Midwifery in Senegal

Only 65% of women in Senegal will give birth assisted by a skilled attendant and 85% of women live at least 45 minutes from a health facility.

Direct entry midwives, or matrons, in Sénégal, deliver the vast majority of babies. Yet their education is very limited. They typically spend only six months in clinical training and are then posted to more rural clinics. During this time they follow and learn from the other matrons and sage-femmes, but they have no academic component to their education. The result is a generally unclear understanding of the anatomy and physiology involved in birth. They are taught a protocol, which is based on outdated Western medical practices such as: extreme fundal pressure, supine delivery positions with stirrups, standard pitocin drips, placental extractions and routine postpartum methergine shots. They are not taught problem solving techniques that facilitate good management decisions, or allowed to incorporate traditional methods or alternative positions. There is currently no system of peer review in place, and they do not use charts to document the woman’s labor progress or communicate with other matrons. The sagefemme who heads the clinic is responsible for all the women who come in and is on call 24 hours a day for complications. She has very little time to train the new matrons in special skills or theory. The cumulative effect is that...

Senegal has a very high infant mortality rate of 51 deaths per 1000 live births (2011) and a maternal mortality rate of 410 deaths per 100,000. On average, one in twenty women will die in childbirth during her lifetime.

African Birth Collective has been able to counter the Western obstetric model that has been handed down through post-colonial education with an alternative view. We support women to walk around during labor, deliver in non-supine positions, and support the perineum to allow for slow restitution of the head to prevent tears. We have also been able to learn effective techniques commonly practiced in Sénégal, such as the “milking” of the cord and inverted resuscitation methods. We also have worked with local non-profit ENDA Sante to translate “A Book for Midwives”, an essential educational manual, into French. This will provide access to clear, illustrated explanations of all birth complications as well as current information of family planning and HIV/AIDS prevention.

Together we are able to understand a wider perspective with which midwifery knowledge can be seen as something always growing and changing, drawing on traditions as well as new experiences and technologies. In this light, protocols must always be reevaluated to determine if they are both useful and appropriate.

View current Senegalese Maternal Health statistics by clicking here