Liberia: The toughest place to be a midwife?
One in 25 babies delivered in Liberia, West Africa is stillborn or dies within 24 hours, making it one of the toughest places in the world to deliver babies, as a British midwife found.
"I've never watched anybody die. It was like she was almost dying in front of my eyes is the best way I can describe it," said British midwife Suzanne Saunders-Blundell.
"You just feel so helpless, don't know what to do, don't know what to say, but she must have been in an awful lot of pain."
Suzanne works in the UK as a labour ward co-ordinator but visited Liberia to spend two weeks helping midwives and doctors at Redemption Hospital in Liberia's capital Monrovia.
The woman they had been treating had become ill after a home abortion, but despite their best efforts she did not recover.
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- Suzanne Saunders-Blundell spent two weeks in Liberia filming Toughest Place To Be A... Midwife, broadcast on BBC Two at 2100 GMT on Sunday 27 February
In Liberia, babies die every day in hospital and mothers risk their lives in childbirth. If something goes wrong or an infection sets in after labour, often there are no medicines to help.
Abortion is illegal, but many women who do not want a child will take herbs and end up critically ill.
"After doing everything, to see a patient die... at times I get so frustrated," said Lucy Bahr, the most experienced midwife at Redemption Hospital, who has worked there 14 years.
Based at the Good Hope Hospital in Sutton Coldfield, West Midlands, Suzanne Saunders-Blundell is used to having experts on call, hi-tech equipment and access to medicines.
In Monrovia she found dedicated staff, working with only basic facilities and limited medical supplies.
But she was shocked to find some Liberian midwives pressing on a woman's abdomen to help move the baby out.
Liberia is home to 3.5m people, and was founded in the 19th Century by freed American slaves.
But in recent years this promised land has been torn apart by one of the most brutal civil wars in African history.
As warlords fought for control, 250,000 people were killed and nearly 800,000 fled. Women were raped, houses burned, and child soldiers as young as 10 held the power of life and death in their hands.
Today, eight out of 10 people live on less than a dollar a day, and even in the capital there's very little electricity and no running water.
Suzanne had hoped to learn more natural birthing processes in Liberia, but found the high demand for help and few beds meant Liberia's midwives had no time to focus on a slow labour.
"I really thought there'd be a lot more tradition, a lot more that these midwives could teach me, signs... of how a labour advanced, not having to intervene and it's none of that.
"It's a big shock and it's a big disappointment, that these are the people who really should be getting back to nature, to improve the care they give, not dominate it."
Staffing shortages in Liberia's hospitals are crippling - there are fewer than 60 Liberian doctors in the country, and midwives are so poorly paid, many leave the profession.
At Redemption Hospital antibiotics were scarce and premature babies were wrapped in tin foil, as nobody knew how to operate an incubator donated by Unicef.
On her first day Suzanne found she had to help deliver a stillborn child. The woman who lost her child was still in her bed when another woman gave birth next to her.
"They've got a woman with diarrhoea, next to a woman who's just had a stillbirth, straight next to a woman who's got a live baby, [next to] somebody who's just had an abortion.
"It just seems really bizarre that all these women are just put together," Suzanne said.
In Liberia, 63% of all births happen away from hospital, as many women live in remote villages, where the roads are bad and they have no transport.
Their babies are often delivered by traditional birth attendants, local women with few medical skills.
"I love the job and I will do the job until I die," one of the birth attendants told Suzanne.
Although they had many traditional beliefs about delivering babies, they all knew they had no way to treat medical emergencies, and had to get women to hospital if they were bleeding.
"I found it really, really touching, very motivating," said Suzanne. "The birth attendants here are all so passionate - really, really passionate about midwifery, really passionate about the health and the well-being of the mums they care for and the babies. They are the unsung heroes of the midwifery world here."
By end of her stay Suzanne was inspired by the strength of the Liberian women, both the midwives and the birth attendants, whom she lived and worked with in such difficult conditions, and who shared her love of the work they did.
"It is a calling that you really want to do, but you dedicate your life to it as much as you can, really."
Toughest Place To Be A... Midwife is broadcast in the UK on BBC Two at 2100 GMT on Sunday 27 February.