Respectful Maternity Care: Reflections from Sierra Leone

Some journeys change you in ways words struggle to capture. When Nicola Lovett, Head of Midwifery at James Paget Hospital, stepped off the plane in Sierra Leone this November as part of LFAM's volunteer mission to train local midwives, she carried decades of NHS experience—but nothing could truly prepare her for what she was about to witness. Here, she shares what happens when hope meets hardship, and when midwives on opposite sides of the world discover they speak the same language of compassion.

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A Reflection by Nicola Lovett, Head of Midwifery, JPUH

Trying to put into words all that we have seen and experienced in Sierra Leone is challenging. The conditions in which midwives live and work are so far removed from our own lived experience that it is hard to truly comprehend. Their everyday challenges seem a world apart from ours.

From their commutes—often on poorly maintained roads and tracks, sometimes on a moped, through traffic so congested it frequently grinds to a standstill—to the facilities in which they provide care, the contrast is stark. The journey itself is exhausting: the dust, the noise, and the cacophony of horns, street vendors, and music leave little space for mental rest.

The sights are equally confronting. The lingering scars of civil war are evident in the mutilated individuals on the streets, fighting to survive, alongside the extreme poverty visible in almost every family we met. These realities form the backdrop against which midwives strive to deliver care, often with limited resources and under immense pressure.

The facilities we visited pose challenges on every level. No running water was available in either the local community facility or the government-run referral hospital, and basic supplies such as PPE or soap were absent. Yet, despite these constraints, midwives continue to provide care with resilience, compassion, and dignity.

But despite these many challenges, there are glimmers of hope. We have been met with love, enthusiasm, and a passion for midwifery and learning that has been a joy to witness. Daily prayers and songs set the tone for workshops, which became platforms for education and community building. Break times—where midwives shared a meal—were as important as the learning, offering space for reflection, friendship, and peer support. Conversations often turned to case comparisons and advice, strengthening professional bonds.

We were privileged to appoint six new Midwife Champions in two districts—the shining stars amongst their peers. These midwives demonstrated skill in teaching and learning, empathy, and compassion. They are natural leaders in a profession that needs a strong voice and compassionate leadership. These Champions will continue to support and nurture their colleagues long after we return to the James Paget, where we face our own political and social challenges.

The support between nations will continue through a peer-support WhatsApp group and the JPUH PenPals initiative, creating a platform for shared experiences and solidarity across the miles.

Respectful Maternity Care was a central theme throughout the workshops. Respect—for women, for communities, and for each other—is essential for safe and effective care. This principle was evident in every discussion and every interaction.

Midwifery has always been a voice for women's health, justice, and social change—and that voice must continue to grow louder. Women's health needs strong and resourceful women advocating for it, and here in Sierra Leone we have been a small part of growing a community of change that will affect midwives across both nations.

Support Our Mission to Train Midwives

The midwives Nicola met in Sierra Leone work with extraordinary dedication despite overwhelming challenges. You can help us continue training these heroes and equipping them with life-saving skills and resources. Every gift—whatever the size—helps us create more Midwife Champions across Sub-Saharan Africa. Donate today and be part of this change.

This is the third in a special series documenting LFAM's November 2025 mission to Sierra Leone. Follow along as we share real stories of courage, community, and the extraordinary power of midwifery to transform lives.