“It was such an overwhelming time,” says Areeba Adil* as she recalls her first pregnancy. “There was so much health information and advice around me but none of it eased my fears.”
Many other mothers-to-be like Areeba remember the constant uncertainty of their first pregnancy. Even though aches and pains are an ever-present part of pregnancy, Areeba’s concern for her baby’s health meant questions were always running through her mind. Is this pain normal or should I consult a doctor? Is there something else I should be doing for the baby?
“A good midwife offers the personal care every woman needs,” says Shahnaz Shahid**, a senior instructor in midwifery at AKU’s School of Nursing and Midwifery. “They are sensitive to the distinct roles they have to play at different stages of the pregnancy and understand how to build trust with the mother.”
As a practicing midwife at AKU’s mother and child health centres in Karachi, Shahnaz Shahid’s primary role is as a patient’s representative; applying her knowledge and observational skills to summarise a patient’s health to obstetricians and highlighting symptoms requiring special care.
But on a day-to-day basis, she notes that a midwife also needs to use her ‘soft skills’. Shahnaz recalls one such moment when Areeba Adil, her sister, was in her second trimester.
Areeba started having abdominal pains in the afternoon that were different from the discomfort associated with morning sickness in the early weeks of her pregnancy. The pain was more intense and she was having to visit the washroom frequently. Fearing the worst, Areeba called Shahnaz, who could sense her sister’s anxiety in her hurried sentences. This wasn’t the time to give advice, it was the time to listen.
“The best midwives recognise when a mother needs to feel heard and switch to becoming a confidant,” said Shahnaz. “Areeba felt much calmer after she had shared everything with me and listening to her patiently enabled me to narrow down the most likely cause of pain.”
Areeba had recently begun to take iron and calcium supplements. The iron supplements led to stomach upset and recurring bouts of diarrhea. Shahnaz reminded her sister about the importance of supplements and counselled her to switch to a chewable tablet that could be taken during meals. Over the next week, Areeba’s symptoms eased and were no longer a source of anxiety.
Shahnaz continued to be a source of support for Areeba throughout her pregnancy, especially when she suffered from false labour pains close to her due date.
“At the time, I needed to adjust my approach to one of a translator,” Shahnaz remembers. “Areeba was looking for detail, so I counselled her on the signs of labour such as progressive, frequent contractions not relieved by rest, and indications of the water-bag breaking. I remember her laughing when I told her that the cure for her back pain was a back rub and that her husband now had the chance to be useful!”
Shahnaz notes that this skill – turning medical knowledge into simple advice – is a key aptitude that students pick up during their practical experience with patients.
“Many people tend to dismiss or diminish a mother’s concerns but midwives are trained to treat both the mind and the body. Young practitioners and students need to alternate between being keen observers, empathetic advocates and sensitive translators. When you play these roles well you notice a change in a woman’s demeanour. Their tone relaxes as they gain confidence in you and their own ability to take care of their health,” Shahnaz stated.
In May 2014, the Adil and Shahid families were overjoyed to welcome baby Furqan in a delivery that lasted just 30 minutes and had no complications. As she looks back on the day, Shahnaz remembers the joy she felt knowing that her years of study, teaching and practice had an impact so close to home.
I enjoy being a midwife ensuring that every delivery brings the same joy we felt on Furqan’s birth, Shahnaz reminisces. “Now as an instructor, it’s really rewarding to see my students working as independent practitioners across Pakistan. It’s always a pleasure to hear that they are respected and trusted because of their time at university.”
* Names have been changed to protect the individual's identity.
** Shahnaz Shahid holds diplomas in midwifery and nursing as well as a master's degree in nursing from Aga Khan University's School of Nursing and Midwifery. She heads the Maternal, Neonatal and Child Health, and Midwifery stream at the School.