Training midwives in inner-city Karachi, Pakistan

This article recounts the author's experiences as a midwife in Pakistan where she has worked since 1998. The Lady Dufferin Hospital is situated in a slum area of Karachi, — 90% of the women come from very poor families. Most of their care is subsidised or free. Pakistan has a deplorable maternal mortality rate. Approximately 30000 women die each year from pregnancy and childbirth related causes, (UNICEF, 1997). While midwifery training exists, it appears that few midwives work outside hospitals. A shocking 80% of women deliver with untrained attendants, either relatives or Dais — untrained birth attendants (Tinker, 1998). The author's job has been to improve the standards of midwifery care, by upgrading the clinical skills of the midwives. The experience has been very positive, with most of the midwives trained now at the stage where they can practise independently.