Sharon Craig Economides is a well-known and highly successful international midwife whose work has touched communities in Russia, the Philippines, Haiti, Afghanistan and United States. In this piece, Sharon shares her journey to becoming the global midwife she is today, as well as bits of wisdom she gathered along the way. She also offers specific advice and resources to those on the path to becoming the next generation of midwives to serve the global community.
I was born into the context of humanitarian relief and development. My parents have worked with refugees and communities in developing countries for over thirty years. When I was an undergraduate student, I became a doula and got increasingly interested in maternal and international health.
In addition to taking paying doula clients, I made a point of reaching out to women who didn’t have support for labor and couldn’t afford a doula. I was an on-call volunteer doula at a hospital in California and attended the births of several immigrant women who were totally alone in labor. I learned how to support a woman in labor even when there was a language barrier.
After my initial year-long apprenticeship with the midwives and obstetrician at a birth center in California, I went to Russia for a 3-month internship with the Russian Birth Project. The transition from candle-lit waterbirths to multi-patient labor rooms with a 4-foot tall delivery table that women had to climb onto was a stark and abrupt one. Though the comforts of a birth center were absent, the Russian midwives and physicians were skilled in protecting normal birth. Even though the hospital we worked in was a tertiary referral center and saw women give birth with an array of complications, the cesarean rate was 8%. I witnessed my first breech births in St. Petersburg. I learned how to suture. I learned how to conserve medical supplies. Perhaps the most important lesson I learned from my expat American midwife mentor was to know your own skills and limitations and respect them – a gem I still remember and use today.
When I returned to California, it took about a month for me to process the numerous triumphs and tragedies I had experienced. I cried about the babies abandoned at the hospital. I learned that to serve women in labor and birth, especially in areas where tragedies and losses are more common, you have to be resilient, and learn how to take time away to grieve and regroup.
I continued to work with the midwives at the Birth Home as an apprentice midwife. I appreciated and learned from a diverse group of practitioners. Each midwife and the sole obstetrician had different approaches on things like perineal support and the birth of the placenta. I stored their varied advice – I was determined to take the experiences they learned from, and add them to my own repertoire for the future.
In the winter of 2004, I went to Davao in the Philippines for another 3-month clinical internship at Mercy Maternity Center. I gained experience in starting IVs, suturing, resuscitation and keeping birth normal even with some risk factors. I saw again how quality midwifery care can be provided with minimal supplies. The most important part was having midwives who were skilled and cared for the women in labor, and knew when referral was necessary. I appreciated the collaboration between students, staff midwives and volunteers. We were a team.
In 2005 I passed the NARM exam and moved overseas. In my first year as a certified midwife, I helped open a maternity ward, NICU and blood bank in a hospital. I was suddenly responsible for 18 midwives. I learned valuable management skills and made the transition from wanting to “just catch babies” to seeing the value in supporting indigenous individuals to gain skills in providing care. I learned that my role in overseas work was changing to one of empowerment and development rather than just direct patient care.
After leaving the hospital, I trained community health educators in a facilitated, discussion-based perinatal health education program for adult learners from an oral-society. Women in the community would share their stories, process what works and what hasn’t worked in saving lives and brainstorm future solutions to alleviate the causes of deaths of women and children in their community. I learned how to listen and how to engage women in conversations about health, and facilitate their process in creating locally feasible solutions.
In 2010 I was called on by the Circle of Health International, for whom I served as a board member, to lead their first team of women’s healthcare providers to respond to the reproductive health needs of women in Haiti. It was my first experience responding in a national crisis. I learned to take every rumor with a grain of salt, and to be aware of how people respond when faced with fear, fatigue, trauma. Team members were told grossly exaggerated stories that people walking the streets with machetes, ready to kill indiscriminately. Others said that there were thousands of people pouring over the border. In the pressure of the situation, people misinterpreted what they saw. The chord that was most resonant in my experience in Haiti was that in a crisis, you need to find a need and humbly do your best to fill it.
Most recently I have been volunteering with a national midwifery association. I appreciate working with an organization that is led and staffed by capable, experienced national midwives who have the passion and commitment to change maternal and child health in their country. My work is mostly behind the scenes- editing speeches, project proposals and curricula.
If you are interested in becoming an international midwife here are some ways to start preparing:
Find resources about midwifery and international health such as:
- The book Monique and the Mango Rains: Two Years with a Midwife in Mali by Kris Holloway
- The film A Walk to Beautiful about obstetric fistulas.
- The film No Woman No Cry about maternal health.
- The film Motherland Afghanistan about an Afghan-American obstetrician volunteering in Afghanistan.
- The United Nations Population Fund’s State of the World’s Midwifery Report.
- The Hesperian Foundation resources such as:
- Where There Is No Doctor
- A Book For Midwives: Care For Pregnancy, Birth, and Women’s Health
- Medicin San Frontier’s: Working with humanitarian organizations: a guide for nurses, midwives and health care professionals.
- Aljazeera’s Birthrights series.
Become familiar with international healthcare policy
- Explore the World Health Organization website, especially the sections on:
- Read the documents posted on the website of the International Confederation of Midwives.
- Read the annual publication from Save the Children entitled State of the World’s Mothers .
- Read the Minimum Initial Services Package and complete the free distance-learning course on Reproductive Health in Crisis Situations.
- Learn about the differences between relief and development.
- Learn about community development and community-based decision making.
- Learn and practice cultural sensitivity.
- Reflect on your own values and prejudices.
- Practice humility and acceptance of people doing things differently than you are used to. Be flexible and learn to be adaptable.
- Have a good sense of humor and a bad sense of smell.
If you are a midwifery student, consider getting midwifery experience abroad. You will gain high-volume clinical experience in a different setting, and learn the important skills of adapting to a new culture and being flexible. You will learn how to do more with less from people who are experienced in providing high levels of care in challenging environments.
- Check out the Midwife International 1-Year Midwife Immersion Program, in which you can gain experience while serving mothers and babies in resource-constrained areas of the world:
- Midwife Training program overview
- International clinical sites (many are NARM approved out of country sites)
- Learn more about NARM approved out of country clinical sites
If you are an experienced midwife, consider volunteering your time and skills abroad to gain valuable practice while serving mothers and babies. Midwife International places experienced certified midwives with a minimum of 3-years out of hospital midwifery experience as preceptors for students in birth clinics around the world. Shorter guest teacher rotations are also available. Learn more by visiting the volunteer midwife preceptor page.
Many of the NARM approved out of country clinical sites take experienced midwives as volunteers as well.
A few parting words of advice
Midwives in other countries tend to have a larger scope of practice than those practicing in countries like the United States, so practice your low-tech/high-touch diagnostic skills. If you do not have training and experience in caring for women who are considered higher-risk in the West, I would recommend getting further training in breech and twin births, postpartum hemorrhage, management of pre-eclampsia and eclampsia, neonatal resuscitation and care for the preterm baby, suturing, IVs and forceps/vacuum assisted delivery. Depending on where you work overseas, there may not be an option to transfer a woman quickly and safely to a hospital for advanced obstetric care. You may also find it rewarding to volunteer with organizations in your area that work with immigrants, fund raise for international healthcare or trainings.
Sharon Craig Economides, LM, CPM, MMid, IBCLC was born at home with a midwife. She has worked as a midwife and humanitarian in homes, birth centers, and in the hospital setting in Russia, the Philippines, Haiti, Afghanistan and California. As an undergraduate, Sharon studied English Literature at the University of California at Berkeley and holds a Masters degree in Midwifery from the University of Sheffield in the UK. She is an International Board Certified Lactation Consultant. She is a freelance writer, her articles have been published in for Midwifery Today, Sojourners, Pakistan’s The Friday Times and other publications.