Fay­ola Fras­er

Be­com­ing a moth­er for many women is an ex­cit­ing and nerve-wrack­ing jour­ney, with child­birth be­ing a ma­jor source of an­tic­i­pa­tion and anx­i­ety. Gen­tly guid­ing moth­ers-to-be and new moth­ers to and through child bear­ing is the job of a mid­wife, a trained health­care pro­fes­sion­al who pro­vides med­ical care, emo­tion­al sup­port and ed­u­ca­tion to moth­ers and new­borns. Mid­wives stand be­side women dur­ing some of the most vul­ner­a­ble, trans­for­ma­tive and in­ti­mate mo­ments in their lives, act­ing as ush­ers for one of hu­man­i­ty’s most pro­found ex­pe­ri­ences: bring­ing new life in­to the world.

Launched in T&T in 1995, the Trinidad and To­ba­go As­so­ci­a­tion of Mid­wives is a group ded­i­cat­ed to ad­vo­ca­cy, ed­u­ca­tion and ad­vance­ment of ma­ter­nal and child health ser­vices in Trinidad and To­ba­go. The Pres­i­dent of the As­so­ci­a­tion, Nicole Re­ece-James, says that the mis­sion of the or­gan­i­sa­tion has re­mained con­stant: “We are com­mit­ted to sup­port­ing mid­wives through ed­u­ca­tion, reg­u­la­tion, re­search and lead­er­ship.”

Re­ece-James ex­plains that “mid­wife means with woman and we are in­deed with women in some of the most vul­ner­a­ble times in their lives, pro­vid­ing an­te­na­tal care, care in labour and de­liv­ery, care for them and their new­born in the post­na­tal pe­ri­od,” high­light­ing the mid­wife as a vi­tal link for grow­ing fam­i­lies. The scope of the mid­wife is all en­com­pass­ing, and ac­cord­ing to Re­ece-James, they “sup­port women and fam­i­lies by pro­vid­ing sex­u­al re­pro­duc­tive, ma­ter­nal, new­born, child and ado­les­cent health ser­vices.”

For more than four decades, Mid­wifery Con­sul­tant at the Unit­ed Na­tions Pop­u­la­tion Fund, Founder & Ex­ec­u­tive Di­rec­tor of Mam­a­to­to Re­source and Birth Cen­tre, Or­der of the Trin­i­ty Re­cip­i­ent and sea­soned mid­wife, De­brah Lewis, has stood with women bring­ing life in­to the world. As the world ob­served the In­ter­na­tion­al Day of the Mid­wife on May 5 and Na­tion­al Nurs­es Week from May 6 to 12, Lewis re­flect­ed on the path that led her to the pro­fes­sion that she says was un­mis­tak­ably her call­ing.

In her 42 years as a mid­wife in Trinidad and To­ba­go, Lewis has helped bring thou­sands of ba­bies in­to the world, so many that she stopped count­ing a long time ago. She laughs that she is now jok­ing­ly called a “granny mid­wife” as some of the ba­bies whose births she once at­tend­ed are now be­com­ing par­ents them­selves.

Her life’s work has placed her at the cen­tre of one of hu­man­i­ty’s most trans­for­ma­tive ex­pe­ri­ences: birth. But for Lewis, mid­wifery has nev­er been on­ly about de­liv­er­ing ba­bies. It has al­ways been about “en­sur­ing women’s care is re­spect­ful, that they are seen as in­di­vid­u­als and care is tai­lored to them.”

Re­flect­ing on how she be­came en­rap­tured with mid­wifery, she re­mem­bers ac­com­pa­ny­ing her moth­er dur­ing vol­un­teer vis­its to the hos­pi­tal dur­ing her child­hood. Wit­ness­ing nurs­es car­ing for pa­tients and con­sum­ing the im­pact that com­pas­sion had on re­cov­ery in­spired her to pur­sue nurs­ing her­self. She did her nurs­ing stud­ies in the Unit­ed States and dur­ing a place­ment in the ma­ter­ni­ty ward, she found her per­fect niche.

“When I got to the ma­ter­ni­ty de­part­ment…oh my God! I saw noth­ing else,” she re­called. “It be­came very clear that this was the work I want­ed to do.” Af­ter com­plet­ing mid­wifery school in 1984 and work­ing in the US, Lewis then came to Trinidad. She spent a short pe­ri­od in the pub­lic health­care sys­tem be­fore mov­ing in­to pri­vate mid­wifery, in­clud­ing at­tend­ing home births. Dur­ing this time, she found a com­mu­ni­ty along­side a small net­work of mid­wives who sup­port­ed one an­oth­er pro­fes­sion­al­ly and emo­tion­al­ly.

The con­ver­sa­tions among her col­leagues cen­tred around their dreams to cre­ate a space to prac­tice mid­wifery in their own way and fa­cil­i­tate child­birth with com­pas­sion and dig­ni­ty. This dream even­tu­al­ly be­came the Mam­a­to­to Re­source and Birth Cen­tre. Found­ed in 2004 by Lewis and oth­er in­de­pen­dent mid­wives, Mam­a­to­to is a word that comes from the Swahili words for moth­er and ba­by. It is al­so an acronym for the Moth­ers and Mid­wives Al­liance of Trinidad and To­ba­go.

Cen­tral to Mam­a­to­to’s ad­vo­ca­cy is cor­rect­ing mis­con­cep­tions about mid­wives them­selves. Ac­cord­ing to Lewis, “In an ide­al world, it’s a team of the ob­ste­tri­cian, the mid­wife and the pae­di­a­tri­cian. Peo­ple of­ten think when you’re preg­nant you on­ly go to the doc­tor, and the mid­wife is the sec­ond-best thing. But mid­wives can be au­tonomous prac­ti­tion­ers.” She ex­plained that mid­wives are ful­ly trained to in­de­pen­dent­ly man­age nor­mal, low-risk preg­nan­cies, labour, de­liv­ery and post­par­tum care. Preg­nant moth­ers are re­ferred to ob­ste­tri­cians if the preg­nan­cy is con­sid­ered high-risk or com­pli­cat­ed. A mid­wife’s care fo­cus­es on holis­tic sup­port. Vis­its of­ten last an hour and ex­tend be­yond blood pres­sure checks and lab work to dis­cus­sions about nu­tri­tion, ex­er­cise, men­tal prepa­ra­tion, par­ent­ing and emo­tion­al well-be­ing.

Speak­ing to Mam­a­to­to’s ac­ces­si­bil­i­ty, Lewis says that the or­gan­i­sa­tion de­vel­oped a three-tier pay­ment sys­tem in­clud­ing full-pay, slid­ing-scale and pro bono care, ap­plied par­tic­u­lar­ly to ado­les­cents and un­em­ployed moth­ers. “We didn’t want our ser­vices to be re­strict­ed on­ly to peo­ple who could af­ford them fi­nan­cial­ly,” Lewis said.

Be­yond birth it­self, the or­gan­i­sa­tion of­fers free com­mu­ni­ty out­reach pro­grammes in­clud­ing child­birth ed­u­ca­tion, breast­feed­ing sup­port, par­ent­ing class­es, sup­port groups and pre­na­tal ser­vices.

Mam­a­to­to al­so has a deeply mean­ing­ful ini­tia­tive, pro­vid­ing a sup­port group for par­ents who have ex­pe­ri­enced loss, whether be­fore or af­ter child­birth, called “Ba­bies Who Live On On­ly In Hearts”, to en­sure that this of­ten over­looked group can find com­mu­ni­ty and share their feel­ings.

To­day, Mam­a­to­to Re­source and Birth Cen­tre re­mains the Caribbean’s on­ly mid­wifery-led birth cen­tre, and Lewis hopes its mod­el can in­spire sim­i­lar ini­tia­tives across the re­gion. “We want every woman and her fam­i­ly to have re­spect­ful care,” she said.

Af­ter more than four decades in the pro­fes­sion, Lewis still speaks about birth with awe. As a moth­er of one, she un­der­stands in­ti­mate­ly the emo­tion­al com­plex­i­ty of moth­er­hood, not on­ly for moth­ers, but al­so for women who hoped to be­come moth­ers, ex­pe­ri­enced loss or con­tin­ue to nav­i­gate in­fer­til­i­ty.