Pass the mic: Sara Jean, World Mental Health Day 

Has the political crisis in Haiti had any impact on your mental health? 

The ongoing political crisis in Haiti has taken a significant toll on my mental health. I often feel stressed, suffer from insomnia, nervousness, severe headaches, difficulty concentrating, and at times, I experience symptoms of depression. I find myself constantly worrying about my little girl—her future, and the completion of her school year, which is repeatedly disrupted by armed gang invasions or the never-ending socio-political unrest in Haiti. Every day, I live in fear that something might happen to her when I drop her off at day-care. 

I also think about the other children, who are still trying to cope with everything. Will they eventually be caught up in the wave of juvenile delinquency that has troubled Haiti for years, making things even worse? I long for a big change in Haiti. It’s very hard to stay mentally strong in these conditions. 

What does a midwife working in a humanitarian crisis look like? 

To me, a midwife in a humanitarian crisis is a hero or a warrior. It’s hard to imagine what health professionals face in such situations. In Haiti, for example, since the political situation worsened, all systems and structures have fallen apart. Midwives leave their homes each day to go to work, without knowing what lies ahead. With 80% of the capital now considered lost territory, controlled by heavily-armed gangs, midwives must cross these dangerous areas regularly to provide essential care to women in these communities. 

A midwife in this context must be mentally strong and resilient to face these dangers and keep working despite the odds. 

What was it like to provide care during the outbreak of the crisis?  

That time will always stay with me because of how hard and complicated it was. I was working in a rural area, while my husband and family were living in the capital. Normally, I worked Monday to Thursday, and it only took me 2 hours to travel between home and work, returning to Port-au-Prince every weekend. But during the crisis, that 2-hour trip turned into 8 hours because gunmen were everywhere in the town. Every time we passed through, we had to pay them, risking kidnapping or worse. 

That wasn’t even the worst part. When we finally reached our destination, one of the most dangerous regions in Haiti, all the serious injury cases, gunshot wounds, and sexual assaults caused by the armed groups came into the hospital where I was working. It was heartbreaking to see that no one was spared, and it deeply upset me. I was also pregnant at the time, and I was exhausted, feeling like I couldn’t keep going. I took a short break to catch my breath, but I couldn’t stay away for long. I like to feel useful, and most importantly, the pregnant women in the community needed me. So, despite the risks, I went back to work at the hospital. 

I was constantly stressed and worried about possible complications with my pregnancy. But my biggest fear was going into labour at night, when the danger was highest, and facing the risk of being beaten or sexually assaulted, no matter how urgent the situation was. 

How did your fellow midwives support you through these times? 

It was a very difficult period, but I was fortunate to have two midwives who were always there for me. They were always available, offering support that went beyond antenatal care. Whenever I felt low, no matter the time, they were there to listen and reassure me. That emotional support was more important to me than any medical care I received during my pregnancy. It made me realise how vital mental health support is during pregnancy and how midwives create a safe, nurturing environment that helps expectant mothers feel secure and understood.  

What lessons have you learned from your experience of mental health and pregnancy? 

Going through pregnancy during a crisis made me truly understand how important it is to prioritise a pregnant woman’s mental health throughout her journey. The support from family, friends, partners, and especially her midwife or healthcare provider, is invaluable. In moments of fear and uncertainty, especially with depression, a pregnant woman places great trust in her midwife to help her through the pregnancy and its challenges. 

Psychological support needs to be part of maternity care, especially in humanitarian settings. The added stress of worrying about pregnancy and personal and family safety can seriously harm maternal health, leading to higher risks of maternal mortality and complications. 

This experience taught me that, beyond medical care, midwives must listen and build a bond of trust. That connection makes a pregnant woman feel safe, supported, and valued. In short, mental health care for pregnant women must be taken more seriously. 

How can midwives be better prepared to support women’s mental health during pregnancy and childbirth, particularly in crisis situations?  

 Mental health in Haiti, as in many other low- and middle-income countries, is often overlooked, along with the consequences of neglecting it. Midwives play a vital role in supporting women’s mental health during pregnancy and childbirth, and this responsibility becomes even more critical in crisis situations. To be better prepared, midwives should receive: 

• Specialised training in perinatal mental health, focusing on issues like depression, anxiety, and post-traumatic stress. This will help them identify mental health disorders early and provide appropriate support to pregnant women. 
• Emergency response training to prepare them for specific interventions, such as psychological first aid and stress management techniques for vulnerable women. 
• Access to resources and support networks to refer women to suitable mental health services, including psychologists or specialised counsellors. 
• Inter-professional support, as midwives often need to collaborate with other health professionals, like psychologists and social workers, to provide holistic and integrated care. 
• Emotional support and stress management for themselves, as midwives are often under significant stress, especially in crisis situations. Providing them with debriefing opportunities and psychosocial support is essential to ensure they can be fully present for their patients. 

I believe that by incorporating these elements into their training and practice, midwives will be better equipped to support women’s mental health, especially in crisis situations where vulnerability is heightened. 

Any recommendations for midwives working under pressure or experiencing mental health issues? 

Midwives working under pressure or experiencing mental health issues need proper support to maintain their well-being. Access to psychological support services, such as consultations with professionals, is essential. Specific helplines for healthcare professionals can also provide quick assistance in times of crisis. Additionally, discussion forums or debriefing sessions after stressful events offer a chance to share experiences and lighten the emotional load. 

It’s crucial to train midwives in stress management and resilience by teaching relaxation techniques. Creating enabling environments is also important; midwives should be encouraged to take regular breaks, practice self-care, and set clear boundaries between work and personal life. Institutions should implement mental well-being policies that allow for sick leave due to mental health issues and foster a culture where these topics can be discussed openly. 

By adopting these measures, midwives will be better equipped to care for their own well-being while continuing to provide quality care to the women they serve.