My children love toys. When they were little, they crawled towards them and chewed them….
Today is International Day of the Midwife. We meet Sara David, a Perth-based midwife who has been saving the lives of mothers in Papua New Guinea with the help of Canberra maternal health charity Send Hope Not Flowers.
What first sparked your interest in midwifery?
I was eighteen and had just moved to Perth with my family from South Africa. I had left my boyfriend behind (who is now my husband) and was feeling very alone and unsure about my future. I ended up chatting to a woman at the local tennis club and she was a senior Nurse Manager with The Flying Doctors Service. I was intrigued with the scope of work her nurses were involved in and set out on a journey towards that goal. She told me I needed emergency nursing experience and then also had to be a qualified midwife.
I went and studied a Bachelor of Science in Nursing at Curtin University from 1990 – 1994 and went on to specialise in emergency nursing. On a shift one day a colleague was studying for her midwifery entrance exam. In that moment I knew I had to do the same, so I completed a diploma in midwifery through King Edward Memorial Maternity Hospital in Perth.
Soon after graduating my husband and I packed up our household and went backbacking around the world for 12 months. We spent most of the time in developing countries like Vietnam, Nepal and India which opened my eyes to the living conditions of the poor. While trekking in Nepal for seven weeks I met several community health workers who were desperate for information to help them provide a better service to pregnant and birthing women. I would sit down on the ground with them and draw pictures in the sand to illustrate some key concepts around birth. In that moment I knew that one day I wanted to be working in an area to educate health workers in developing nations where literacy was low and access to health care difficult.
As a midwife I’ve learned to be open to new information. I’m constantly amazed and inspired by the power of women to bring in the next generation. I especially love to learn more about how different cultures experience pregnancy and birth. There are a lot of similarities around the world. I think in our culture we’ve lost that respect for the sacredness of bringing new life into the world. A midwife once told me there’s something deeply spiritual that happens when a baby is born; it’s like glue has been spread around the room and everyone present receives a drop of it.
What have been your greatest lessons along the way?
My greatest lesson has been that women are strong, incredibly powerful and that their instincts are always right. When a woman tells me that she can’t put her finger on it, but just feels there is something not right, I listen and investigate further. I never discount her experience. A mother’s intuition about what’s happening with her baby and her body are a very important part of holistic care.
How did your knowledge impact on your own experience having babies?
I became a midwife, went travelling and then came back to Perth to have babies as a 30-year-old. I was keen to have midwifery-led care for my pregnancies because I was healthy and strong. My pregnancies went well aside from the awful nausea in the first four months. My trouble was I had big babies. No one in generations of women in my family had ever had a Caesarean section, but I ended up with one for my first due to obstructed labour. I laboured all the way to 9cm at home with the support of a homebirth midwife and then went backwards as his head would not flex to get through my pelvis. After transferring to the local hospital and being given every opportunity to birth naturally, the Obstetrician recommended a C-section. I was involved in teaching antenatal classes during my pregnancy and I remember very clearly asking the obstetrician a question I used to teach couples attending my classes, “is there anything else that we can do?” and he said, “No”. Just having the power to ask that question really helped me recover well and accept that I had done everything I could to birth my baby naturally. After he was born I remember thinking that if I was living in a developing country I probably would have died. I was very thankful for our maternity services in Australia.
Following my son’s birth I joined a support group for women who had had a Caesarean section and became very active in supporting other women through the emotions and challenges of recovery following an operative birth, and also when trying to plan a Vaginal Birth After Caesarean (VBAC). In 2003 I had my own VBAC and then went on to help set up a specific clinic for women who were planning their Next Birth After Caesarean at KEMH which is still running today.
What are the joys and challenges when a woman gives birth?
Birthing is the time of most power and vulnerability in a woman’s life. We are blessed in Australia to have the maternity services we have BUT there is a lot of fear associated with birth now. Recently I saw an award-winning film called Birth Time. The documentary makers travelled around Australia talking to different groups about birth. There is growing trauma associated symptoms due to a lack of respectful, mindful, kind care during birth. These have a long-term affect on bonding and attachment. Maternity services have become systems focused and not woman and/or family-focused. I often say to people that I wish maternity care providers would view birth in humans in the same way as they do in animals – undisturbed but watchful. When seeing a woman give birth without interruptions and people she doesn’t know coming in and out of the room, it’s an incredible privilege to be in the room with her.
How did you end up working in PNG?
In 2011 I was invited to the remote village of Yamen in East Sepik Province the husband of a friend of mine who had just come back to Perth from a trip training pastors. He had asked the leaders what their needs were, and the local leader of the churches said without hesitation that their mothers were dying when giving birth, there were no health services and they needed a midwife to train their Village Birth Attendants. Mike knew I was a midwife and so he asked me if I’d join him on his next trip. That was in August 2012.
The connection with the churches has been pivotal to our success in remote PNG because through the church leaders we’ve been given an invitation and access to women from far reaching places.
How huge is the scope of issues women face there? And how is it different to Australia?
My first trip to Yamen felt like I’d been plucked from Earth and taken to another planet. I have a photo which hangs in my house from that time. Jungle mist in the distance with a dirt road leading into nowhere. I had no idea what to expect. So many unknowns and new experiences. Now when I look at that photo I know what’s on the other side of the mist. I know the villages, the rivers, the faces and the names of the faces. The people are no longer unknown to me but dearly loved friends.
The first trip there were simply no health services for anyone. I was overwhelmed with the many sick people: children and pregnant women. Women pregnant, breastfeeding an older baby with a toddler at her feet. There were babies everywhere. Stories of preventable deaths from bleeding, having a seizure, infection, malaria, tuberculosis, diarrhoea etc. No fresh running water. No power. No shops. No money. Women having no power to make decisions. Even if they did manage to get into a boat and travel to a health centre it was locked or the staff were nowhere to be found. The referral hospital was closed or only providing a small emergency clinic with no equipment or medicines.
No family planning.
The first request from the women after I’d listened to their stories to try and understand what the problems were, was for ‘Spasim Pikinini’ – contraception to space their babies. A woman fell at my feet with her hands clasped together in prayer asking for this. I remember standing there and thinking, “how on Earth am I going to get contraceptives and be able to bring them into PNG?”. It was confronting. But where there is a will there is a way and I was connected to a Rotarian by Professor Glen Mola, who was rolling out a contraceptive implant family planning service. The rest is history.
What have you been able to achieve?
We have trained over 100 Village Birth Attendants and health volunteers from about 50 different villages in the Keram and Yuat River catchments, a huge geographical area with a population of over 60,000. They have walked or paddled in canoes to get to training. We’ve provided this training in small increments of information over eight years and 15 outreach trips. We’ve developed illustrative flipcharts to help remind the VBAs about important information and have also equipped them with solar lights, aprons, eye protection and clean birth kits. A big part of our work with the VBAs has been to develop trust between the women and VBAs and health services. This is going to take time, but already the VBAs are reporting that the women trust them and the men trust their decision to evacuate a woman to a health centre for emergency care.
We have provided three training outreaches to qualified health workers in Angoram District since 2016. This has led to several staff returning to their remote health posts feeling more confident to provide services and care to pregnant women and more importantly feeling that they haven’t been forgotten. We continue to remain in touch with as many as possible to mentor and support them. We’ve provided some basic equipment for them to enable them to do their job such as obstetric wheels, stethoscopes and BP cuffs, measuring tapes, pinnard fetoscopes, flipcharts and job aids to prompt them with important information to educate their clients.
We have helped renovate a house for a midwife to live in Angoram and supported her to start up maternity services again at the Hospital. We have provided essential equipment for the labour and birth room. She is developing closer relationships with the VBAs and the referral system is much better now for women from the remote areas.
In 2019 we provided the first continuing professional development upskilling program in Wewak for midwives and nurses from all over the Province. Most came from very remote health posts and had not had any training since they graduated. The program runs for two weeks and includes theory and supervised clinical practise to meet the International Confederation of Midwives basic competencies.
We introduced the contraceptive implant to East Sepik Province. We have trained several health workers who are now independently able to provide the service through their health centres. In the remote villages we have been working, over 6000 contraceptive implants have been provided since 2014. As a consequence the village leaders are reporting that their mothers are happier and healthier. Due to the fact we have introduced this method of family planning in a slow respectful way, the men have become great advocates and the demand for family planning now is high and suspicion less.
We have started a program called Care Groups which divides a village into clusters of 10 households each with a female volunteer trainer. We started with a nutrition and hygiene program of education which has been very well adopted by the whole community especially the men. They are now helping to expand the program to other villages.
During covid we have been sending boxes of essential PPE and other supplies to specific maternity care providers.
A significant achievement but one that is in the background, is the ongoing advocacy work I do. I’m continually writing letters to politicians and other health leaders to remind them of the needs in PNG. We have also been instrumental in connecting different organisations and introducing them to the area therefore sharing the load and bringing others into the area with their expertise.
What does it mean to have the International Day of the Midwife?
It’s a time to celebrate what Midwives do and highlight women’s right to have quality care provided by a skilled birth attendant.
When did you set up Living Child and why?
At the end of my first trip to Yamen a PNG male leader asked me in front of a group of leaders what my vision was for midwifery in the Keram. I felt quite confronted by that question as the needs were great. So I answered very carefully. I suggested that I could see some potential for further training and would go back to Australia and talk to some people about what could be done.
I kept my promise. I went home and talked to many people and organisations and was left with no other option than to start my own organisation. I could not forget the suffering of these women. Living Child was registered in March 2013.
How important has it been to receive funding from Send Hope along the way?
SHNF funding has truly enabled us, a small grassroots organisation with no history back in 2013, to become established as a recognisable and respected midwifery-led organisation helping to save lives of mothers and newborns. Where we go is VERY remote and it is tough – hot, humid, malaria is rife, no roads and other generally accepted comforts. SHNF has supported us to support our volunteers to join our teams to make a difference. Ongoing support from SHNF has meant the locals have learned to trust us, that we do return and we are responding to their needs. We have not forgotten them.
Do you have anything planned for today?
We are holding a fundraising conference co-badging with the Australian College of Midwives WA Branch. Unfortunately there has been a COVID outbreak in Perth so we are living day to day at the moment. So far it will go ahead with delegates wearing masks. We have Tim Costello AO as a Keynote speaker as well as Australian Living legend Professor Fiona Stanley AC and several other health leaders including First Nations health professionals talking about health for marginalised women.
You can make a direct donation to support Sara’s work through Living Child or through Send Hope Not Flowers (which supports Sara and a range of other midwives and health professionals tackling maternal mortality in developing countries across the world.)