JOLAN FUTAKI
35 years | Baar, Switzerland

I became interested in birth later in life, when I had my first baby. I was not aware that this universe existed, only when I experienced it first-hand. I did not have a doula accompanying me at the time.

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“The day after my first birth I realized someone was missing in the room: I had the healthcare provider; I had my husband around me. However, I was missing a supportive presence, a supportive energy. I was missing this motherly figure who would tell me: everything is alright, everything is normal.”

It was when I started looking into the profession of a doula. I found a doula agency in New York, which also provided training. It became my passion; and the more I learned about birth, the more it amazed me. “I was so blown away by the information and the different types of support one can get. It was a calling and something I would passionately do!” I took doula training and was fascinated by all the possibilities one can offer during birth. In the next four years I worked as a birth doula and had another baby myself.
While working as a doula I also encountered a few negative experiences, mainly in the hospitals. The more births I attended, and the more experience I gained, the more I recognized a pattern on how women are being treated. I also had experiences where I was belittled as a doula. I was given the sentiment that my role was nice but not important. I however wanted that people see the importance of the role and that a doula can be of help in a meaningful way. I realized then that I need to gain more competence, so I can change the environment in which women are birthing from within.
“My main motivation why I decided to become a midwife was that I wanted to provide a positive environment where women do not have to outsource their power. Where they do not have to give up anything and can birth in integrity, however they want to. Where women can be in their power, be the person in the centre, where they have control over everything.”
Midwives graduate from midwifery school with a different perspective than doctors from medical school. We see physiology. That is also why all the studies show that midwives are the best providers when it comes to low risk pregnancies. Even when we learn about pathology, our focus is to direct the birth back to physiology. My goal in the future is to uphold this and help women birth in their best possible environment.
I am a registered attorney in New York. I went through law school, followed by a master in the United States. My experience in the legal field is valuable to some extent as I always had a desire for learning rules and systems. Moreover, I think the legal and the medical fields are very similar: one must learn structures and systems and apply them. I am older as well than most of my classmates and there are advantages and disadvantages to it of course.
While in New York I worked for a non-profit organization where we advocated for employment law discrimination. We had a lot of pregnant clients who were mistreated due to their pregnancy and that also triggered me in a sense, but at the time I did not know what the trigger was.
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“Rights in birth are human rights and we cannot separate human rights from reproductive justice or mistreatment in the birth environment.“

I love the personal connection to people and being a midwife allows me to work closely with them. We are the closest to women; we are at eye level and often in bodily contact with them. This is not necessarily the case for doctors; they must keep more distance, they have more patients and less time.

I love that we have more time for the women, we have the capacity for one-on-one care and we can help them with the decision making. It depends on the provider, everyone could make time and space for this, but our world inherently includes this personal connection. The topic of birth moves a lot of people. It is very important; it is in the centre of life and how life becomes.
The educational system in Switzerland is wonderful. I feel lucky to be able to experience midwifery studies in such system. Before applying to the program, as a pre-requisite, one must complete an internship of eight weeks, in a hospital or in a private practice. The entry exam consists of a written exam and a personal interview. In our school we now have 90 spots, the number of students was increased recently. The ZHAW has the capacity to train more midwives, but the institutions for our placements cannot absorb that many midwifery students because there is a shortage of midwives [i.e. preceptors]; this is a vicious cycle.
In the first semester, we learned about physiology and physiological birth and I find it wonderful that our entry into the field begins with this. The second semester is mainly about physiology, but we are also introduced to pathology. After the second semester we have a 14-week long internship, which requires some knowledge about both. We are expected to be able to support physiological birth but also pathology to some extent, though we observe every type of birth during the placement. Afterwards we return to school, we can apply our knowledge from the internship and learn mainly about pathology. And then the fourth and fifth semesters are 14-weeks long placements. The sixth semester we again return to school and finish the BA thesis. After the third year we are required to do our 10-months long placement, which is divided into three 14-weeks long units. Afterwards we receive our degree and are officially allowed to work as a midwife.

We are lucky as the school organizes all the placements. There are four midwifery trainings in Switzerland: two are in the French speaking part of Switzerland, and two are in the German speaking part in Bern and Winterthur. The ZHAW in Winterthur, where I study, gets all the placements in the institutions located in the North of Switzerland. These are small and large hospitals, but also independent midwife practices. Though in the first three years we are only placed in hospitals.
I find it incredible how the system is set-up: We start practical training from the very first week onwards and have at least one practical day per week. We go to the skills lab, where we are expected to behave as if we were in the hospital. The skills lab has many supplies; anything that you can imagine is there: sterile gloves, pelvic models, baby mannequins. We even have a model that allows to demonstrate water births. We also have scarfs hanging from the ceiling where we can practice different birthing positions. It is really well balanced: a great mixture of practical and theoretical experience.
One thing I felt lucky about when doing my training in Switzerland, apart from the supplies and the infrastructure is, that we could continue with our training regardless of the pandemic. I know midwifery students, for example in the US, who were not allowed to continue with their training during the pandemic. In Switzerland we did not experience any disruption, we never had to leave the hospital, and they never limited the number of students in the hospitals.
During the year we have different modules per semester; it can include anatomy, legal aspects of midwifery, clinical assessments and so on. In the first semester the modules were organized by phases: pregnancy, labour and the postpartum period. We always have three to four professors per semester, each responsible for a module. And we have other professors who are not in the lead but who are lecturers within the module. In one semester we see around 20 different professors or even more, depending on the number of topics.

At the beginning of my studies, I asked one of our professors what kind of books we use. And I was shocked by the response! I was told we do not use textbooks in the traditional sense, as they are not always up-to-date and do not include the most evidence-based and recent information. Instead they provide us with a lot of studies and we use the “Hebammenkunde”, a series of handbooks containing checklists that we use in practice, with the most recent edition being published this year.
Since the Covid pandemic the school implemented a hybrid education model. We are physically at school about two days per week and one day we are taught online. There are days when we split into two groups of 45 students to practice in the skills labs. We are then sub-divided into three groups of approximately 12 students, with one lecturer being responsible for the smaller group; and split into groups of three for practical training.

Mainstream education cannot cater everyone. If we have an issue with something we can always contact the head of the module. We have practical exams, so called OSCEs, and we have theoretical exams. The theoretical knowledge is tested through multiple choice questions and not everyone is happy about it as it does not necessarily show what we have learned and our progress, but instead it only shows a minute of the knowledge you have gained. But it is a system that works.
When it comes to placements, every practice institution knows our required competencies, including the theory and the practical background related to it. There is a written list of the taxonomies. The representative of the practice institution also meets with the responsible person of the ZHAW once a year to discuss what we are supposed to learn and to align. As we progress with our placements in the third, fourths or fifths semester it gets more challenging. We also have a handbook, which was developed by the school and which tells us what tasks and skills we are supposed to gain throughout our studies. Our practical progress is being recorded by using the EU booklet, which defines the same requirements across the European Union. We must take care of 100 pregnant women; the same is true of postpartum care. Furthermore, we must actively take part in at least 40 spontaneous vaginal births. It is obviously sometimes challenging to fulfil the 40 births, as the placements are organized by the school and in some institutions the C-section rate is higher. There are also other experiences we can list in the EU booklet which count. For example, I have shadowed a lactation consultant which I can enter into the booklet.

During the last ten months of our studies, in which we gain further practical experiences, we are given more flexibility regarding our placement. The school supports us by finding us placements, but we can also organize it ourselves. While the first placements take place in the postpartum or labour ward, during the last ten months we can also be placed in the neonatal unit or accompany a freelance midwife or travel abroad. A colleague of mine went to Australia for example. However, the births we accompany abroad do not count in our EU booklet.
In the first semester we elected a few students who represent us in different matters. Further, we have a student association. As we have five different studies at ZHAW the association is represented by someone from each of the different studies. Our class is quite diverse, for example we have a total of eight mothers; we stick together a lot and support each other as parents. Also, the age range is quite diverse between the age of 19 and 50. The ZHAW also tried to experiment when it comes to part-time studies. One of my colleagues for example is doing two modules instead of four modules per semester and does a sixty percent placement instead of full time.
As much as people love midwives, I think they were not as represented and visible in the past. Around ten years ago the situation was far from ideal and people did not know that midwives can provide prenatal care, care throughout the pregnancy and birth as well as postpartum care. Now it is more common to seek support from a midwife during postpartum care; but it remains mostly uncommon to receive prenatal care from a midwife only during pregnancy. In Switzerland, most women go to their gynaecologist for antenatal care and continue to do so. I think it is a matter of trust: you go to your trusted provider and do not want to encounter change as this is what you are used to. But ideally you should be cared for by someone who provides a holistic approach. I think it would be great if midwives could meet and bond with clients already prior to becoming pregnant. I wish midwives could do “well visits” and provide pre-conceptional counselling and care.

I am not yet fully aware of the challenges midwives face and I think I will realize that as soon as I start working. Something I am noticing already is that some of the challenges are created by the lack of universal child care. As the majority of midwives are women, they are adversely affected by the lack of universal childcare. Last year I read an article about the midwife shortage in Switzerland: young midwives are leaving the profession due to burnout or the lack of an opportunity to maintain work life balance and family life; and old midwives retire- we have a huge problem. Another challenge for independent midwives is the high cost of malpractice insurance. On a positive note I think people in Switzerland really value community and are actively creating it. They establish WhatsApp groups, circles, supervision circles etc. I think it is important to be connected even if you do freelance work because you cannot carry the burden alone.

When we return from our placements we usually have two weeks to jointly process the information we have gained and the experiences we have made. All 90 students come together, and the school provides us with a lot of tools to process what we experienced. One example is the “intervision technique”: We get together as a group and everyone presents an issue they faced during their placement. We then jointly select one issue and we use a playbook providing us with a step-by-step approach to look at the issue from different perspectives.
“I treat my midwifery as my third baby. It is at the core of my heart and a passion I never want to give up again in my life. It is my calling to become a midwife. I am also very interested in pushing boundaries. I am not sure what the future holds and how I want to work. But I know that I want to empower women and create the best setting to do so. If I cannot change it from within in the hospital, (…) I may do so by working as a freelance midwife. But I will always be a midwife.”
We also get a real emphasis on inter-professional collaboration in our studies. We had for example an exciting project last year, which was a collaboration between ETH and ZHAW. The first-year medical students visited our school; and we as the second-year midwifery students taught them everything we learned about physiological birth. I was very lucky to participate in this project and I thought it was fantastic. They learned the birth through the lens of a midwife. Learning from each other will allow us to better work together in the future and truly collaborate as a team with the health and well-being of the women at the centre.

Interview by Leah F. Bohle, 02 April 2023

Photo by Marion Bernet/Leah F. Bohle/Fairpicture