Midwife

WHAT IS MSF ?

Médecins Sans Frontières/أطباء بلا حدود  بلا أطباء (MSF) is an international, independent, medical humanitarian organization that delivers emergency aid to people in 70 countries who are affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF offers assistance to people based on need, irrespective of race, religion, gender or political affiliation and our actions are guided by medical ethics and the principles of neutrality and impartiality.

We offer basic healthcare, perform surgery, fight epidemics, rehabilitate and run hospitals and clinics, carry out vaccination campaigns, operate nutrition centers, and provide mental healthcare. Our activities include the treatment of injuries and disease, maternal care and the provision of humanitarian aid. Where necessary, we set up sanitation systems, supply safe drinking water, and distribute relief to assist survival.

A FEW WORDS ABOUT THE PROJECT

The project started in Sept. 2013 in Shatila, where MSF currently manages an outpatient center for chronic non-communicable diseases (NCDs), vaccination services with transversely integrated mental health services and health promotion, and referrals for patients who require services beyond the scope of MSF activities. Additionally MSF opened a women’s health center with sexual and reproductive health care.
During 2018, low risk deliveries were relocated from Shatila to Rafik Hariri University Hospital compound, where MSF runs a Birth Centre. MSF took this as an opportunity to work together with external partners as catalyst for change around midwifery model of care and demedicalization of deliveries. The antenatal care services remains in the camps, to serve the most vulnerable women.
In Bourj el Barajneh camp, besides the above mentioned activities, MSF provides in addition home based care for those patients who are housebound or bedridden often due to an advanced NCD disease.

MSF BIRTH CENTER (BC)

The MSF Birth Center is unique in Lebanon, in its objective to develop a midwife led model of care. The midwives are responsible  for all of the deliveries and are only required to consult the obstetrician in case of complications. The model focuses on low risk pregnancies. There is an assesment room for all patients being followed in ANC, including the higher risk cases and they may attend at any time to be assessed. The most important role of the obstetrician is to manage any complicated cases either in BC or prior to referral to another hospital, and to be active in teaching, coaching and empowering of the midwives and nurses to help develop the midwife led model of care.

Here is a short video about BC

MAIN RESPONSIBILITIES

Provide evidence based obstetrical care to pregnant women and their babies,  before, during and after delivery, according to MSF obstetrical and reproductive health protocols, universal hygienic and newborn caring standards and under supervision of the midwife supervisor, in order to ensure a healthy pregnancy and uncomplicated delivery  and avoid post-delivery complications. When necessary, appropriately  manage and complications arising. Follow the MSF medical ethics with respect of the patient’s autonomy, dignity and cultural and religious beliefs.

This position will primarily be located in the MSF Birth Centre located in the ground of RHUH, whilst maintaining its independence, the BC will collaborate closely with RHUH. This centre is unique in focusing on a midwifery led care model for all acts. The Birth Center will hopefully develop over time to become a place for training external staff, in the midwifery model of care.

This position requires mainly shift duties (7 am to 7 pm // 7 pm to 7 am), with occasional day work needed in Shatila and Burj al Barajneh camps.

DETAILED ACCOUNTABILITIES:

• Ensuring the implementation and continuity of antenatal and postnatal care, family planning, obstetrical care (BEmONC 1), and comprehensive neonatal care, management of victims of sexual violence, reproductive tract infections and  in accordance with MSF Reproductive Core Package of Activities and reinforce the implementation of standardized protocols.
• According to MSF protocols in force, conduct normal deliveries independently Manage obstetric emergencies; identify cases needing referral and send them in time, clean up the newborn, executing and registering first neo-natal medical acts (cutting and cleaning the umbilical cord, vaccination, etc.), detecting possible anomalies/infections of the newborn and reporting them to the doctor, in order to ensure successful interventions
• Ensuring patients’ right to privacy and confidentiality is respected, and treating them in this manner.
• Collaborating with the medical doctor and /or nurse in the management of Sexual Violence cases
• Assessing the feasibility for referral of pregnant women from the OPD or IPD to affiliated hospitals for medical evaluation and/or complicated deliveries.
• Ensuring hygiene and sterilization criteria (including  universal precautions) are met according to MSF specifications.
• Performing cleaning and minor maintenance  for  biomedical equipment used. Following the user manual and  protocols and alert supervisor in case of malfunctioning.
• Appropriate use and management  of drugs and equipment required for maternity activities.
• Properly following up all newborn babies from delivery until discharge, informing mothers and relatives about importance of breast feeding, vaccination and possible complications resulting from harmful traditional practices.
• Supervising that administrative procedures of admissions and hospitalizations comply with MSF protocols , as well as verify patients are properly informed and receive the documents required (birth certificate, vaccination card, etc)
• Participating in the organization of the ward in collaboration with other midwifes and the maternity ward supervisor. Ensure transfer of relevant information to the next shift team (specially identifying risk cases)
• Supervises the use of drugs, facilities and obstetric material, in order to ensure, in accordance with number of patients and prescriptions, a rational use.
• BEmONC = basic emergency obstetric and neonatal care = Administration of antibiotics, oxytocics, anticonvulsants, manual removal of the placenta, removal of retained products following abortion, assisted vaginal delivery, preferably with vacuum extractor and newborn care including neonatal resuscitation. 

ADDITIONAL ACCOUNTABILITIES

During assessment in pregnancy, labour, delivery and post-partum

• Provide the women with quality care during all phases of pregnancy, labour, delivery and post-partum period according to MSF protocols.
• Support and monitor the normal progression of labour and use non-medical interventions to help labour progress
• Conduct normal deliveries and monitor the wellbeing of mother and baby
• Do the immidiate care of the newborn after delivery including resuscitation, physical examination and vaccination
• Initiate early breastfeeding and educate the families about the importance of breastfeeding
• Support, educate and inform the women and caretakers about the normal process of pregnancy, labour, delivery and post-partum.
• Detect complications if they arise, inform the obstetrician and assist the doctor in treatment of the patient.
• During all patient contact show respect for the dignity, cultural and religious belives.
• Document all aspect of the work accordingly in the patient file
• Participate in detecting victims of SGBV and assist in the treatment

Referral of high risk women / newborns

• Consult with the obstetrian/pediatrician/referral nurse when referral is deemed necessary based on criteria. Prepare the patient/newborn accordingly and complete the required documentation.
• Communicate handover with affiliated hospitals and find a place for the patient according to protocol. Administrative work regarding referral to be done.
• Inform family / caretaker accordingly
• Accompany patient / newborn when needed
• Refer for mental health or social worker support when needed.

Participates in the department related pharmacy and medical equipment control and maintenance

• Perform handover of medicines and materials at every shift
• Ensure no materials are removed from the wards withour prior authorisation
• Check that the medical equipment in the department functions properly (suction pump, BP machine pulse oximeter)
• Cleans and disinfects materials after each patient.
• Monitors and records the consumption of medical materials and supplies and report to midwife supervisor about near-ruptures.

Hygiene / aspesis, waste disposal and stock keeping

• Ensure appropriate waste management and  use appropriate containers and bins (sharps, medical waste, domestic waste)
• Follow cleaning and instrument sterilisation procedures
• Respect standard precautions and aspesis during procedures
• Awareness of PEP kit and follow up of AEB procedure

Additional Responsibilities

• Participate in collecting needed data for monthly medical reports
• Participate in the regular meetings of the medical team
• Participates in all training delivered  to the department and makes an ongoing effort to maintain and update obstetrical/medical/ paediatric knowledge and skills.

REQUIREMENTS

Education : Midwifery degree + Registration with the Syndicate of Midwives in Lebanon

Desirable experience : working experience of at least two years in midwife activities related jobs.

IT skills: Essential computer literacy (word, excel)

Soft Skills: Results and Quality Orientation,  Teamwork and Cooperation,  Flexibility,  Commitment,  Stress management