Midwife Works to Improve Maternal Care in Haiti

Carine Richard, a certified nurse midwife of St. Joseph Hospital in Reading, PA, is every bit a Haitian: confident, emotive and tell-it-like-it-is. The Haitian-American Project HOPE volunteer grew up in the Petionville neighborhood of Port au Prince, Haiti, leaving with her family when she was 12-years-old to move to New York city. But her assertive and sunny bedside manner has made her a favorite for those she works with at the outlying clinics run by the Hospital Albert Schweitzer in Deschapelles, Haiti.

Duties during her three-week rotation have included not only training nurses and auxiliaries in safe deliveries, but teaching them more advanced techniques and reviewing basic skills to fill knowledge gaps.

“When midwives in this area do deliveries at home, they don’t do episiotomies,” says Richard, who describes discovering a massive vaginal tear in a woman during a routine check-up three days after she had given birth. Richard performed the procedure with no surgical lights. “It was an experience.” She adds, “If anyone thinks they are coming down here as a midwife strictly to deliver babies, they have to think again.”

“There is a midwife program thanks to Project HOPE, says Ian Rawson, managing director of the hospital. “ As midwives age out and there is no one take their places, we have had to search for alternatives.” The hospital had been seeking nurse midwives to train the staff in their clinics to regularly deliver babies and administer prenatal and follow up care. Project HOPE stepped up to the plate, providing a steady stream of midwives to the hospital over the past few months.

“There is a big need,” explains Richard. “For the past two weeks I saw a lot of premature babies, very underweight term babies. If we can get the nurses or midwives to be able to assess the condition of the mother and baby before birth we can reduce much of this and the maternal mortality rate.”

She describes teaching some of the clinic staff how to use a basic delivery date diagnostic chart, which many had never seen. “A woman walked into the clinic—32 weeks pregnant—and told the staff that she was two months pregnant, and the staff proceeded as if this was the case,” says Richard. ‘If you haven’t learned to calculate a delivery date in school, how can you accurately predict the correct birth date? If we really want to decrease the rate of mortality and morbidity we need to teach these people.”

Despite her busy daily workload, there have been rewards for Richard. Recently, a baby that she helped to deliver was named after her. And she has seen progress in her patients. “I’ve always encouraged human touch,” says Richard, who tells of fathers-to-be so unsure of their role in a birth that they have told staff that they were a sibling of the laboring woman in order to avoid being in the delivery area. “Now you can sometimes see men massaging their partners during the process.”

She starts a new job as a nurse midwife at a hospital near Lancaster, PA, in November. “But if I’d known how much I was going to love what I’m doing for HAS, I would have looked for a more flexible position so that I could do more rotations here!”

“I felt like I was in a dream before-- like I was not alive. Now I’m alive. I can’t imagine going back to the US and not thinking about this place—not doing more.”

She adds, “It’s not only prenatal care, I want to help my country.”

Story and photos by photojournalist and HOPE volunteer, Allison Shelley.

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