19 May 2025 by Limpho Sello

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“During the third home delivery, the placenta got stuck.”

Terrified, Matebalo Morokole and her fellow untrained home birth attendants tried everything they knew to help the struggling woman. 

When their efforts failed, panic set in. Left with no other option, they rushed her to a health facility in Nazareth, about 40 kilometres south-east of the capital, Maseru.

What Morokole and her team encountered is medically known as a retained placenta (RP)—a potentially life-threatening complication following vaginal delivery. 

RP is a major cause of maternal morbidity and mortality, and when attempts at manual removal are made without proper training or equipment, the risk of severe postpartum hemorrhage (PPH) increases dramatically.

If not managed promptly, RP and PPH can lead to emergency hysterectomy, circulatory collapse, or even maternal death. Survivors may face long-term complications such as anemia, failure to lactate, and postpartum depression.

Having witnessed these dangers firsthand, Morokole described the experience as harrowing—one that left her deeply shaken and resolute in her decision to never again assist in a home birth.

“Years ago, before I was officially trained, we used to help women give birth at home. I was there when a woman almost died because none of us knew what to do,” Morokole told Uncensored News on May 9, 2025 on the sidelines of the International Day of Midwives celebration in Nazareth in Maseru. 

She added: “That was the last time. I decided I would never again deliver a baby. I couldn’t live with the guilt if something happened to a mother or her child. I have proof of how dangerous and risky home births can be.”

Morokole’s account echoes the message championed by the United Nations Population Fund (UNFPA), which underscores the critical importance of skilled attendance at birth. According to UNFPA, having trained professionals at delivery—supported by emergency care when needed—is the single most effective intervention for ensuring safe motherhood.

The agency defines skilled birth attendants as health workers such as doctors, nurses, or midwives who are equipped to manage normal deliveries and recognise early signs of complications.

“They perform essential interventions, start treatment, manage some basic complications and supervise the referral of other complications to comprehensive emergency care. Skilled attendance is also vital for protecting the health of newborns, as the majority of perinatal deaths occur during delivery or in the 48 hours afterward,” stated a UNFPA article stated July 30, 2024. 

Meanwhile, the World Health Organisation Country Representative Dr. Innocent Bright Nuwagira has emphasised the critical role of midwives in Lesotho, where maternal mortality remains high at 530 deaths per 100,000 live births and neonatal mortality at 26 per 1,000.

“Midwives are not a luxury. They are indispensable to achieving Universal Health Coverage,” Nuwagira said.

He indicated that WHO is committed to strengthening midwifery-led care through health system reforms, maternal death audits, and quality-of-care initiatives.

Why Morokole chose change

Morokole began assisting pregnant women in her Ha Mapale village in Nazareth after being “trained” by older women in the community. With no formal education in childbirth, she relied on traditional practices passed down through generations. In the beginning, her experience seemed positive.

“The first two were smooth. The babies were born healthy. But the third made me realise just how risky childbirth can be without proper medical support.”

Reflecting on those early days, she recalled how they did their best to maintain hygiene—washing hands with soap, using hot water and clean towels, and cutting the umbilical cord using traditional measurements. Still, she admitted that mothers and their newborns were only taken to a health facility after the umbilical cord had fallen off.

As a mother of seven, Morokole understands the realities many women in rural areas face. She revealed that she gave birth to three of her children at home—not out of preference, but due to limited access to healthcare services.

“For all my pregnancies, I attended antenatal care. But labor caught me at home three times, and my mother helped. It wasn’t ideal.”

Today, Morokole is one of the hundreds of Village Health Workers (VHW) in Lesotho – a programme which plays a key role in improving primary health care and attaining universal health coverage to achieve health for all. 

As a full-time VHW, she actively encourages expectant mothers to attend antenatal care and to deliver at health facilities under the supervision of skilled midwives. 

“Home deliveries are too risky, especially with the spread of infectious diseases. Thankfully, waiting rooms for mothers who live far from clinics are helping to change that now,” she said.

She emphasised the importance of early referrals. 

“We refer pregnant women to health facilities as soon as we discover they are expecting. But it’s not always easy. Some young girls hide their pregnancies, sometimes planning unsafe terminations. We try to intervene early to protect them and their babies.”

Strengthening midwife-VHW collaboration

Morokole’s commitment to early referrals and community health education reflects the vital role Village Health Workers play in safeguarding maternal and newborn health—especially in remote areas where access to medical care is limited.

Recognising this crucial contribution, Keneuoe Nelly Fobo, President of the Independent Midwives Association Lesotho, called for stronger collaboration at the same event.

“Let us revive our relationship with Village Health Workers,” Fobo said during the International Day of Midwives, which was attended by VHWs like Morokole.

Fobo indicated that strong partnerships between VHW and midwives can help increase access to quality maternal services because VHW are “the first line of contact in communities.”

“They know the women, the families, and the challenges on the ground. Their work is vital in identifying pregnancies early, encouraging ANC attendance, and ensuring women get to the clinic in time for delivery.”

Fobo stressed that without VHWs, the national effort to reduce maternal and neonatal mortality would stall. 

“Midwives must value the work of VHWs. We must collaborate more intentionally and consistently. Together, we can strengthen community-based health systems and ensure safer maternal practices. Together, we save lives.”

A nation in crisis

Meanwhile, Fobo also echoed this year’s International Midwives Day theme—Midwives: Critical in Every Crisis—adding that even without wars or climate disasters, Lesotho is grappling with its own crisis. 

“We are swimming in a crisis in this country,” she said. 

“Because of our mountainous terrain and lack of infrastructure, some women walk more than eight hours to access health services. And they are expected to do that eight times during pregnancy to meet ANC standards.”

She warned that Lesotho’s shortage of midwives and healthcare workers is compromising maternal and neonatal care. “Our appeal to the Ministry of Health is urgent—address the human resource crisis. Without enough skilled personnel, women and babies will continue to die from preventable complications.”

Fobo also challenged her fellow midwives to reflect on their role: “Are we doing enough? If not, what interventions are we putting in place? If we are failing, then the association must be asked why.”

Building on this call for accountability, UNFPA Country Representative Innocent Modisaotsile highlighted the deeper purpose behind midwifery, emphasising that it is more than a job—it’s a calling.

“We are committed to strengthening midwifery education, ensuring access to essential supplies, and advocating for policies that protect and empower midwives,” Modisaotsile said.

He emphasised that investing in midwives is investing in Lesotho’s future. 

“It’s about building stronger, healthier, and more resilient communities. Midwives are the backbone of maternal healthcare. They are the guardians of new life.”

On his part, the World Health Organisation Country Representative, Dr. Innocent Bright Nuwagira, stressed the regional scale of the challenge. 

“In Africa, more than one million newborns and 178,000 mothers die each year. Midwives are lifesavers. From delivering babies in snowy mountains to managing emergencies with no referral support, midwives show up—and they save lives.”

He added: “To every midwife: today we celebrate you. But more importantly, we recommit to standing with you, not only during recognition events but in your daily struggles. When midwives are supported, every woman and baby has a better chance to survive and thrive.”

Echoing this commitment on the ground, Matebalo Morokole, a village health worker who has witnessed firsthand how home deliveries can end in fatalities, calls for unity between VHW and midwives.

“We can’t do this alone. Midwives and village health workers need to work hand-in-hand. They know the hospital protocols, and we know the women in the villages.”