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A fascinating job

Meet Sophie Desbenoit,  a midwife who has been an international mobile employee for Doctors Without Borders since 2016. In that time, Sophie has been on more than 5 assignments to places including Congo, Afghanistan, Greece and South Soudan. We asked her a few questions about her life as a midwife in our projects.

What do you like about your job as a midwife?

My role as a midwife is fascinating! It combines the human element, interaction and technical aspects. A midwife mainly handles follow-up for women in many different areas of care.  I have a particular interest in obstetric emergencies, as well as family planning (contraception), pregnancy monitoring, abortions, and so on. I am really lucky to be able to work in all these areas and experience new cultures.

How is working as a midwife in MSF projects different from working in Belgium?

During my first assignment, I was responsible for the post-partum component of the huge MSF maternity hospital in Afghanistan, which handles 2,000 deliveries a month. In the hospital where I worked in Belgium, we handled 500 deliveries a year!! In Belgium, we have the use of advanced diagnostic equipment (monitoring, full blood tests, bacteriological analysis, x-rays, etc.), the doctors are never far away, and the midwives do not make decisions entirely on their own. In the field, I was confronted with situations I had never experienced before: malformations, foetal positions that were difficult to identify without ultrasound, or caesarean section decisions that needed to be made.  I felt like I did not have the required skills. In fact, it was a whole new job I was learning.

I learnt an enormous amount from my national colleagues (in each country, healthcare professionals receive different training). They may not have had my four years of theoretical training, but they had significant practical skills: they knew how to perform a uterine exam or a cervical stitch very quickly, whereas in Belgium, we call for medical back-up (doctors, anaesthetists). Before MSF, I had never taken care of a victim of sexual assault, performed abortions, or inserted implants. These are things I learnt in the field.

What are the cases/conditions that you see in our projects?

There are typical conditions that I had seen during my training, but had rarely come across in practice. Pre-eclampsia and eclampsia for example. In Afghanistan, they happen every day! MSF has clear protocols and the team on site is used to these situations, so I also learnt how to manage them. Another very common condition in the field is post-partum haemorrhage. Some patients have 9 to 10 children and the risk of haemorrhage is much higher. Then there are the neonatology cases; often patients are not monitored during pregnancy and a lot of malformations are only seen clinically once the baby is born. In Belgium, these cases are diagnosed beforehand.

Midwife with MSF: a journey

"In the field, I was confronted with situations I had never experienced before: malformations, foetal positions that were difficult to identify without ultrasound, or caesarean section decisions that needed to be made."

What have you learned from your national colleagues?

On your first assignment, you learn more than you teach.

I was not fully proficient in breech births: we learn about it during our training, but in my hospital in Belgium, it was done by the doctor. When my colleagues had a breech birth, they called me so I could learn and do it with them. It was a two-way thing. On all my assignments, I learnt a lot. On my last assignment (South Sudan), my colleagues called me when there were cases of female genital mutilation so I could learn how to manage these types of situations. And yet, it was my fifth mission!  Once you have earned the national team’s trust, knowledge and practical skills can be shared in both directions.

In Afghanistan, we had received contraceptive implants. I had never inserted implants before and none of the midwives I was supervising had any experience in that area. The gynaecologist taught both of us, and then we had to teach all the staff. After that, we inserted 150 every month!

What are the most difficult situations to manage in the field?

For me, the cultural differences were often one of the more complex aspects to manage.

During one of my assignments, I had a patient in my post-partum intensive care unit whose vagina had been stitched following sexual intercourse. When I asked my field colleagues what the diagnostic was, the answer was ‘honeymoon’. I wondered how to behave in this situation, which I found shocking, while remaining professional, respectful of the culture, and while also trying to understand. For me, it was useful to talk about it with the team to help the patient and be empathetic with her in a context where non-consensual intercourse within marriage is common. In these situations, there was sometimes a sense of awkwardness, and my role was to find a way to raise the team’s awareness of violence against women.

There was also a woman who came to the maternity ward with a prolapsed umbilical cord (and a baby who was still alive), which poses a risk for the baby, but not for the mother. We gave her the choice: ‘The baby may die, we suggest going to theatre for a caesarean section?’ She replied that she had to go and work in the fields the next day and, if she had a caesarean, she would have to stay in hospital for three days. So, she refused the caesarean and wanted us to attempt childbirth. This kind of situation does not occur in Belgium. (The baby survived, but it was a stressful situation!)

What qualities do you need to be a midwife with MSF?

I would say that the most important thing is being able to adapt to any situation and keep a calm head. To cope with the situations we come across in the field, you need to have patience, to be sympathetic, and to be able to bond with the team and patients. Despite the differences in education and standards, you need to be open to these differences and not be afraid to discuss them.

What do you take with you into the field?

My music speaker, some board games to clear my mind in the evening, and my coffee thermos – for a good dose of energy!

As a midwife, what type of medicine/materials do you have access to?

It's fairly standard in a lot of missions: there is no monitoring equipment, we work with Dopplers and Pinard stethoscopes. There is not always an ultrasound machine, but we have all the essential and necessary drugs for patient care, such as oxytocin, misoprostol, magnesium sulphate, fluids, iron, antibiotics, and so on. MSF protocols are based on WHO protocols; this was very reassuring in some situations where I did not know how to do something. I could simply do some research and base my practices on those protocols. 


"On your first assignment, you learn more than you teach."

What motivates you to go back?

The bond shared with the local people is very strong. I have gone on five missions as a midwife, and I love the feeling of having a positive impact.  MSF goes to areas where no one else goes, often conflict areas. I love the variety in the job and the combination of management and clinical aspects.

I love the ambiance that there can be with the other expats when we live together in the MSF compound.  All of that motivates me to go.

Women’s health and reproductive health are major problems in the world. Our patients are often women who are victims of the situation: whether it is war, a natural disaster, etc. It is incredible to be able to do something in this field and to feel useful. 

What would you say to a midwife who was hesitant about applying to MSF?

In the field, I have come across many things that I had never done before. Yet, there was always someone to give me a hand: the national and international teams, the headquarters advisors, etc. Have confidence in your skills, because you can learn anything, with humbleness and willingness.

Don’t be afraid of management. In fact, I quickly moved into supervisor or manager positions (which I also learnt in the field; I had not had any prior experience) – but on all my assignments there was still a balance between the management and the clinical aspects.

Don’t hesitate to apply. It’s an incredible experience, a way to learn a lot about your own profession and expand your skills. MSF values midwives and gives them autonomy, which I appreciate enormously.

To the job profile midwife

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