Instinctive tenderness. It’s not a phrase you’ll find in midwifery textbooks, but I’m no good as a midwife without it.
Words, smiles, gestures are all important when you meet women at possibly the most vulnerable or challenging time of their lives, but it’s also a virtuous cycle, because when the woman or birthing person looks back at me with trust, it gives me strength and confidence in my skills.
All this changed when I worked for a year as a midwife in a huge Rohingya refugee camp in Bangladesh. Here smiles, kind words, eye contact were often regarded with suspicion or fear.
The women I worked with here were frequently traumatised, having fled persecution in Myanmar. They all lived in extreme poverty, many were victims of sexual assault and trafficking. Here, pregnant and labouring women often shied away from me, they did not want my gestures or touch. We did not share the same language, and due to years of persecution, they did not trust anyone - even their midwife.
At first, I was incredibly thrown. While it’s never OK to touch someone who does not want to be touched, without touch, without gaze, something powerful and precious is gone and I needed to find a new way of working.
My humanitarian work with MSF (Médecins Sans Frontières, or Doctors Without Borders) remained essential. These Rohingya women had no other access to healthcare, and harm - or even death - was a real risk for their pregnancy. But if I tried to offer comfort in the ways I was used to, I only made them feel worse.
My first breakthrough came on a hot day in March. I’d been in Bangladesh for two months. I was sweating from the high humidity as we trudged through a wasteland of shacks made from scraps of plastic and mud. I was determined to find Rashida, a young woman I’d met the previous month, who’d hidden timidly behind her orange headscarf. Her story of loss was almost unimaginably sad: 14 consecutive miscarriages when she had no access to a midwife, and now her husband was missing. Rashida was in the early stages of her fifteenth pregnancy, and she prayed she would get to have this baby.
When she saw us at the door of her shack, she hid her face in the familiar headscarf, but nodded that we could enter. I took off my walking boots and stooped into the dark room, my sweaty socks leaving footprint marks on the swept mud floor. In the corner lay the remains of last night’s cooking fire, a single cooking pot, and a wooden spoon. The air was still acrid with wood smoke. A few items – bag of rice, kindling wood and a bamboo mat to sleep on - was the bleak sum-total of Rashida’s world belongings. The victim of a humanitarian emergency, she’d lost everything.
Sarika, my Bangladeshi counterpart, and I, gained consent to do a full antenatal check-up for Rashida, including all the usual checks like blood pressure monitoring. To our joy we found this pregnancy was progressing well. When we heard the familiar ‘sh-sh-sh’ from listening into the baby’s heart rate for the first time on our doppler, we smiled, and the conversation between Sarika and Rashida in Rohingya seemed to flow a little easier.
Then ,to my amazement, I saw Rashida looking directly at me. Did I even see a slight smile? I was holding my breath as Sarika explained that Rashida was very grateful, we’d taken off our shoes as we’d entered her hut, which was respectful. I didn’t understand at first, but Sarika helped me to see that for all Rashida’s life, she had been treated like a nobody. Worse, she had been abused, humiliated. Although this shack was humble, it was still her home, and she was grateful for our respect to her.
As we left, Rashida promised to return to our clinic in a month’s time for a check-up, one cycle of the moon, or sooner if she had any pain or bleeding. Although I yearned to hug her or reach out, I knew better by then. As I stooped to leave, she reached out and gently touched the back of my arm, with a slight smile. This small touch felt like a huge breakthrough for me. The atrocities unfolding around us would continue to unfold, we had no power over them, but the touch of her hand on my arm gave me a glimmer of hope and the strength to continue the fight for safer births. Everyone deserves access to dignified maternity care from a skilled midwife, regardless of where in the world they happen to have been born.
Later, after I’d helped create a birth unit for the women of the camp, and we trained local midwives, Rashida was one of the first women to attend in labour. The joy, the relief I felt watching her birth her first live child after her 14 losses, will stay with me forever. She named her boy Yusuf, after her husband, who was never found. Rashida looked at her baby with such pride, such love it was almost overwhelming to see.
I will never forget Rashida. With that small gesture of touching my arm with her hand, she showed me the power of touch. Both she and her son survived despite all the risks against them, and I will be forever grateful for the trust she showed in me.
MSF is still working within the Rohingya refugee camps of Bangladesh, and the birth unit still runs today with over 100 safer births each month.
Frontline Midwife: Finding hope in life, death and birth by Anna Kent is out now in paperback