GreenLamp has initiated a teacher exchange program between the University of Applied Science(ZHAW) in Switzerland and Hamlin College of Midwives in Ethiopia. The program launched in March 2017, when MSc in Midwifery and ZHAW senior lecture Denise Eigenmann spent three months in Ethiopia teaching at the Hamlin College and visiting rural health centers. Here's Denise's story in her own words:
"So I will tell you about the teaching of the birth positions. I had been told that most (or even all) births in the Health centers of Ethiopia take place in Lithotomy position (on the back with the legs in the stirrups). Since this is known by good evidence as the worst position for the mother and the baby (less breathing - less oxygenation, less strength to push, no gravity helping, less intimacy, less space in pelvic outlet, more birth injuries, more episiotomies, more vacuum-deliveries), I have put my focus on that topic and was first teaching the students in theory about the advantages and challenges of upright birth positions.
I have already been trying to make them experience some positions in the classroom themselves, but in that environment, it was difficult to make them try the positions. So I showed them myself how it would look. I went on "all fours" or squatting position and pretended to have labor contractions. They were very surprised about me doing this, laughed quite a lot about it and seemed to feel embarrassed, but I am sure this was the key to make them not afraid to try it themselves later. I also think that they first needed to know me well enough and trust me.
At the end of a break between lectures, I found the students sitting outside in the sun and this gave me the idea of using this environment for the practical part. So I told them to stay outside, got the baby-doll and the slides with my prepared questions for them to think about when using the different positions. I then started to practice the positions as well as discussing with them about the questions (what do you think about the space in the pelvic outlet in this position? How good is the breathing? ....)
When I finished my teaching I asked the midwife students for suggestions for next time. One student told me she wanted to thank me for my teaching and that she liked it very much, especially the practical part about the birth positions. I was really happy to hear that.
Since this idea of upright birth is new in at least some areas of Ethiopia I thought that the midwives may face a lot of resistance in practice. I believe it is very important that they themselves are convinced about the advantages and have at least practiced it in a skills-training way, so they would really be encouraged to go on "fighting" for the implementation in practice.
I had a great experience assisting births in the Walga HC. Here they are using upright birth positions and they ask all pregnant women to have a birth companion when they come for labor. So the mothers are getting real emotional support, kind massage and a wet towel to refresh their face when sweating.
This was a good opportunity to explain to the students why it is important to be caring as well as professional, because it really has an impact on the birth process. If the mother feels safe and "being in loving, caring hands" she can relax and be confident, she is breathing deeper and providing more oxygen for her baby, her muscles are less tensed (in between contractions), she will release more endorphins (as a natural pain relief) and oxytocin (supporting the contractions and the bonding between mother and baby) and due to all these factors the risk for complications during the birth process is reduced.
Of course the students laughed at me quite a lot sometimes because of my theatrical way of showing them how the midwife or the mother can behave! But then they were also practicing some positions and really working well, answering the questions and trying to practice in assisting childbirth in all different positions.
They have been asking if I would come back and teach them next year again, which I think is a good sign that the exchange was a success."