When I first stepped into a maternity unit in a government hospital in Sierra Leone as a Seed Global Health midwife educator, I was met by a group of student midwives from different training institutions. 

Mostly women, some held onto their notebooks and avoided eye contact. Many were transitioning from nursing into midwifery, while others had entered the profession directly. 

When I asked why they had chosen this path, only a few spoke softly about saving mothers and newborns. Most remained silent. 

During clinical rounds, their eagerness to learn hands-on skills was clear, yet limited access to skilled preceptor midwives left mentorship gaps, disconnecting theory from confident, evidence-based care at the bedside.

At the same time, my interactions with local health workers revealed a country deeply committed to transforming maternal and newborn health. 

Between 2020 and 2023, Sierra Leone’s maternal mortality ratio fell from 443 to 354 deaths per 100,000 live births, progress that I believe reflects a growing investment in the health workforce and in midwifery in particular. 

Bold policy choices

At the heart of this progress are bold policy choices. In 2023, Sierra Leone enacted the Nursing and Midwifery Act, established the Sierra Leone Nursing and Midwifery Council, and set an ambitious goal to add 3,000 midwives to the workforce by 2030. 

These steps formally recognized midwifery as a profession and created a stronger foundation for training, regulation, and professional growth. As someone who came to Sierra Leone eager to support midwives, I felt deeply encouraged by the country’s commitment and the momentum that was already building.

As a midwife educator, I have seen how this commitment is taking shape on the ground. Together with Seed Global Health, the Ministry of Health, and our partner midwifery schools, I work to strengthen midwifery education so that graduates are confident and practice-ready from day one. 

Seed has committed to training 1,100 midwives and to supporting innovations that improve the quality of both teaching and clinical mentorship.  

One of the most impactful of these innovations is midwifery “preceptorship”, a concept I was introduced to in Sierra Leone. This is a structured mentorship model that pairs experienced midwives with students and newly qualified practitioners to strengthen skills, confidence, and compassionate care at the bedside.  

Skill gaps

There are gaps in the clinical skills of both graduating and practicing midwives, as highlighted in the State of the World’s Midwifery Report (2021). These gaps include the ability to respond quickly and effectively to obstetric emergencies, provide safe and attentive care after birth, and perform essential lifesaving hands-on tasks with confidence. 

These skills gaps cause delays in recognizing complications, inconsistent support during labor, or lack of confidence in critical procedures, which put lives at risk. Programs like preceptorship and continuous mentorship are fundamental in elevating the quality of services mothers and newborns receive.

Preceptors are experienced midwives who mentor and guide students and newly qualified midwives, helping them translate theory into practice and grow in confidence at the bedside. Their role goes beyond supervision; they nurture critical thinking, compassion, and professionalism in the next generation of health workers. 

I see preceptorship contributing to a revolution that is emerging within Sierra Leone’s health system and shaping the future of midwifery and maternal and newborn health.

Building confident, competent care

A key part of my work is teaching preceptorship, ensuring experienced midwives are equipped to mentor students effectively. By collaborating with faculty, preceptors, and students alike, this approach ensures that no student learns in isolation and no midwife works without guidance, helping build a confident, competent maternal and newborn health workforce. 

Unlike before, when students often had to observe passively or learn by trial and error, the preceptorship model provides structured mentorship, feedback, and opportunities to apply classroom knowledge in a supportive environment.

During a daytime shift in the labour ward last year, I watched a student midwife hesitate at the bedside of a woman in active labour. She knew the steps for monitoring labour using the labour care guide, but her hands trembled as she decided what to do next. 

Before preceptorship, moments like this often ended with students stepping back to observe. This time, a Seed-trained preceptor stood beside her, asking gentle guiding questions and encouraging a systematic assessment, documentation, and reassurance of the woman in labour. I watched with pride as the student completed the assessment, identified slow labour progress, and escalated appropriately.

Bridging the gap

 With their wealth of experience and training in both clinical excellence and teaching, preceptors bridge the gap between classroom learning and real patient care. They model respectful, compassionate care on the ward, ensuring that by graduation, students are confident and practice-ready from day one. 

Preceptors also mentor in-service midwives, continuously strengthening the quality of care through both practice and teaching.

The ripple effect of this training is transformational. Training and growing the midwifery workforce means more midwives and better outcomes for mothers and newborns in Sierra Leone.

To date, 20 preceptors have been trained in Sierra Leone and another 40 have just completed a one-year preceptorship program across Seed’s three partner schools in the country. 

The preceptorship training program has recently been granted diploma status by the Ministry of Health, and the potential maternal health gains from this development are immense for Sierra Leoneans. 

The move signals a national commitment to strengthening the country’s maternal health workforce and accelerating progress toward its goal of training more midwives to close workforce shortage and care gaps.

Positive impact

I have already witnessed positive maternal and newborn outcomes as a direct result of the midwife preceptorship program. Recently, during the morning briefing where maternity staff gather and night staff present patients’ conditions with a focus on critical cases and how they were managed, gaps identified and action points proposed, a loud bell rang signaling an emergency. 

A pregnant woman had been rushed in from the antenatal clinic, convulsing. The atmosphere shifted instantly; urgency filled the room. I assisted while watching our midwife preceptees and preceptors take charge with calm confidence. 

Two of the midwife preceptees gently positioned the woman on her left side to protect the airway, then put two large-bore cannulas, while another quickly checked her blood pressure and called out the reading. 

Under the guidance of one of the preceptors on the drug, dose, route and duration, one of the student midwives got magnesium sulphate, drew it up and administered it to manage convulsions and oxygen was applied. 

With additional, systematic measures taken step by step, they stabilized the mother, who was suffering from eclampsia. Each of these preceptors had undergone training not only in clinical skills but also in how to respond, teach, and lead under pressure, and it was evident in how they were able to act swiftly and save the mother and her baby. 

Moments like these reminded me that preceptorship is not a luxury; it is a necessity because it saves lives.

Looking ahead

Like Sierra Leone, my home country of Uganda faces challenges with clinical midwifery education, midwifery mentorship, and a shortage of highly skilled midwives, while those in service often work with limited resources to provide optimal care. 

They also face emerging health conditions linked to the impacts of climate change, further straining their ability to deliver quality services to mothers and newborns. 

I would like to see the preceptorship program replicated in Uganda and other low-resource countries. This way, more midwives would be trained, upskilled, and empowered to adapt to the daily health challenges such contexts encounter, ultimately saving more lives.

My experience here in Sierra Leone shows me that across sub-Saharan Africa, a quiet revolution is taking shape, one driven by skilled health workers who, with the right training, resources, and opportunity to flourish, can transform care from the ground up. 

Their impact is redefining what health systems can achieve when health workers are prioritized and invested in. When health workers thrive, health systems do too.

Every day, I’m reminded that preceptorship is more than a program. It’s a lifeline that empowers midwives, strengthens care, and helps ensure safer, more positive birthing experiences for mothers. 

Watching this transformation unfold is deeply fulfilling for me as a midwife educator.

Lilian Nuwabaine is a midwife educator in Sierra Leone and recipient of the 2025 Episteme Award, an international award from the Sigma Nursing Society presented to a nurse scientist* or team of nurse scientists for highly significant research, acknowledging a breakthrough in nursing knowledge development that impacts the underserved.

Image Credits: SEED.