“It was worse to imagine the pregnant lady arrived here at the hospital ambulant but dead at discharge, and the trauma of debriefing the family regarding the deceased. It is so boring to imagine the humiliation in the maternal review meeting,” revealed another participant.

In two cases, teams consisting of medical officers, managers, and midwives participated in attempts to resuscitate mothers. One had used herbal concoctions prior to delivery, and the other had undergone a caesarean section (C-Section). Both cases involved post-partum haemorrhage.

“After the death, I saw almost all members of the resuscitation team shocked and depressed, in denial that death had occurred, to the extent that we continued resuscitating for a while after the medical superintendent had declared the mother dead.

“We were all praying for her recovery, but it was too late, and it was very stressful. I felt so depressed after experiencing the tragedy of maternal death, to the extent that my mind became occupied with fear of re-experiencing it whenever I was conducting a delivery,” said another midwife participating in the study.

Midwives report diverse coping mechanisms

Lethato Mohale co-authored the study that looks into the emotional toll of maternal deaths on midwives in Lesotho. Credit: NUL Research and Innovations Facebook Page.

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The study also highlights the coping mechanisms midwives adopt following a maternal death. It reveals a range of strategies, from healthy activities to more concerning behaviours.

One participant shared their approach to recovery: “I’ve found partying an effective way to help me forget and recover from the trauma of a maternal death. Engaging in recreational activities like taking trips, attending gala dinners, and playing sports such as soccer and snooker has been very beneficial in my recovery process,” the study quotes.

Another midwife found solace in a more introspective method. “Crying has been a great stress reliever for me. When I’m overwhelmed, I find a private place to sit and cry, releasing the pain until I feel somewhat relieved,” as cited in the study.

However, some coping mechanisms raise concerns. The study indicates that nearly all ten participants resorted to alcohol to distract themselves from the distress associated with pregnancy-related deaths.

“Most often, after a maternal death, I excessively consume alcohol to divert my mind. Regrettably, this usually results in becoming drunk and re-experiencing the trauma the next day,” one participant admitted.

Another participant described using sedatives as a coping strategy: “Following a stressful event like a maternal death, I often buy sedatives like diazepam from the local pharmacy to induce sleep. If that doesn’t work, I sometimes combine the sedative with other substances, such as marijuana or high-grade, for a temporary relief, though the distress often returns once the effects wear off.”

Addressing the overlooked midwives’ psychological struggles

Keneuoe Fobo, a former midwife and the current president of the Independent Midwives’ Association of Lesotho (IMAL), spoke with Uncensored News about the prevalent deep-seated depression among midwives.

She highlighted a major contributing factor: the minimal time midwives have between encountering a maternal death and attending to the next delivery. This relentless pace affords them scant opportunity to process their grief and cope with the emotional trauma stemming from pregnancy-related deaths.

She emphasised the critical, yet often overlooked, need for psychological support for midwives.

“Midwives are among the most traumatised professionals, yet it is seldom recognised that we need counselling. The daily challenge of dealing with illnesses affecting expectant mothers or newborns is extremely taxing. In our era, we witnessed more children’s deaths than those of expectant mothers, but each loss profoundly impacts us,” Fobo explained.

In their December 2023 study, Lethato Mohale and Isabel Nyangu underscore a significant gap in research focusing on the experiences of midwives after maternal deaths, especially in African countries. The study brings to the forefront the often-ignored emotional and psychological burdens borne by those at the forefront of maternal care.

“The study suggests that psychological experiences may vary based on the frequency of encounters with death. This underscores the need for psychological support programs tailored for midwives in Lesotho,” the study notes.

Meanwhile, the World Health Organization (WHO) identifies the leading causes of maternal deaths in Lesotho as haemorrhage, hypertensive disorders during pregnancy, and complications from unsafe abortions.

The WHO points out key challenges in Lesotho, such as the unavailability of blood and blood products during obstetric emergencies, contributing to a high maternal mortality rate of 566 per 100,000 live births.

“The WHO recognises the urgency of supporting Lesotho in identifying the primary causes of maternal deaths, developing strategies to address them, and providing the necessary technical assistance to implement these strategies effectively, thereby reducing preventable maternal and newborn deaths,” the WHO website states.